A Review of the Effectiveness and Mechanisms of Change for Three Psychological Interventions for Borderline Personality Disorder

The therapeutic uncertainty common in much of the early literature on borderline personality disorder (BPD) has given way to a growing research base with findings indicating the effectiveness of a number of psychological treatments. This article will review three major evidence-based treatments for BPD: dialectical behavior therapy, schema-focused therapy and mentalization-based treatment. While not a panacea, these treatments have provided, to differing degrees, a reasonable level of evidence indicating therapeutic effectiveness. The evidence base for each of these models is discussed as well as possible mechanisms of change. The article highlights similarities between the differing modalities as well as the features that distinguish the models. The article contends that increasing mentalization skills may be a common underlying factor in all treatments for individual with BPD. The authors conclude by discussing the difficulties and potential benefits of treatment integration.     

Family Systemic Approaches for Borderline Personality Disorder in Acute Adult Mental Health Care Settings

This thematic literature review explores the contribution of family/systemic approaches in the treatment and care of people with borderline personality disorder (BPD) in acute adult mental health care settings. It recognises the importance of early childhood trauma, family dynamics, and relationships in the aetiology of BPD and outlines key benefits and constraints of a family systems approach. The article discusses institutional, cultural, and power structures that influence the diagnosis and treatment process for adult clients with BPD and the value of relational ethics in guiding or mediating care between the family, healthcare system, and community.     

Biology,Gender, and Politics:

This paper analyzes the application of the biopolitical perspective to explanations of gender differnces in political participation. Using the heuristic device of a causal model, two endocrine-based mechanisms proposed in political science literature are examined: 1) the linking of male androgens with more assertive kinds of political involvement; and 2) the linking of menstruation with cyclical mood changes and political behavior and attitudes. After a review of pertinent biological, psychological and political science literatures, both explanations are rejected. In the concluding section, an interactive biobehavioral paradigm is outlined, and several examples are suggested for further exploration of biological factors in political behavior and gender.     

Residential landscapes as social-ecological systems: a synthesis of multi-scalar interactions between people and their home environment

Residential landscapes are a common setting of human-environment interactions. These ubiquitous ecosystems provide social and ecological services, and yard maintenance leads to intended and unintended ecological outcomes. The ecological characteristics of residential landscapes and the human drivers of landscape management have been the focus of disciplinary studies, often at a single scale of analysis. However, an interdisciplinary examination of residential landscapes is needed to understand the feedbacks and tradeoffs of these complex adaptive social-ecological systems as a whole. Our aim is to synthesize the diversity of perspectives, scales of analysis, and findings from the literature in order to 1) contribute to an interdisciplinary understanding of residential landscapes and 2) identify research needs while providing a robust conceptual approach for future studies. We synthesize 256 studies from the literature and develop an interdisciplinary, multi-scalar framework on residential landscape dynamics. Complex human drivers (attitudinal, structural, and institutional factors) at multiple scales influence management practices and the feedbacks with biophysical characteristics of residential landscapes. However, gaps exist in our interdisciplinary understanding of residential landscapes within four key but understudied areas: 1) the link between social drivers and ecological outcomes of management decisions, 2) the ecosystem services provided by these landscapes to residents, 3) the interactions of social drivers and ecological characteristics across scales, and 4) generalizations of patterns and processes across cities. Our systems perspective will help to guide future interdisciplinary collaborations to integrate theories and research methods across geographic locations and spatial scales.     

A review of the biopsychosocial aspects of caregiving for aging family members

With the ever-increasing growth in the aging population, the need for care providers will also continue to rise. Many of these caregivers will provide informal care to family members and friends at a price to their own physical, psychological, and social well-being. This article examines the phenomenon of caregiving and provides a review of the biological, psychological, and social impacts of caregiving to care providers. George Engel’s biopsychosocial model is explored to examine the biological, psychological, and social factors that can affect a caregiver’s health and well-being. This article further explores social work practice implications and strategies for future intervention to reduce caregiver burnout and aid in their self-preservation.     

