The added value of couple-based interventions compared to individual treatment for patients with personality disorder and their partners

The purpose of is this study is to contribute to the knowledge of couple-based
interventions for patients with personality disorder.Personality disordered
individuals have great difficulties in emotion regulation and experience major
and repetitive problems in relationships, work and social functioning.For many
people, the relationship they have with their partner will be the most
important interpersonal relationship they develop in their lifetime Recent
studies show that a personality disordered partner can have a severe impact on
the relationship and that partners can play a role in maintaining dysfunctional
personality patterns. Therefore it seems logical to assume that the treatment
approaches for personality disorder could benefit from involving the partner.


Couple-based interventions are considered a useful complement in treatment for
personality disorder. They can help in gaining knowledge and insight into how
patients and partners personality patterns contribute to emotion dysregulation
and relationship dysfunction. Couples can develop a sense of empathy,
sensitivity, and responsiveness toward one another in order to reduce, or
simply better manage, the unhelpful and rigid personality features that
increase interpersonal discord. The rationale for treating individual distress
or psychopathology with couple and family treatment stems from a substantial
amount of research in which relationship factors have been shown relevant to
individual psychopathology, and vice versa, in a number of different ways. Yet,
little is known about the effectiveness of couple-based interventions for
couples in which one partner suffers from personality disorder.

Studies examining the effect of couple therapy or couple-based interventions in
treatment for personality disorder are very scarce and more research is
required. Therefore, the present study examines the effect of couple-based
interventions in treatment for all kinds of personality disorders on
relationship satisfaction, emotion regulation and global mental distress. This
study examines the effect of couple therapy, in a multiple baseline design
where couple therapy combined with individual treatment is compared to
individual treatment as usual for patients with personality disorders. We focus
on two basic components of emotion regulation, that is awareness and clarity of
emotions (Gratz & Roemer, 2004). Furthermore we examine the effect on
relationship satisfaction and general mental distress.

The study is a non concurrent multiple baseline design. The non concurrent
multiple baseline design allows participants to be evaluated at different point
in time. The non concurrent MB design is essentially a series of A-B
replications in which the length of each baseline phase differs (Carr, 2005)
The A-phase (baseline) is treatment as usual (individual treatment) and the
B-phase is treatment as usual (individual treatment) combined with couple-based
interventions. Three different baselines are used as recommended by Christ
(2009). For this study we use the following baselines: 4 sessions, 5 sessions
or 6 sessions of TAU.

Per participant, patients and their partners, 17 measurements are performed.
One measurement prior to treatment and 16 weekly measurements during treatment
period.

All participants receive the same treatment, that is treatment as usual and
experimental treatment. The general focus of treatment is increasing global and
interpersonal functioning, increasing emotion regulation and decreasing
psychological complaints.
This study can best be described as an A-B-A design.


In phase A patients receive treatment as usual, that is individual treatment
for Personality Disorder. The amount of TAU is 4, 5 or 6 sessions, depending on
the baseline condition. The sessions takes 45 minutes, with a frequency of one
session a week.
In phase B patients receive 6 sessions of TAU and 6 sessions (containing
couple-based interventions) with their partner. The sessions of TAU and the
sessions with partner take 45 minutes per sessions, with a frequency of one
session a week.
After phase B, phase A follows again. This phase serves as a follow up period.
It also eliminates any occurring differences between baseline conditions so
that all patients receive the same amount of sessions.
A protocol is written for the sessions with partner (containing couple-based
interventions), using the principles of the pluralistic model of Snyder and
Whisman (2003) (Snyder & Balderrama-During, 2012). This protocol provides
guidelines to determine which theoretical approach and intervention is needed
in which specific stage (see attachment 2).
Total duration of treatment is 16 weeks. When necessary, individual treatment
and treatment with partner can be continued after research period of 16 weeks.

Per participant, patients and their partners, 17 measurements are performed.
One measurement prior to treatment and 16 weekly measurements during treatment
period. Completing the questionnaire takes about 5-10 minutes. The
questionnaire can be conducted digital or by telephone. In clinical practice
couple or family therapy is not frequently used in the treatment of personality
disorders, and if it is added, it is later during the treatment. With this
study we would like to increase the use of this kind of therapy. All
participants receive the same sort and amount of treatment. We believe that
risks for patients who participate in the present study are low. Given the
duration of the study (16 weeks) and the number of therapy sessions that
partner is involved (6 sessions), we think that this period of time is a viable
investment for the patient and their partner. We consider the burden for
patients and their partners therefore limited. In this consideration, we have
also taken into account that an average treatment for personality disorder
takes about 1-3 years.