550
Views
6
CrossRef citations to date
0
Altmetric
Original Investigations

Autonomic nervous system activity and dialectical behavioral therapy outcome in adolescent borderline personality pathology

, , , , , , & ORCID Icon show all
Pages 535-545 | Received 23 Mar 2020, Accepted 17 Nov 2020, Published online: 01 Feb 2021
 

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.

Additional information

Funding

The authors thank the Dietmar Hopp Foundation, Germany, for their funding of the “Ambulanz für Risikoverhalten und Selbstschädigung” (AtR!Sk) where our study was conducted. However, the foundation was not involved in participant recruitment, data management, data analyses or in the process of preparation and submission of the manuscript.

Log in via your institution

Log in to Taylor & Francis Online

PDF download + Online access

  • 48 hours access to article PDF & online version
  • Article PDF can be downloaded
  • Article PDF can be printed
USD 65.00 Add to cart

Issue Purchase

  • 30 days online access to complete issue
  • Article PDFs can be downloaded
  • Article PDFs can be printed
USD 341.00 Add to cart

* Local tax will be added as applicable

Related Research

People also read lists articles that other readers of this article have read.

Recommended articles lists articles that we recommend and is powered by our AI driven recommendation engine.

Cited by lists all citing articles based on Crossref citations.
Articles with the Crossref icon will open in a new tab.