Family Experience of Borderline Personality Disorder

Individuals with borderline personality disorder (BPD) struggle with unbearable emotions that arise out of interpersonal difficulties. Self‐harm and suicidal behaviours serve to regulate these emotions and to gain a sense of well‐being and control in a treatment context where hospital admissions are avoided by mental health services. Clinician engagement with families may be constrained by their knowing the accepted etiology of the disorder, which includes a causal link with the family environment. Other constraining factors include the negativity of those with BPD toward their family, and their clinicians' diagnostic uncertainty or confusion. This qualitative study explored the experience of families whose close relative with BPD has a long history of self‐harm and/or suicide attempts. Family members were found to have chronic and traumatic stress. Family roles and relationships were strained, as were relationships between the family and the mental health system. The findings of this study indicate that treatment for BPD needs to adopt a systemic approach that considers individuals and their significant family relationships, as well as relationships between the family and treatment providers.     

Borderline Personality Disorder and Adolescence

SUMMARY

This chapter addresses many of the potential challenges clinicians face when working with adolescents with BPD. First, we present the diagnostic issues related to an adolescent population. Second, we review issues related to the families, peers, and larger systems (e.g., schools) that reciprocally influence the adolescent and the treatment. Third, we discuss specific treatment concerns and propose solutions, including how to effectively manage therapists' own reactions to working with this population. Many of the clinical vignettes and suggested interventions in this chapter derive from our experience working in an outpatient adolescent Dialectical Behavior Therapy (DBT) program. As described later in this book, DBT is an evidence-based treatment effective for suicidal multi-problem individuals with promising data published with suicidal adolescents diagnosed with borderline features (Rathus & Miller, 2002).     

Back to Stir It Up: Erectile Dysfunction in an Evolutionary,Developmental, and Clinical Perspective

In this review, we analyze erectile dysfunction (ED) in the context of sexual selection. We highlight that ED is a specific human male characteristic linked to the loss of the baculum or penile bone and results from a range of physical and psychological factors. We discuss evolutionary interpretations that consider dysfunctional penile erection as an honest signal of a low-quality male. We further emphasize the importance of considering psychosocial context and early attachment dynamics for understanding the etiology of some types of ED. Finally, we suggest that the integration of developmental factors for understanding the emergence of this sexual disorder is instrumental for the calibration of more effective therapies.     

Disability and identity: the challenge of epilepsy

Through examining the case of people with epilepsy (which, as we demonstrate, has an ambiguous status in relation to both popular and academic conceptions of disability) we explore the fluid, negotiable and contingent nature of identity and, in particular, the identification as ‘disabled’. Disability, we argue, cannot be reduced to either biology or social oppression, or even primarily to biological or social factors: it is the outcome of a complex interaction between a multiplicity of factors – biological, environmental, social, psychological, cultural and political – which will interact and be experienced differently by different people, at different times and in different situations. Rather than conceiving of disability in ‘all or nothing’ terms and of differing explanations as competing and mutually exclusive, it would be more productive to see them as partial and potentially complementary contributions to the better understanding of a complex and multifarious reality.     

Gambling Disorder in Veterans: A Review of the Literature and Implications for Future Research

To review the scientific literature examining gambling behavior in military veterans in order to summarize factors associated with gambling behavior in this population. Database searches were employed to identify articles specifically examining gambling behavior in military veterans. Cumulative search results identified 52 articles (1983–2017) examining gambling behavior in veteran populations. Articles generally fell into one or more of the following categories: prevalence, psychological profiles and psychiatric comorbidities, treatment evaluations, measurement, and genetic contributions to gambling disorder. Results from reviewed articles are presented and implications for future research discussed. Research to date has provided an excellent foundation to inform potential screening, intervention and research activities going forward. The authors suggest that a public health approach to future research endeavors would strengthen the evidence base regarding gambling in veteran populations and better inform strategies for screening, prevention and treatment.     

