Upload
shannon-mckinney
View
215
Download
0
Embed Size (px)
Citation preview
The Reduction of Self-Mutilation in Borderline Personality Patients using Sensory Integration Therapy
Aron LipmanDepartment of Applied PsychologyNew York University
Acknowledgements
Specialized Programs in Occupational Therapy Services (SPOTS)
Prudence Heisler, OT/L
Michelle Kafko, OTR/L
Lindsey Britchkow, OTR/L
Peer Reviewers
Self-Mutilation
Definition
A way to cope, release tension, lessen anger, gain control and security, self-regulate, and create a feeling of euphoria.
Self-mutilation can also have an immediate orienting effect, acting as intense, calming, or alerting stimuli enabling the individual to feel alive.
Types
Culturally Sanctioned Deviant
Major Stereotypic Superficial
Compulsive Episodic Repetitive
Pathways to Self-Mutilation
Excessive Stress
Feeling overwhelmed, unable to cope
Self-mutilation
Feeling relieved, in control, and calm
Pathways to Self-Mutilation
Dissociation
Feeling numb, overwhelmed, unreal
Self-mutilation
Feeling real, alive, able to function better
Borderline Personality Disorder
BPD is a “pervasive pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by…recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.”
BPD is the only mental illness under
personality disorders in the DSM-IV-TR that has self-mutilation as one of its main diagnostic criteria.
DSM-IV-TR, 2002
Self-Mutilation among BPD Patients
6-10 million Americans are diagnosed with BPD.
75% of BPD patients engage in self-injurious behavior.
The rate of unintentional suicides, as a result of self-injurious behavior in BPD patients, is rising.
There is a major gap in the research in terms of effective forms of treatment that properly address the growing number self-injurious BPD patients.
Moro, 2007
Occupational Therapy The use of purposeful activity or interventions
designed to achieve functional outcomes.
Occupational therapists help people who are injured or ill regain their maximum level of functioning.
Therapists address three crucial aspects of a person’s life:
Activities of daily living
Work/productive activities
Play/leisure activities
Sensory Integration
Sensory-based therapy addresses:
An understanding of the sensory dimensions of human behavior.
The brain’s interpretation and organization of stimuli from an individual’s environment.
Adaptive responses for appropriate engagement in occupation.
The use of controlled sensorimotor experiences that help individuals function better in their environment.
Baranek, 1998; Bright, Bittick, & Fleeman, 1981; Moro, 2007
Types of Sensory Integration
Wilbarger Protocol Deep Pressure Brushing Joint Compressions Sensory Diet
Champagne & Stromberg, 2004
Types of Sensory Integration
Weighted Pressure Vest
A woman with a history of self-mutilation described her weighted pressure vest as a “bullet proof vest…in which nobody can hurt me.”
She now asks for her vest when she has the urge to self-mutilate because the pressure across her back and chest helps her “stay in control.”
Champagne & Stromberg, 2004
Types of Sensory Integration The Sensory-Modulation Room offers a combination
of sensorimotor activities with calming and alerting options for all sensory areas.
Champagne & Stromberg, 2004
Related Studies
There have only been two studies looking at the use of sensory-based techniques and sensory-modulation rooms as treatment for self-injurious behavior.
In one study (N=47), 89% of the participants reported positive effects from the use of a sensory-modulation room.
In the second study (N=3), 2 out of the 3 women reported that after receiving sensory based treatment they no longer felt the urge to engage in self-injurious behavior.
Champagne & Sayer, 2003; Moore & Henry, 2002
Research Question & Hypothesis Is Sensory Integration, as provided by an
occupational therapist, an effective form of treatment for people diagnosed with borderline personality disorder who self-mutilate?
The use of sensory integration therapy, specifically the Wilbarger Protocol and sensory-modulation rooms, will significantly reduce the desire and incidence of self-mutilation on patients diagnosed with BPD.
Participants
150 females all diagnosed with BPD and with known self-injurious behavior.
Must be 20 years of age or older at the beginning of study.
SES, race, and ethnicity will not be taken into account.
Participants must be willing to commit to a two-year longitudinal study.
Treatment Procedure
Control Group (n=75)
Experimental Group (n=75)
Daily group and individual psychotherapy sessions
X X
Medication X XIndividualized sensory diets X
3x weekly individual sensory integration therapy sessions
X
Use of sensory-modulation room X
Procedure Participants will be interviewed by a psychologist
using the Revised Diagnostic Interview for Borderlines (DIB-R) at baseline.
Participants will receive 4 months of inpatient treatment, followed by 8 months of outpatient treatment.
Participants will be required to record daily their desire to self-mutilate, their feelings, and if applicable, their response to the desire to self-mutilate.
At the end of the first year, a standard discharge plan will be suggested to each participant.
A follow-up interview will be conducted at the end of the second year.
Expected Results and Benefits
The results of this study will show that sensory integration therapy and the use of a sensory-modulation room as components of a larger treatment plan will reduce the use of self-injurious behavior in patients diagnosed with BPD.
Current trends indicate that the numbers of people self-mutilating are increasing, and as a result unintentional suicides are also increasing.
Additionally, the results of the study will benefit all people who use self-mutilation as a coping mechanism or a way to self-regulate.