Développement d’une intervention de remédiation cognitive pour le trouble de personnalité limite

Background

Over the past decade, there has been growing recognition and investigation of neuropsychological impairments in BPD. These impairments have been linked to symptom severity, suicidal behavior, self-harm and treatment adherence. While current therapies for BPD have been linked with symptom reduction, research has shown that psychosocial functioning tends to remain impaired in BPD patients. Although it has not been extensively explored in BPD, research has demonstrated that impairments in psychosocial functioning can be linked to neuropsychological deficits. To our knowledge, there is no specialized intervention addressing these impairments for the BPD population. Therefore, cognitive remediation therapy (CRT) could present itself as a compelling alternative. Given this observation, researchers and clinicians from the Institut Universitaire de Santé Mentale de Montréal (IUSMM) worked on developing a CR intervention that would be specialised for BPD.

Objective

The aim of this article is to describe the conceptual method and to outline the program designed.

Methodology

The development of the program followed phases 0 to 2 of the Medical Research Council (MRC) of the United Kingdom for complex interventions. Phase 0 consisted of a scoping review of the BPD neurocognitive profile and existing CR interventions, Phase 1 involved defining the components of the intervention through consultations with nine mental health professionals (psychiatrists, neuropsychologists and occupational therapists), and Phase 2 involved an exploratory clinical trial with five participants with BPD to assess the feasibility and acceptability of the intervention.

Results

The results demonstrated the feasibility of the intervention for a group of 3 to 5 participants, with necessary adjustments (additions of examples, explanations, discussion questions). Although the dropout rate was high (40%), the intervention was shown to be acceptable with suggestions for improvement (addition of a session on impulsivity). The revised CR program is an 8-week intervention of 2-hour group sessions where participants identify goals, train their cognitive functions, receive psychoeducation, take part in group discussions, and learn coping strategies. Each week, participants put in practice a problem-solving strategy called Goal-Plan-Do-Check. It is a global cognitive strategy. A theme is addressed in each session, and participants are requested to identify a goal regarding the theme. In chronological order, the themes addressed are lifestyle habits, impulsivity, attention, memory, executive functions, motivation, and procrastination.

Discussion

The pilot study's positive findings on feasibility and acceptability pave the way for further research. This BPD-specific CR program, with its shorter duration and focus on both cognitive deficits and metacognitive strategies, holds promise for improving quality of life for individuals with BPD. Future studies with larger groups are needed to confirm its effectiveness on cognitive function, BPD symptoms, and daily living.