In the Shadow of Death: Relational Paradigms in Clinical Supervision

The process of clinical supervision is a complex undertaking that is influenced by multiple factors, including the personalities and characteristics of the supervisory dyad, developmental considerations, social attitudes, ecological factors and the parallel process. The supervisory interchange becomes even more difficult and complex when it occurs in the context of HIV and AIDS related practice, which introduces the reality of untimely death accompanied by grief and loss. In this paper, I will review the literature in regards to developmental aspects of the supervisory relationship, transference and countertransference paradigms and the parallel process. These particular issues will be framed within a relational perspective and the ways it shapes the supervisory process. The focus of this paper will be clinical work with clients diagnosed with HIV and AIDS and the impact of death and dying on the supervisory paradigm. The literature review will be elaborated on through a clinical vignette followed by an extended discussion.     

Sexual desire in later life

There has been relatively little research on sexuality in later life, particularly among persons over 60 years of age. The existing literature consists of studies of small samples, much of it from a biomedical perspective. This literature suggests that age, hormone levels, specific illnesses, and various medications negatively affect sexual functioning in older persons. This study reports results from a survey of a large sample (N = 1,384) of persons age 45 and older that included measures of a variety of biological, psychological and social factors that potentially influence sexual functioning. We report bivariate and multivariate analyses conducted separately for women and men. We find that the principal influences on strength of sexual desire among women are age, the importance of sex to the person, and the presence of a sexual partner. Among men, they are age, the importance of sex to the person, and education. In this sample of the population of older persons, attitudes are more significant influences on sexual desire than biomedical factors.     

Adjustment to disability

This article will focus on the biopsychosocial challenges encountered when an individual is disabled at an early age as well as when an individual acquires a disability later in life. Two case examples will focus on the adaptations/life choices that are necessary to adequately meet psycho/social/developmental needs and enhance individual self esteem. The case of Rita, a woman who lost her hearing at age two, highlights the importance of integrating a biopsychosocial approach to understand the multiple challenges and adaptations of individuals who are disabled at an early age. Laureen, a woman who acquired a spinal cord injury during her late teen years, described her struggles as a young adult adapting to a physical disability. Both cases highlight the importance of integrating an ecological/systems framework focusing on a biopsychosocial perspective, emphasizing the interrelationship between biological, psychological, social, technological, cultural and political factors.     

Adaptation to Parenthood During the Post-Adoption Period: A Review of the Literature

Substantial research has been conducted on new parents’ adjustment during the transition to biological parenthood. However, very little is known about adjustment experiences during the transition to adoptive parenthood. Such information could assist in creating support systems for adoptive parents similar to those that currently exist for biological parents. A systematic literature review was conducted to examine individual and relational adjustment outcomes during the transition to adoptive parenthood, limited to those studies that examined the immediate post-adoption period through 3 years post-placement. By searching six databases using a variety of keywords including post-adoption, adapt, and parent, 11 research studies were identified that reported on parental mental health, physical health, and intimate partner relationship satisfaction in the immediate post-adoption period. The studies reviewed appear to indicate that post-adoption depression is relatively common, although perhaps less so than depression among biological parents. It is difficult to draw conclusions about physical health and relationship satisfaction as only one study directly assessing each outcome was located. Findings suggest that additional research is warranted to provide a clearer characterization of physical and psychological adaptation to parenthood among adoptive parents.     

Sexuality in Older Adults (65+)—An Overview of the Literature,Part 1: Sexual Function and its Difficulties

Objectives: The aim of the current article was to provide an overview of literature on sexual function and sexual difficulties in older adults. Method: The authors conducted a narrative review of papers published in English between January 2005 and July 2015 based on an extensive search in PsycINFO. Results: The review showed that although common biological changes may adversely affect sexual function in old age, sexual experience seems to also be affected by psychological and interpersonal factors. Conclusions: Greater life expectancy and better medical care will result in older individuals with chronic diseases living longer. The need for help to cope with changes in sexual health is likely to increase in older adults, as sexuality may be negatively affected through several pathways.     

