Borderline Personality Disorder: How Effective are Psychotherapies?
Dialectical behavior therapy and psychodynamic treatment approaches in borderline personality disorders (BPDs) are effective in improving patient symptoms and co-morbidities, however the effects may be small. Those are the findings of a new study published in JAMA Psychiatry.
A systemic review of 33 randomized clinical trials, including 2,256 participants, was conducted by a group of international researchers. All of the trial's participants were diagnosed with BPD, and the researchers divided the studies into stand-alone designs (in which an independent psychotherapy was compared with control interventions) and add-on designs (in which an experimental intervention added to usual treatment was compared with usual treatment alone).
Results showed that the investigated psychotherapies were moderately more effective—as assessed by standardized mean differences (Hedges g)—in terms of borderline symptoms, self-harm and suicide 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).
Results for stand-alone designs showed similar outcomes with favorable efficacy for investigated psychotherapies than control interventions including self-harm (g=0.32; 95% CI, 0.09–0.54), suicide (g=0.44; 95% CI, 0.15–0.74), health service use (g=0.40; 95% CI, 0.22–0.58), and general psychopathology (g=0.32; 95% CI, 0.09–0.55). However, dialectical behavior therapy (g=0.34; 95% CI, 0.15–0.53) and psychodynamic approaches (g=0.41; 95% CI, 0.12–0.69) were the only two types of psychotherapies more effective than control interventions.
By assessing the trials through 4 domains of Colchrane Collaboration Risk of Bias tool, the researchers found that the risk of bias was a strong moderator in both subgroup and meta-regression analyses. The authors stated that this bias inflated their findings. Future studies, they say, are needed to clarify the stability and practical relevance of dialectical behavior therapy and psychodynamic treatment in BPD specific psychotherapies.
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