Background: pBPD is present in 14% of clinical postnatal populations (Prasad et al, 2022) with clear documented effects on offspring (Petfield et al, 2015). Nevertheless, very few specialised treatment programs address both the maternal emotional dysregulation and parenting difficulties. Dialectical behaviour therapy (DBT), an evidence-based treatment for BPD, was adapted with a mother-infant focus to each module – mother-infant DBT (MI-DBT). Approximately 200 dyads have completed MIDBT with 70% retention rates. Quantitative (Sved Williams et al, 2021) studies show evidence of improvement in depression, anxiety and BPD symptoms, but with insufficient change in the mother-infant relationship (Francis et al, 2022) ongoing maternal concerns regarding parenting. A new study, MI-DBT+, provides an additional 10 weeks of an evidence-based mother-infant intervention, Attachment Biobehavioral Catchup (ABC). with 2 arms.
Method: Women referred for MI-DBT are offered ABC therapy either prior to commencing the prior or after its completion. Measures provided at 4 time points (before, conclusion first and second therapy offered) and at 6 month follow-up include Depression Anxiety and Stress Scale, MacLean Screening Instrument for BPD, Borderline Symptom list-23, Parental Reflective Functioning Questionnaire, Parenting Sense of Competence, Ages and Stages Questionnaire, NCAST parent-child interaction (observational).
Results: Preliminary results for completing dyads indicate continuing gains for the mother-infant dyad in both subjective (at interview) and objective measures. These will be discussed further.
Conclusions: Mothers with BPD have high awareness of their mental health difficulties and a strong motivation to improve their own and their infants’ lives, indicated both by retention rates for groups and qualitative and quantitative feedback. Intergenerational change is a worthwhile goal and requires long-term therapy, but problems in financing, inter-sectoral coordination and accessibility are ongoing concerns. Additionally, long-term outcomes require continued availability of these families, many of whom have significant psycho-social problems which can interfere with many aspects of their lives.