Ulleval Personality Project (UPP)
A randomised controlled study of intensive day treatment followed by long-term outpatient conjoint individual and group psychotherapy treatment, compared with eclectic individual therapy for poorly functioning patients with personality disorders. Synopsis | Theoretical frames | Treatment | Goals | Design | Hypotheses | Methods | Schedule | References | Publications | Presentations
Theoretical frames of reference
There are currently extensive and treatment relevant theories on PD from psychodynamic, cognitive, and cognitive-behaviour perspectives. Day treatment will typically employ several theories and techniques. In this study, we have selected an integration of attachment based object relations theory and self psychology (Bateman & Karterud, in press). There are relevant efficacy studies for both of these schools of thought (Stevenson & Meares 1992, Bateman & Fonagy 2001). They are consistent with the tradition that has developed in Norway (Karterud et al. 2001). In addition, therapeutic guidelines have been developed combining day treatment, group psychotherapy, and individual therapy for patients with serious PD (Bateman 1995, Karterud 1999, 2001, Bateman 2003). Attachment theory. It is now well documented that various types of insecure attachment patterns (in childhood and adult age) are risk factors in the development of PD (Dozier 1990, Patrick et al. 1994, Fonagy & Leigh 1996, Fonagy et al. 1997, Crittenden 1995,1997, Simpson 1999, Meyer et al. 2001). Insecure attachment patterns are associated with poorly developed reflective functioning and defective interpersonal interpretive mechanism (Fonagy & Target 1997, Fonagy et al. 2002). There is a need for treatment studies of PD investigating the effect on these variables ( attachment pattern and reflective functioning), not restricting evaluation of treatment outcome to measures of symptoms or social functioning. Affect awareness. Affective dysregulation is a characteristic of borderline PD, whereas the avoidance of negative emotions has been hypothesized to be a characteristic of avoidant PD. Affect integration is a central part of the treatment theory and technique in this study (Fonagy et al. 2002). It has been shown that psychotherapy focusing on affect awareness has had a good effect in the treatment of serious PD (Monsen et al. 1995). The Affect Awareness Interview (ABI) designed by Monsen et al. (1996) measures four dimensions of affect. The typical pattern for various PDs is still unclear. In this study we will investigate the patterns and change in affect awareness pursuant to ABI in patients with borderline and avoidant PD. There is currently a need for randomised controlled studies which 1) study the effect of short-term day treatment, 2) study the effect of long-term treatment in general and long-term conjoint treatment in particular, 3) have sufficient statistical power to document clinically significant effects, 4) comprise outcome measurements of personality change beyond symptom-related and functional measurements, 5) maintain a meaningful relationship between personality and personality disorder theory, treatment technique and outcome measurements. This is such a study.