What is Family Connections? - Borderline Personality Disorder

Family MattersPerry D. Hoffman, Ph.D.PresidentNational Education AllianceforBorderline Personality Disorder(NEA-BPD)Special appreciation to the National Institute of Mental Healthfor their research support

Why Focus on Family Members

The Well-Being of the BPD Sufferer

Expressed Emotion1. Critical Comments2. Emotional “over”involvement3. Hostility

Demographic and Clinical Predictorsof RehospitalizationTotal hospitalizations r(30) = .26, nsYears ill r(32) = .00, nsLiving situation r(35) = -.19, nsSES r(31) = .11, nsAge r(35) = -.04, nsSex r(35)=.05, nsP < .05

EE and Borderline PersonalityDisorder: SummaryCriticism and hostility not predictive of overall outcomeOverall clinical outcome and rehospitalization arepredicted by emotional overinvolvement (EOI)Higher “emotional involvement”is associated withbetter outcome

Expressed Emotion and Clinical Outcome♦ EOI predicts clinicaloutcome (1-5 5 scale)r (35) = - .40, p < .022.52♦ EOI predictsrehospitalizationr(35) = - .44, p < .02EOI1.51HospNotHosp♦ Patients do better the moreemotionally involved theirrelatives are0.50Hooley and Hoffman, AJP, 1999

The Well-Being of the Family Member

Loss of Mastery

Family Member Well Being♦ Grief♦ Burden♦ Depression♦ Mastery/empowerment

Burden♦ Worry about patient's future: 94%♦ Intensity of family friction: 87%♦ Impact on own ability to concentrate: 87%♦ Upset household routine: 84%♦ Reduced leisure time: 78%♦ Fear own behavior makes patient worse: 77%♦ Worry how much patient changed: 74%

Family Members Seek Information

Correlates of Relative’s Knowledge♦ Information-Hostility r=. 40♦ Information-Burden r=. 44♦ Information-Subjective burden r=. 51♦ Information-Depression r=. 52♦ Information-Brief Symptom In. r=. 65

Is Ignorance Bliss?

Family Psychoeducation♦ Information and current research♦ Skill acquisition to increase coping abilities♦ Support network

© Family ConnectionsPerry D. Hoffman, Ph.D.Ellie Buteau, Ph.D.Alan E. Fruzzetti, Ph.D.Emily R. Neiditch, B.A.Dixianne Penney, Dr.PH.Patricia Woodward, M.A.T.Frederic Hellman, M.A.Elmer Struening, Ph.D. Family Process June 2005

What is Family Connections?♦12 week, multi-family community-based program♦ Family members only♦ Designed specifically for BPD/BPD features♦ Co-led by family members trained by NEA-BPD

Family Connections Goals♦ Current information and research♦ Coping skill strategies– Individual skills-“mini” DBT skills– Family skills♦ Social support around BPD issues

Is Family Connections Beneficial?

Changes in Grief5452504846PrePostFollowup4442Texas Grief Instrument

Changes in Distress/Depression1210864PrePostFollowup20BDI

Changes in Burden Experienced55504540PrePostFollowup3530Burden

Changes in Mastery/Empowerment4644424038PrePostFollowup3634

Replication Studies♦ Study 2: 52 participantsStudy 3: 58 participants♦ Five sites♦ Initial study replicated in both studies

Future Research♦ Conduct Randomized Control Trial♦ Understand the mechanisms of change:♦ Information♦ Skill building♦ Support network♦ Measure patient change

Tele-Connections♦ 12 week, conference call format♦ 8 participants♦ Two seasoned Family Connections leaders♦ Secure page on NEA-BPD site