Physical consequences of falls in the elderly: a literature review from 1995 to 2010

In the last decade, population ageing has been registered as a global phenomenon. A relation exists between falling and ageing, since falling frequency increases significantly with age. In fact, one in three older adult falls annually. Although ageing is generically associated with decrease and degeneration of psychological and physical functions, it is still not common for the correct identification of risk factors to lead to a clinical prognosis of the elder being in risk of falling. Therefore, the goal of this review article is to identify, categorise and analyse typical ageing and fall factors mentioned in the literature as well as to quantify the number of times they were referenced. The research considered hundreds of publications, but analysis was then restricted to the 87 most pertinent articles written in English and published in journals or scientific magazines between 1995 and 2010. We concluded that falls among older adults can be characterised by the following: anatomic characteristics and physiological consequences of ageing; the pathologies that induce falls, which can be neurological, musculoskeletal, cardiovascular and other diseases; causes and risk factors of falls that can be behavioural, biological, environmental or socio-economic; type of physical consequences of falls, including fractures, bruises, injuries or other physical consequences; and strategies to prevent, mitigate or rehabilitate, which can be of a physical, environmental or behavioural nature.     

An examination of the mechanisms underlying the effects of physical activity on brain and cognition

Physical activity positively influences brain health and cognitive functioning in older adults. Several physiological and psychological mechanisms have been identified to underlie such a relationship. Cardiovascular fitness is accompanied with changes in mechanisms such as cerebral blood flow, neurotrophic factors, neurotransmitter systems and neural architecture that have themselves been associated with cognitive performance. Factors associated with exercise such as arousal, mood and self-perception of competence seem also to influence cognitive performance. Other explanation for the benefits of exercise in cognition, results from the fact that the performance of motor skills involve an important cognitive component (e.g., executive functions and information processing speed). Evidence of brain plasticity and behavior has been provided from studies where animals are exposed to enriched or complex environments. Exposure to such paradigms in which physical activity plays an important role has been found to influence various aspects of brain function and structure. Studies using neuroimaging techniques have established a link between the acquisition of different motor skills and the occurrence of neuroplasticity in human adults. This literature review indicates that the type of exercise and its specific perceptual and cognitive characteristics may influence cognitive performance. However, most of the research has been focused on self-paced movements or automatized skills and few intervention studies have examined the results of merging exercise and cognitive training in a single program. An important scientific challenge for the coming years is to design exercise programs capable of mobilizing several type of mechanisms underlying the effects of physical activity on brain and cognition.     

Sexual expression in later life: a review and synthesis

In the past decade, researchers have begun to study the sexual functioning of typical older persons. This review summarizes literature on the sexuality of men and women over age 50 as researched by social and health scientists. Research on the relationship of biological factors (changes accompanying aging), health (physical, mental, and medication use), psychological factors (attitudes, information about sex), relationship factors (status, satisfaction), and sexual functioning (desire, dysfunctions, treatment) to sexual behavior is reviewed. The review suggests that (a) men and women remain sexually active into their 70s and 80s, (b) aging-related physical changes do not necessarily lead to decline in sexual functioning, and (c) good physical and mental health, positive attitudes toward sex in later life, and access to a healthy partner are associated with continued sexual activity. In turn, regular sexual expression is associated with good physical and mental health. Progress in understanding later life sexuality requires development of comprehensive theoretical models, a broad focus on intimacy, attention to measures and samples, and research on couples. Progress in understanding is especially important, given the aging of populations.     

Maintenance of Urban Ethnic Boundaries: the French in St. Boniface*

The tendency to doom French Canadians outside Quebec to assimilation seems to be based on the premise that state boundaries with political and economic control over an ecological boundary are required in order for a population to be nationalized into a cohesive group. Although the French had early opportunities to dominate ecological, demographic, political and economic macro-structures in St. Boniface, they quickly lost out to the British. The French community has remained strong for 160 years by means of enclavic social factors such as residential segregation, institutional completeness, cultural identity, and social distance. French self-identification with social psychological factors such as a religious ideology, amidst rich historical symbols, is strongly supported by the status elite and a majority of French residents in St. Boniface. This enclave is changing to some extent but a distinct core of French identification remains. A resurgence of Franco-Manitoban identity is hardly taking place, but there is much evidence of reinterpretation and revitalization.