Role of emotion regulation and social connectedness on adult Post-Traumatic Stress Disorder, and treatment non-completion: a research portfolio

Abstract

BACKGROUND: The overarching aim of this research portfolio was to investigate variables which may enhance clinical practice and treatment for adults with severe and enduring mental health presentations.

These variables included treatment disengagement and protective factors against future psychopathology. Within this portfolio, the systematic review examined the role of clinical, psychological and therapeutic process variables on treatment non-completion in adults with a Borderline Personality Disorder (BPD) diagnosis. The empirical study sought to investigate a theoretical model of the impact of childhood maltreatment on adult Post-Traumatic Stress Disorder (PTSD) and how this relationship may be mediated and/or moderated by emotion regulation skills and social connectedness.

METHODS: A PRISMA systematic search was conducted across 4 electronic databases, followed by manual searches. The included studies were rated against quality assessment criteria and findings were synthesised. The empirical study investigated pre-treatment data from patients receiving a group intervention (i.e. Survive & Thrive) by using correlation, mediation and moderation analyses to explore the theoretical model, within a crosssectional design.

RESULTS: Sixteen studies were included in the systematic review, with results highlighting variability in the definition of treatment non-completion, and robust evidence for the association between a variety of clinical, psychological and therapeutic-process variables and treatment noncompletion in adults with a BPD diagnosis. Assessment of quality indicated a number of limitations within included studies. In the empirical study, different types of group identifications mediated the relationship between childhood emotional abuse and PTSD. The link between childhood sexual abuse and PTSD was meditated by emotion regulation skills and moderated by identification with family.

CONCLUSIONS: Various clinical, psychological and therapeutic-process variables are associated with and predict treatment non-completion in BPD, which inform clinical practice. A consistent measure of treatment noncompletion and qualitative studies with service users can further enhance knowledge in this area. The empirical study revealed that targeting adaptive emotion regulation strategies and improving social connectedness can help protect against adult PTSD symptoms and the impact of childhood emotional and sexual abuse, however the results need to account for socioeconomic deprivation and high levels of emotional maltreatment in the sample.