Design and validation of "family connections"a dialectical behavioral therapy-based skills training program supported by an app for relatives of people with borderline personality disorder

Resumen

Family Connections (FC) is the most empirically supported skills training program for family members of people with borderline personality disorder (BPD) (Hoffman et al., 2005). Five uncontrolled clinical trials with pre- and post-treatment assessments and follow-up have been conducted (Ekdahl et al., 2014; Flynn et al., 2017; Hoffman et al. 2005, 2007; Liljedahl et al., 2019). Across studies, results were consistent, indicating significant decreases in psychological variables, hopelessness and burden, and significant increases in family mastery and empowerment, well-being and family functioning. However, none of these were compared to another active treatment in a randomized clinical trial nor did they take into account measures of people with BPD. We know that BPD affects both patients and their families and is an important public mental health problem that has a major impact on psychological symptoms and burden on family members of people with BPD (Fruzzetti et al., 2005; Wilks et al., 2017). Therefore, there is a need to develop useful and accessible interventions specifically targeting caregivers. Smartphone interventions with Ecological Momentary Assessment (EMA) and Ecological Momentary Interventions (EMI) offer several potential advantages in this regard (Heron and Smyth, 2010; Shiffman et al., 2008). On the other hand, the COVID-19 pandemic has had a significant impact on the family environment due to hardships generated by job losses, deaths, increased rates of family and domestic violence, poor mental health outcomes, and estrangement in personal relationships (Pfefferbaum & North, 2020; Weingarten & Worthen, 2018). Finally, the aim of the thesis is to extend our knowledge about the FC program by considering the efficacy of this program in the Spanish population. In particular, we decided to translate and adapt the FC program into Spanish and compare it with an active treatment to demonstrate its efficacy and to design a smartphone application to support the improvement of this treatment.