4 Exploring the mediating role of alexithymia in BPP 119 and fully experience emotions - should be specifically targeted in treatment of BPP [32, 100-103]. Nowadays, in treatments available for BPP/BPD such as dialectical behavioral therapy (DBT) already considerable time is spent on training patients in recognizing emotions and other internal processes to help them gain control over SIB and other detrimental behaviors [18]. 2. Methods 2.1 Participants To be eligible to enter the study, patients had to be under the care of a mental health professional during testing; be 18 years of age or older; be able to speak Dutch to a sufficient level to be able to participate without an interpreter. Participants could not participate in this study if they were currently going through the active phase of a psychotic or manic episode at the time of testing. Patients were also excluded in case of moderate to severe learning disability; if they had a substance addiction other than tobacco or caffeine (e.g., alcohol, cocaine, cannabis). Criteria were verified twofold: by inquiring patients personally, and by checking diagnoses and dates of birth in their medical record. All participants gave written consent for checking their medical record this purpose. To determine the minimal required sample size to detect a mediated effect we used the guideline provided by Fritz and McKinnon [104]. Based on empirical evidence, their guideline lists the required sample sizes for six of the most common and most recommended tests of mediation for various combinations of parameters. Using Bias-Corrected Bootstrap as a method for analysis, a p-value of = .05 and a power of 0.8 ([− =.2 ), having evidence of an existing moderate correlation (r <.30 and >.50; [105]) between Borderline Personality Problems (‘X’) and Alexithymia (mediator) (see [22]), and a moderate correlation between alexithymia and respectively DEP, DIS and SIB, (‘Y’, see [42, 78]), the empirical estimate of the sample size needed was 71. Initially 82 patients signed up. All had been diagnosed with one or more psychological disorders according to the DSM 5, based on clinical examination by a psychiatrist or clinical psychologist. All were in treatment at the mental health care institute where the study took place. Nine participants decided to forfeit ahead of the first appointment. Six gave an explanation for their decision to withdraw: they had (suddenly) stopped treatment (N=2), experienced a setback in mood and functioning (N=2), could not participate due to somatic illness (N=1). One participant had to withdraw because she was admitted to a hospital after a traffic accident. 3 participants did not mention why
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