Abstract
Objectives
We aimed to investigate whether pre-treatment cardiac autonomic nervous system (ANS) activity, indexed by heart rate (HR) and heart rate variability (HRV) predicts clinical outcome and therapy drop-outs in adolescents with borderline personality (BPD) pathology receiving dialectical behavioural therapy (DBT-A). We further tested for an association between changes in ANS function and clinical outcome over time. Traumatic experiences were considered as potential confounding factor.
Methods
N = 43 (95.4% female, Mage = 15.5 years) adolescents fulfilling at least sub-threshold criteria for BPD (≥3) were investigated before and after outpatient DBT-A as well as at follow-up. N = 10 patients dropped out of treatment (<50% of treatment sessions). Latent growth curve models were used for analyses.
Results
Greater pre-treatment resting HRV significantly predicted clinical improvement (decrease in BPD pathology/increase of global functioning) over time. Pre-treatment ANS activity was unrelated to treatment drop-out. Further, changes in ANS activity over treatment were associated with changes in clinical outcome.
Conclusion
This study is the first providing evidence that pre-treatment HRV predicts and is related to treatment response in adolescent borderline personality pathology. Implications for the use of ANS measures in clinical practice and directions for future research are discussed.
Acknowledgements
The authors acknowledge the support by our research assistants, Annegret Jacobs, Grace Bae, Jana Pott in data processing, as well as Mirjam Sophie Rüger in data collection.
Ethical approval
The study protocol was approved by the ethics committee of the Medical Faculty at the University of Heidelberg, Germany (Study: ID S-425/215) and conducted in accordance with the ethical standards of the declaration of Helsinki (World Medical Association Citation2013). Written informed consent was obtained from all patients and their legal guardians before study inclusion.
Author contributions
MK as principal investigator (PI) of the study centre Heidelberg and KS (PI of the study centre Basel, Switzerland) conceptualised the clinical and multicenter trial. KS, MK, SW, JK, PP, RZ designed the study. RZ and SW conducted the study. SW and JK prepared the manuscript. PP ran statistical analyses and advised on methodological issues throughout the study and manuscript preparation process. FR supervised the clinical process as head of the department for child and adolescent psychiatry in Heidelberg. All authors read the final version of the manuscript and gave their approval. They will take full responsibility for the accuracy of data and content of the manuscript.
Statement of interest
None to declare.