Day Hospital Treatment of Emotional Dysregulation: A Quantitative Analysis

Research on brief therapeutic interventions for those diagnosed with BPD have often involved a year or more of treatment in an outpatient, inpatient or partial hospitalization setting. The goal of this research proposal is to examine if a 5-week day hospital treatment program at a tertiary hospital within Shared Health can demonstrate effective amelioration of subject symptoms on a number of measures.

As noted in the introduction there is significant public health considerations associated with persons living with borderline personality disorder pathology. Evidence-based public health should be informed by practice-based evidence stemming from the rigorous evaluation of relevant natural experiments. Due to logistic and ethical considerations a randomized control trial isn't feasible. Given these considerations, the proposed research design is a naturalistic pre- post-intervention with no control group. Although causality cannot be determined in a naturalistic design, methodological rigour employed will mitigate the impact of outside variable from invalidating the results obtained from the proposed research. Participants data will be collected at two times and the data from the same individual will be compared focusing on differences between pre- and post-intervention. The benefit in the longitudinal design is the potential to control for temporal or secular changes observed in the outcome. A challenge in interpreting randomized control trials is potential biases that impact external validity and reduce the ability of the researchers to generalize the outcomes associated with an intervention. Naturalistic studies can reduce the impact of confounding variable by identifying and controlling potential variables, such as socio-economic factors.

Sample Characteristics and Selection Participants are referred to the STAT program through emergency room consultations, family physician referrals and from psychiatrists working in the community, outpatient department or during an inpatient admission. Participants are individuals 18 years and older.

Although participants in the STAT program are primarily females there is no exclusion criteria based on gender. These participants are assigned a therapist who will complete a psychiatric interview and review a self-report each participant is required to complete prior to the initial interview. Potential participants will meet with a psychiatrist to review the information gathered in the therapist interview and determine if the client will be admitted to the STAT day hospital program. Participants are accepted if they meet admission criteria as determined by the psychiatrist. Participants are excluded if they have a diagnosis of antisocial personality disorder, criminal charges, or significant substance abuse. Participants are required to formulate behaviour-oriented goals to work on while participating in the STAT program. Participants are not admitted to the program if they do not formulate treatment goals. Potential participants referred from one of the above noted sources are assigned to a therapist each Tuesday at a weekly meeting of the STAT program staff. The therapist will contact the individual and arrange a date for an initial interview. If a therapist is unable to reach an individual by phone, a letter with the date for an appointment is mailed along with the self-report questionnaire each client is expected to complete for the first interview with the therapist. The self-report materials include a series of questions to elicit a social history of the individual along with current stressors and self-identified problems. The assessment process involves roughly two appointments with the therapist and an additional appointment with the psychiatrist requiring roughly three weeks to complete. Participants will be given a letter of invitation outlining the research project as well as the SCL-90-R and DERS psychometric questionnaires. Individuals will be asked to complete the SCL-90-R and DERS at the beginning of their first appointment if they agree to participate in the research project.

Once an individual is accepted to the STAT Program, they are placed on the waiting list for a period of roughly four to six weeks. During that period, the therapist will meet with clients roughly two times to assist in formulating treatment goals and develop a therapeutic rapport. While a client is admitted to the program and participating in the groups, they are also seen by their assigned therapists on a weekly basis for an individual therapy session. Individual sessions with the therapist assist participants in understanding the psychoeducation group learning materials, assist with homework, and to process current stressors.