La pandémie due à la COVID-19 a impacté l’accessibilité à la psychothérapie pour des patients particulièrement vulnérables pendant la période de confinement. Nous présentons les adaptations d’un programme de thérapie comportementale dialectique et les conséquences du confinement sur le vécu de patients souffrant d’un trouble de personnalité borderline.

Nous avons, pour sept patients, comparé deux périodes de huit semaines, avant et pendant le confinement. Nous avons analysé leurs cartes journalières (n=426) et le recensement hebdomadaire de la fréquence de leurs comportements problèmes (n=69).

L’analyse des cartes journalières indique que la période de confinement prédit une diminution significative des sentiments de peur, de honte ou culpabilité et de tension mais une augmentation de la détresse. Le suivi hebdomadaire montre une diminution significative des comportements hyperphagiques.

Malgré le petit nombre de patients inclus, cette étude se base sur des échantillonnages d’expérience au quotidien et des mesures hebdomadaires. Ces deux types de mesures répétées indiquent certaines améliorations pendant le confinement, attestant des capacités d’adaptation de ces patients, soutenus par un cadre thérapeutique intensif qui a été maintenu.

The COVID-19 pandemic impacted the accessibility of psychotherapy for particularly vulnerable patients during the period of confinement in the French-speaking part of Switzerland. We had to adapt our usual therapeutic programs. We illustrate this approach in an outpatient program of dialectical behavioral therapy for patients with borderline personality disorder. Each week the individual therapies took place by videoconference or phone. The skills training group was held individually by videoconference or phone and was supported by an online skills training program. Patients filled out their diary cards online. Intersession contact with the therapist remained available as usual and we could organize team consultation. The aim of this study is to describe how a sample of our patients experienced the period of confinement.

We compared the experiences of seven patients suffering from borderline personality disorder during two periods: eight weeks prior to confinement, and during the eight weeks of confinement. We analyzed their daily diary cards (n=426) and their weekly frequency of problem behaviors (n=69). We performed multilevel analyses to take into account the hierarchical structure of the data and the autocorrelation of observations.

The seven patients were predominantly female (85.7 %) and had an average age of 35.1 (11.5) years. Measurements prior to the start of the pandemic indicated on average severe depression (Beck Depression Inventory, m=30.9 [10.0]) and marked hopelessness (Beck Hopelessness Scale, m=15.0 [5.0]). Analysis of the daily diary cards indicated that the confinement period significantly predicted a decrease in feelings of shame or guilt, fear and tension. At the same time, however, there was an increase in distress. Weekly monitoring of problem behaviors showed a decrease in binge-eating behaviors and a trend towards a decrease in alcohol consumption during confinement.

Despite the small number of patients included, two types of repeated measurements indicated convergent results, with some improvements during confinement: a decrease of the feelings of fear, shame or guilt, and tension, and a decrease of the frequency of binge-eating behaviors. The decreased pace of daily social and professional life may explain these improvements. The diminution of the above-mentioned feelings as triggers for addictive and compulsive behaviors may also account for the improvements regarding binge-eating. However, they also experienced an increased distress that may reflect the loneliness experienced during this period. The pre-pandemic development of computerized tools that were already familiar to patients greatly facilitated the necessary adaptations to maintain an intensive therapeutic setting during the confinement. This may partly explain why these patients were able to adjust the challenges of this period.