Multiple psychotherapy interventions effective in borderline personality disorder

1. In this study, statistically significant effects were observed for dialectical behavior therapy (DBT) and mentalization based treatment (MBT).

2. When added as adjunctive treatments, DBT skills and training (DBT-ST) groups demonstrated beneficial effects on BPD severity and psychosocial functioning.

Evidence Rating Level: 2 (Good)

To date, psychotherapy is recommended as the primary treatment for borderline personality disorder (BPD) since pharmacotherapy has not been associated with convincing, sustainable effects. A broad variety of treatments have been investigated though the certainty of the evidence has been low, especially if only a single study was available. As a result, the objective of the present systematic review and meta-analysis was to evaluate any psychotherapeutic treatment on BPD with evidence from at least two randomized controlled trials.

Of 2203 identified records, 31 (n=1870) were included in the analysis from database inception up to February 2021. Studies were included if they were RCTs comparing an active treatment with any kind of control treatment in BPD patients. Bias was assessed using the Cochrane Collaboration risk of bias tool. Quality was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool. The inverse-variance meta-analysis was used for pooling the data.

Results demonstrated that statistically significant effects were observed for dialectical behavior therapy (DBT) (reducing self-harm and improving psychosocial functioning) and mentalization based treatment (MBT) (decreasing self-harm and suicide-related outcomes). Furthermore, when added as adjunctive treatments, DBT skills and training (DBT-ST) groups demonstrated beneficial effects on BPD severity and psychosocial functioning. Despite these results, the study was limited by the inclusion of studies that were predominantly female which limits the findings to men. Nonetheless, the comprehensiveness of the search strategy provides reasonable grounds to suggest the usefulness of various psychotherapeutic interventions for individuals with BPD.

Click to read the study in The British Journal of Psychiatry 

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