(PS10-C70) Initial Symptom Severity as a Moderator for BPD Compass Treatment Success

Initial Symptom Severity as a Moderator for BPD Compass Treatment Success

Lauren Cravens, Matthew W. Southward, Shannon Sauer-Zavala

Background: The most common treatments for borderline personality disorder (BPD) are long-term, intensive and costly. Many individuals with BPD exhibit less severe symptoms (Trull et al., 1997), suggesting that extant treatments may not be necessary for all presentations of this condition. BPD Compass (Sauer-Zavala et al., in press) was developed as a relatively short-term (i.e., 18-weeks in duration) outpatient protocol for patients with BPD. Given that this intervention was developed explicitly for less severe cases of BPD in mind, we explored whether initial symptom severity predicts response to BPD Compass.

Methods: Participants who met criteria for BPD were randomly assigned to receive 18 weekly sessions of BPD Compass immediately or after an 18-week wait. All participants completed clinician-rated and self-report assessments before beginning treatment and after completing treatment. Germane to the present study, symptom severity at pre-treatment operationalized as the dimensional BPD score on the self-reported Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD; Zanarini, 2003), endorsement of suicidal behavior on the Structural Clinical Interview for DSM-IV Axis II disorders (SCID-II; First et al., 1995), the number of comorbid conditions diagnosed via the Diagnostic Interview for Anxiety, Mood, and Obsessive-Compulsive and Related Neuropsychiatric Disorders (DIAMOND; Tolin et al., 2018), and personality-related impairment measured by the Level of Personality Functioning Scale-Brief Form 2.0 (LPFS-BF 2.0; Weekers et al., 2019). Treatment response was operationalized as post-treatment dimensional ratings of BPD on the self-report versions of the ZAN-BPD.

Results: We calculated linear regressions in order to determine whether our pre-treatment indicators of initial severity could predict self-reported total ZAN-BPD scores following the 18^th treatment session, controlling for pre-treatment levels on this measure. We found that pre-treatment level of self-reported BPD symptoms significantly predicted post-treatment levels (B = .271, p = .013). Additionally, we found that initial number of comorbid conditions (B = .620, p = .070) accounted for a provisionally significant greater amount of variance in self-reported BPD symptoms at post-treatment, over and above the contributions of pre-treatment levels of this variable, whereas endorsement of suicidal behavior (B = -1.459, p = .085) and initial personality-related impairment (B = .237, p = .881) did not.

Conclusions. These findings suggest that pre-treatment BPD symptom severity and number of comorbid conditions may impact that extent to which patients improve with BPD Compass. Future research is needed to determine the level of severity that would warrant referral to a more intensive intervention. Care should also be taking, during treatment with BPD Compass, to explicitly link skills to comorbid difficulties.