Veränderung von Bindungsmerkmalen im Verlauf einer Dialektisch Behavioralen Therapie für Borderline-Patientinnen

Background: Attachment organization is considered as one major constituting factor in the development of a Borderline-Personality Disorder, especially in the context of the patients' affective and interpersonal problems. In this pilot study several attachment related measures were administered to 26 patients with Borderline Personality Disorder (BPD) and 26 matched healthy controls. Assessment were before, during and after one year of outpatient treatment with Dialectic Behavior Therapy (DBT). Measures: Attachment representations were assessed with the Adult Attachment Projective Picture System (AAP). We examined changes of attachment styles and subjective evaluations of affective, emotional and autobiographic valence of personalized sentences from the participants' own AAP interviews by using parametric and non-parametric tests before, during and after one year of DBT treatment. Results: As expected BPD patients showed a significant higher proportion of unresolved trauma (disorganized attachment representation) in the AAP, a higher amount of traumatic-dysregulating makers in AAP narratives in response to AAP pictures inducing potential emotional states like abandonment or loneliness (monadic pictures), a higher score on attachment anxiety and avoidance (ASQ) and a higher amount of BPD relevant affects related to enhanced autobiographic and emotional valence when confronted with their personalized sentences from their own MP narratives. After one year of DBT treatment the patients' high scores on attachment anxiety and avoidance were substantially decreased, and attachment security was increased significantly. Patients still evaluated the personalized sentences as autobiographically relevant, however after DBT treatment they showed less BPD-specific emotions, a higher acceptance and reduced emotional valence, comparable to the evaluations of healthy controls. Conclusion: The pilot study confirmed changes of attachment features towards attachment security and an improved capacity to emotionally integrate attachment related autobiographical features in the course of DBT treatment. To ensure a secure therapeutic alliance with positive attachment experiences in the therapeutic relationship we suggest that one year of treatment is an appropriate time frame.