Preschooler Emotion Regulation in the Context of Maternal Borderline Personality Disorder
Condition: Borderline Personality Disorder; Emotional Problem
MeSH terms: Personality Disorders; Borderline Personality Disorder
Study type: Interventional

Summary: 
      Offspring of mothers with Borderline Personality Disorder (BPD) are at serious risk for
      developing mental illness at every stage of their life, and yet little is known about how
      this risk is transmitted. This study will leverage Dialectical Behavior Therapy Skills as an
      experimental intervention to determine if preschool emotion regulation develops more rapidly
      as a result of improvements in mothers' ability to regulate her own emotions. The knowledge
      from this study will identify a modifiable pathway by which maternal BPD places offspring at
      risk for later mental disorders and will quantify how much improvement in children's ability
      to regulate their emotions can be achieved by treating mothers alone.
    

Detailed description: 
      Borderline personality disorder is a serious mental illness characterized by extreme
      emotions, chaotic interpersonal relationships, suicidal behaviors, and a poor sense of self.
      Offspring of mothers with Borderline Personality Disorder (BPD) are at an elevated risk for
      developing mental illness across the lifespan. Difficulty managing emotions are a hallmark
      feature of BPD, and yet the ability to do so is necessary for responding effectively to
      childrens' emotions. This process is called maternal emotion socialization, which has a major
      impact on how children develop their own emotion regulation (ER) skills. ER develops rapidly
      during preschool and deficits in preschool ER are recognized as underlying future mental
      disorders. This proposal will test a model examining the extent to which maternal ER and
      emotion socialization impact child ER, which may be a significant pathway by which mental
      health problems are transmitted to offspring of mothers with BPD. This proposal will leverage
      Dialectical Behavior Therapy (DBT) Skills training, a robust and effective method for
      improving ER as a tool to change maternal ER in mothers with BPD. By completing multiple
      assessments of biobehavioral markers of child and mother ER, this study is poised to uncover
      a potentially modifiable pathway by which these offspring are at risk. Specifically, the
      investigators propose to conduct a stratified randomized controlled trial of DBT Skills for
      mothers with BPD who have preschoolers. A total of 300 dyads (initial child age: 36-54
      months) will be collected in Eugene, Oregon and Pittsburgh Pennsylvania, with 100 pairs in
      each of three groups: children who have mothers with BPD who receive DBT Skills, children who
      have mothers with BPD who receive Family Services as Usual, and children who have
      non-disordered mothers, matched on income, with this final group only participating in
      assessments (as to quantify normative ER growth). All children will be assessed 4 times every
      2-months, with the first assessment occurring prior to treatment assignment. Investigators
      will use a biobehavioral laboratory battery to measure child ER, assessing emotion
      understanding, strategy use, attention regulation and inhibitory control, and parasympathetic
      regulation. In mothers, a similar multi-method approach to assess emotion acceptance,
      strategy use, recognition, and parasympathetic regulation will be employed. Finally, during
      each laboratory assessment, there will be observations of mother's ability to effectively
      respond to children in the context of child negative emotions. Growth curve modeling will
      chart child ER trajectories for all 3 groups so that investigators can compare child ER
      growth as a function of: group status (DBT Skills vs. Family Services as Usual vs. income
      matched, non-disordered controls), changes in maternal ER, and changes in maternal emotion
      socialization. Findings from this proposal will identify a modifiable pathway by which
      offspring of mothers with BPD are at risk, determine the extent to which child ER can be
      restored by treating mothers, and will be the first DBT Skills trial to measure outcomes in
      offspring.
    

Intervention name(s): Dialectical Behavior Therapy Skills
Intervention type(s): Behavioral
Intervention description(s): DBT Skills Training will follow the DBT Skills Training Manual Second Edition and the DBT Skills Training Handouts and Worksheets Second Edition.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment