Efficacy of Psychotherapies for Borderline Personality Disorder: A Systematic Review and Meta-analysis
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Citations
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References
A schema-focused approach to group psychotherapy for outpatients with borderline personality disorder: a randomized controlled trial.
Systems Training for Emotional Predictability and Problem Solving (STEPPS) for Outpatients With Borderline Personality Disorder: A Randomized Controlled Trial and 1-Year Follow-Up
The Effectiveness of Cognitive Behavior Therapy for Borderline Personality Disorder: Results from the Borderline Personality Disorder Study of Cognitive Therapy (BOSCOT) Trial
Psychotherapy for Borderline Personality
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Randomized controlled trial of outpatient mentalization-based treatment versus structured clinical management for borderline personality disorder
Frequently Asked Questions (11)
Q2. What databases were used for the search terms for BPD?
Search terms were combined for borderline personality and randomized trials in PubMed, PsycINFO, EMBASE, and the Cochrane Central Register of Controlled Trials (from database inception to November 2015), as well as the reference lists of earlier meta-analyses.
Q3. Why were the commonly cited approaches underrepresented?
Frequently cited approaches, such as schema-focused therapy, were underrepresented, mainly because they were mostly studied in head-to-head trials.
Q4. What were the effective psychotherapies at posttest?
For borderline-relevant outcomes combined (symptoms, self-harm, and suicide) at posttest, the investigated psychotherapies were moderately more effective than control interventions in stand-alone designs (g = 0.32; 95% CI, 0.14-0.51) and add-on designs (g = 0.40; 95% CI, 0.15-0.65).
Q5. Why did the authors effacing subtle differences between orientations?
Owing to the small number of trials, the authors grouped therapies in broader categories, effacing subtler differences between orientations.
Q6. What was the common method of calculating the effect size?
The authors used a software program (Comprehensive MetaAnalysis, version 3; Biostat) for computing and pooling effect sizes, with a random-effects model for pooling effect sizes.
Q7. What did the authors consider as nonsignificant effects for borderline-relevant outcomes?
Trials with low RoB for at least 3 of the 4 domains considered generated nonsignificant effects for borderline-relevant outcomes.
Q8. What was the approach used to delineate the therapy and control conditions?
Given the diversity and complexity of therapy orientations, the authors used an inclusive approach in delineating the psychotherapy and control conditions.
Q9. What type of studies focused on DBT followed by psychodynamic approaches?
Most trials focused on DBT followed by psychodynamic approaches, and both types generated significant, small between-group effect sizes, with low heterogeneity for DBT.
Q10. What is the effect of a manualized protocol on treatment outcomes?
While treatment intensity per se did not seem to influence outcomes, there are indications that a control group balanced for the involvement of the study team in treatment or with a manualized protocol is as effective as psychotherapies tailored for BPD.
Q11. What was the exclusion criteria for concurrent medication use?
Concomitant medication use was not an exclusion criterion unless it was prescribed in a standardized way, as in trials in which individuals were randomized to a combination of psychotherapy and either pharmacotherapy or placebo.