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Table 2 Summary of the contents of Iconic Therapy and Structured Support Therapy programmes

From: Effectiveness of iconic therapy for the reduction of borderline personality disorder symptoms among suicidal youth: study protocol for a randomised controlled trial

Therapy group Programme compositiona
Iconic therapy + treatment as usualb Module 1: Understanding the problem, motivating and acquiring some basic coping skills.
Session 1
Content:
- Presentation.
- Explicative model of pathology: visual understanding of the problem origins and perpetuation as an enduring vicious cycle (the sinking, the blinding and the flight icons)
- Education to recognize patient’s affective reactions (the map icon).
Objectives:
Understanding that it is possible to develop healthier alternatives to replace dysfunctional patterns of thinking, feeling and behaving (to be learnt and trained during the length of the therapy).
Session 2
Content:
- Therapeutic model elaboration: emotional self-regulation techniques (the key phrase and the cooling off time icons).
- Basic skills training: decision making and self-improvement techniques to manage remorse after hurting another (the corsage of alternatives, the telephone and the zig-zag icons).
Objectives:
Acquiring new learning experiences and general self-management skills to control inappropriate emotional responses.
Module 2: Intimacy and empathy.
Session 3
Content:
- Interpersonal problems solution: expressing criticism to reach an agreement (the sacks attack and the translator icons).
- Practical examples and role-playing in groups.
Objectives:
Experiencing self-effectiveness when sharing experiences in interpersonal relationships.
Session 4
Content:
- Interpersonal problems: accepting criticism and getting distance from negative relationships (the black grain, the glass wall and the rock wall icons).
- Practical examples and role-playing.
Objectives:
Sharing experiences of interpersonal relationships in groups.
Session 5
Content:
Negative emotions and cognition management:
- Hostility (the mountain icon)
- Inhibition (the pen icon)
- High expectations from others (the bouquet of flowers icon)
- Cognitive filters (the coloured sunglasses icon)
- External attribution (the tower of books icon)
- Practical examples and exercises.
Objectives:
Detecting and changing negative ways of perceiving and interpreting other people or events.
Practicing motivated behaviors, reflecting intentions and desires.
Module 3: Self-esteem and identity.
Session 6
Content:
- Personality trait optimization (the river icon).
- Others comparison avoidance (the coloured bars icon).
- Overcoming the need to receive a torrent of affection (the self-disqualification pitfall icon).
- Mimetization vs reaching a genuine position (the mimetization and the positioning icons).
Objectives:
Gaining a more stable sense of self and personal security.
Session 7
Content:
- Sense of Emptiness (the Matryoshka dolls icon).
- Negative vs positive behavioral tendencies (the positives and negatives icon).
- Prejudices avoidance (the Mozart icon).
Objectives:
Gaining a more stable sense of self and personal security.
Session 8
Content:
- Emotional balance clues (the table icon).
- Personal dependence avoidance (the flag icon).
- Uselessness of complaining about past experiences and how to take advantages of them (the web and the embankment phrase icons).
- Practical review by sharing practical uses of the icons on group.
Objectives:
Reaching independent self-advise on daily situations.
Module 4: Self-direction.
Session 9
Content:
- Liberty vs impulse slavery: reconceptualization (the bypass road icon).
- Goals setting (the range icon).
Objectives:
Strengthening impulsiveness and risk-taking control.
Session 10
Content:
- Adversity as an impulse towards the goal (the sailboat icon).
- Values and prosocial standards to guide our decisions (the compass icon).
- Practical exercises of people finding their own concretes and vital goals.
Objectives:
Instigating normative ethical behaviour.
Final review (Session 11):
Relapse prevention. Workshop reviewing learned strategies and post-treatment evaluation.
Sixth month review (Session 12):
Relapse prevention. Workshop reviewing learnt strategies.
Twelveth month review (Session 13):
Relapse prevention. Workshop reviewing learnt strategies and 12-month follow-up evaluation.
Structured support therapy + treatment as usualc Session 1: Social relationships.
Content:
- Presentation.
- Video and debate. May friends or acquaintances turn into relatives for you? / What is the importance of having a friend to stand by? / Is it possible to find a friend on the internet?.
Objectives:
Participants interacting with other participants of similar characteristics in a casual and secure environment.
Session 2: Risks on the internet.
Content:
Video and debate. What do you use social websites for? selfies, finding partners, photos, risks, problems.
Objectives: Participants interacting with other participants of similar characteristics in a casual and secure environment.
Session 3: Emotional instability and impulse control.
Content:
- Information about the role of emotion regulation and emotional instability (coordinate axis) in emotional disorders.
- Impulsivity definition. The turtle technique (detect the emotion, stop, hide and breathe in the shell, go out and think of a solution).
Objectives:
Debating about the given topics and sharing strategies to deal with them.
Session 4: Emotional regulation and jacobson relaxation technique.
Content:
- Role-playing: The therapist reads a short story and the participants play a role simulating different attitudes towards the story (distracted, aggressive or interested). The rest of the participants try to detect name, intensity and coping skills to deal with shown emotions.
- Soft music and Jacobson relaxation technique.
Objectives:
Session 5: Social skills.
Content:
- Defining empathy and assertiveness.
- Role-playing “the assertiveness umbrella”: the participant with the umbrella is required to express his complaints in front of the rest of the group.
Objectives: Learn to detect internal and external social skills.
Session 6: Social skills ii.
Content:
- Role-playing. The participants are invited to introduce themselves, ask the therapists questions, maintain a conversation with their closer partner or express, in his/her opinion, the best characteristic of the partner on the left.
Objectives:
Increasing assertive behavior in a secure environment.
Session 7: Self-image and communicational styles.
Content:
- Defining identity and self-image by thinking of an admired person (famous, family or friends) and detecting similar traits within themselves.
- Defining communicational styles: passive, aggressive, assertive.
- Videos with examples of people with different communicational styles.
Objectives: Learning to detect their own and other’s necessities.
Session 8: Mindfulness.
Content:
- A specialized volunteer psychologist delivers a mindfulness session lying on the floor, with raisins to be consumed by the therapist and participants as a shared contemplative experience.
Objectives:
Enhancing stress tolerance and contemplation capacity.
Session 9: Self-esteem.
Content:
- Defining self-esteem and main personal characteristics: each participant writes his or her 5 main characteristics on an anonymous paper and gives it to the therapist, who reads them all. When there is a negative characteristic, the therapist tries to explain its usefulness and the way to make it positive.
Objectives:
Improving self-awareness.
Session 10: Self-esteem ii.
Content:
- Self-esteem: participants are incited to exercise their body, trust in their qualities and use them, don’t look for other’s approval, take perspective and accept their problem.
- Self- realization: bearing in mind their best qualities, participants are invited to think of an activity they are motivated for as well as different ways to keep in touch with it.
Objectives: Improving the self-esteem.
Session 11: Relapse prevention. Reviewing the strategies learned across the program and contents and post treatment evaluation.
Sixth month review (Session 12):
Relapse prevention. Workshop reviewing learnt strategies.
Twelveth month review (Session 13):
Relapse prevention. Workshop reviewing learnt strategies and 12-month follow-up evaluation.
  1. Notes. aAll patients are free to contact the principal investigator throughout the process to solve practical questions about the use of session contents. b10–12 group sessions given by 2 specifically trained psychologists using the guideline draft. c11 group sessions given by 2 psychologists using a non-manualized program