Anhedonia in patients with borderline personality disorder: the efficacy of cognitive-analytic therapy (CAT)

Background

Anhedonia is recognized as one of the core symptoms of depression but it is also seen in other mental disorders. Cognitive-Analytic Therapy (CAT) is a type of brief psychotherapy which has been proven efficacious for patients with various psychiatric diagnoses. The present study aims to: 1) Investigate the presence of anhedonia in patients with borderline personality disorder (BPD) 2) Evaluate the CAT outcome on anhedonia, depression and anxiety of these patients.

Materials and methods

The sample of the study consisted of 57 patients, who attended the Mental Health Center of N/W district of Thessaloniki and received a diagnosis of BPD or personality disorder NOS with predominant borderline personality traits according to DSM-IV criteria. These patients completed a 16-sessions of CAT and attended a 2-month follow up. The Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI) were used as evaluation instruments both at the intake and at the follow up time. Anhedonia was tested by the relevant question of BDI.

Results

At the 2-month follow-up, the patients showed a statistically significant improvement on BDI total score, on the anhedonia sub-scale score, as well as on the state and trait scores of the STAI, compared to the intake (p<0.001). Furthermore, significantly fewer patients were still anhedonic (18/39 vs 50/57, x2=37.32, p<0.001) in comparison to pre-therapy evaluation. Finally, patients with BDP only (N=21) and those with BDP and an additional axis-I diagnosis, except a depressive disorder (N=11) had a lower score on anhedonia compared to BDP patients with an additional depressive disorder (N=25). However, the difference showed only a tendency for statistical significance (p<0.1).

Conclusions

CAT is an effective psychotherapeutic approach in reducing anhedonia in patients with BDP. The improvement of anhedonia comes into the line with the amelioration of anxiety and depressive symptoms. Anhedonia is a core symptom of a depressive disorder but it is also seen, not infrequently, in patients BDP