Year

2023

Degree Name

Doctor of Psychology

Department

School of Psychology

Abstract

There is increasing emphasis on not just symptom amelioration but broader considerations of recovery and quality of life as important treatment targets for borderline personality disorder (BPD). Collective reports from service users also identify that people want psychotherapeutic approaches for BPD to better address a wider range of recovery goals in service of increasing personal meaning and quality of life. Conceptual frameworks that define ‘quality of life’ and ‘meaningful recovery’ emphasize the relevance of personal values. Connecting to personal values across important life domains may be one way to bring more meaning to people’s lives and for informing treatment target directions for increasing quality of life. Although the clinical utility of values in the treatment of BPD has been acknowledged in the clinical literature, empirical research had yet to examine values in this population. Addressing this gap formed the primary aim of the current thesis. Drawing upon a sample of people who present with BPD, the specific aims of the current thesis were to explore and empirically examine (i) how people identify with values across important life domains, (ii) motivational sources that may serve value engagement, (iii) factors that may mitigate valued based living, (iv) whether changes to values can occur across treatment, and (v) whether these potential changes in values were associated with other mental health improvements. The first study explored the ways in which individuals with BPD identify with values across a variety of commonly valued life domains. One hundred and six people diagnosed with BPD completed the 90-item Personal Values Questionnaire which is a self-report measure of values. Results found that people can identify with values across different life domains in terms of their importance. Relationships as well as health and wellbeing were endorsed as most important to people. A common pattern of results identified that discrepancies existed between higher levels of value importance and lower levels of commitment, desire to improve, and successful value pursuit across all valued life domains. Implications are that identification of such discrepancies in treatment could provide practitioners with opportunities to target and prioritise personally meaningful goals in treatment that are consistent with valued domains. The first study also drew upon Self Determination Theory predictions to examine motivation in relation to values. Hypotheses were partially supported. It was found that successful value pursuit related differentially to value motivations (internal vs. external) depending on the valued life domain, although for most domains, value success related to the additive effects of both internal and external motivation sources. Treatment practitioners could make use of identifying and understanding the type of motives driving the pursuit of particular values with their clients to assist harnessing motivations in service of their personally meaningful goals. Study 2 utilised the same sample as Study 1 and investigated whether experiential avoidance, alexithymia, and affective symptoms (depression, anxiety, and stress) were related to values engagement. Results identified that only depression and experiential avoidance were unique predictors of values engagement. Higher levels of experiential avoidance and depression were related to lower levels of values engagement. Implications highlight potential clinical benefits in targeting experiential avoidance and depressive symptomology in the context of assisting people to engage more successfully with their values in BPD treatments. The final study aimed to examine whether people’s relationships towards values change across treatment and whether these potential changes relate to other therapeutic outcomes. A subsample of 29 people presenting with BPD completed measures at the start and follow-up of psychotherapeutic treatment, approximately 1 year later. Measures assessed values, and other targeted outcomes including depression, anxiety, stress, alexithymia, and experiential avoidance. Post treatment, there were significant increases to value commitment and success and these changes were associated with changes in other targeted mental health outcomes. This study provides the first examination of values across the course of treatment for people who present with BPD. Together, these studies clarify the diversity of values that those with BPD identify with and highlight the life domains of most importance in this sample. They indicate that the strength of internal versus external motivations can vary in relation to values however components of both forms of motivation are evident across all the valued life domains assessed here. Higher levels of experiential avoidance and depression are associated with lower levels values engagement. Finally, in a subsample of participants, it was shown that success in pursuing valued life directions improves over the course of treatment and is associated with improvements in other therapeutic outcomes. The studies are limited by the use of participants from a single service and high attrition of participants completing the follow-up measures. Despite such limitations, overall, the collective findings from this thesis further understanding on values within a BPD population and provide the first empirical evidence for the clinically utility of values in this population.

FoR codes (2008)

1701 PSYCHOLOGY, 170106 Health, Clinical and Counselling Psychology

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Unless otherwise indicated, the views expressed in this thesis are those of the author and do not necessarily represent the views of the University of Wollongong.