Are recommendations for psychological treatment of borderline personality disorder in current UK guidelines justified? Systematic review and subgroup analysis: Impact of treatment process on outcomes of BPD
Abstract
Current U.K. guidelines on the management of borderline personality disorder include specific recommendations about the duration of therapy and number of sessions per week that patients should be offered. However, very little research has been conducted to examine the impact of these aspects of treatment process on patient outcomes. We therefore undertook a systematic review to examine the impact of treatment duration, number of sessions per week and access group-based therapy on general mental health, depression, social functioning and deliberate self-harm. We identified 25 randomized trials for possible inclusion in the review. However, differences in outcome measures used meant that only 12 studies could be included in the analysis. Statistically significant reductions in self-harm and depression and improvement in social functioning were found for treatments that include more than one session per week and those that included group-based sessions but were not found for those that deliver in individual sessions or one or fewer sessions per week. Longer term outcomes of short-term interventions have not been examined. Further research is needed to examine the impact of shorter term interventions and to compare the effects of group-based versus individual therapies for people with borderline personality disorder.
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Momentary intervention provided as a real-time intervention in the real world may be valuable for emotion regulation.
“As emotional sensitivity in personality disorders leads to the experience of negative affect across various contexts and situations,14 momentary intervention provided to people as a real-time intervention in the real world15 may be valuable for emotion regulation.”
From Recovery-focused self-help intervention using vodcasts for patients with personality disorder: Feasibility randomised controlled trial (2024) · cites this paper as [15]
Despite criticism, the NICE guidelines have been highly influential.
“Despite criticism of some of the recommendations [20], the guidelines have been highly influential.”
From European guidelines for personality disorders: past, present and future (2019) · cites this paper as [20]
Cites
Meta-analysis in clinical trials
DerSimonian, R., & Laird, N. (1986) · Controlled Clinical Trials · doi:10.1016/0197-2456(86)90046-2 · Cited by 39,552 · see citing works
Cognitive-behavioral treatment of chronically parasuicidal borderline patients
Linehan, M. M. (1991) · Archives of General Psychiatry · doi:10.1001/archpsyc.1991.01810360024003 · Cited by 2,203 · see citing works
Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard, H. L., Korslund, K. E., Tutek, D. A., Reynolds, S. K., & Lindenboim, N. (2006) · Archives of General Psychiatry · doi:10.1001/archpsyc.63.7.757 · Cited by 2,025 · see citing works
Bateman, A., & Fonagy, P. (1999) · American Journal of Psychiatry · doi:10.1176/ajp.156.10.1563 · Cited by 1,416 · see citing works
Borderline personality disorder
Lieb, K., Zanarini, M. C., Schmahl, C., Linehan, M. M., & Bohus, M. (2004) · The Lancet · doi:10.1016/s0140-6736(04)16770-6 · Cited by 1,369 · see citing works
Yusuf, S. (1991) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.1991.03470010097038 · Cited by 1,014 · see citing works
Bateman, A., & Fonagy, P. (2009) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2009.09040539 · Cited by 961 · see citing works
A consumer's guide to subgroup analyses
Oxman, A. D., & Guyatt, G. H. (1992) · Annals of Internal Medicine · doi:10.7326/0003-4819-116-1-78 · Cited by 914 · see citing works
McMain, S. F., Links, P. S., Gnam, W. H., Guimond, T., Cardish, R. J., Korman, L., & Streiner, D. L. (2009) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2009.09010039 · Cited by 729 · see citing works
Dialectical behaviour therapy for women with borderline personality disorder
Verheul, R., van den Bosch, L. V. D., Koeter, M., de Ridder, M. D., Stijnen, T., & van den Brink, W. J. (2003) · British Journal of Psychiatry · doi:10.1192/bjp.182.2.135 · Cited by 663 · see citing works
Doering, S., Hörz, S., Rentrop, M., Fischer-Kern, M., Schuster, P., Benecke, C., Buchheim, A., Martius, P., & Buchheim, P. (2010) · British Journal of Psychiatry · doi:10.1192/bjp.bp.109.070177 · Cited by 440 · see citing works
Farrell, J. M., Shaw, I. A., & Webber, M. A. (2009) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2009.01.002 · Cited by 428 · see citing works
Blum, N., St. John, D., Pfohl, B., Stuart, S., McCormick, B., Allen, J., Arndt, S., & Black, D. W. (2008) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2007.07071079 · Cited by 407 · see citing works
Credibility of claims of subgroup effects in randomised controlled trials: systematic review
Sun, X., Briel, M., Busse, J. W., You, J. J., Akl, E. A., Mejza, F., Bała, M. M., Bassler, D., Mertz, D., Diaz-Granados, N., et al. (2012) · BMJ · doi:10.1136/bmj.e1553 · Cited by 394 · see citing works
Churchill, R., Hunot, V., Corney, R., Knapp, M., McGuire, H., Tylee, A., & Wessely, S. (2002) · Health Technology Assessment · doi:10.3310/hta5350 · Cited by 368 · see citing works
Davidson, K., Norrie, J., Tyrer, P., Gumley, A., Tata, P., Murray, H., & Palmer, S. (2006) · Journal of Personality Disorders · doi:10.1521/pedi.2006.20.5.450 · Cited by 362 · see citing works
Empirical Evidence and Psychotherapy: A Growing Scientific Base
Gabbard, G. O. (2001) · American Journal of Psychiatry · doi:10.1176/appi.ajp.158.1.1 · Cited by 357 · see citing works
Selwood, A., Johnston, K., Katona, C., Lyketsos, C., & Livingston, G. (2007) · Journal of Affective Disorders · doi:10.1016/j.jad.2006.10.025 · Cited by 342 · see citing works
Comparative efficacy of individual and group psychotherapy: A meta-analytic perspective.
McRoberts, C., Burlingame, G. M., & Hoag, M. J. (1998) · Group Dynamics: Theory, Research, and Practice · doi:10.1037/1089-2699.2.2.101 · Cited by 253 · see citing works
Gregory, R., Chlebowski, S., Kang, D., Remen, A., Soderberg, M., Stepkovitch, J., & Virk, S. (2008) · Psychotherapy · doi:10.1037/0033-3204.45.1.28 · Cited by 129 · see citing works
Weinberg, I., Gunderson, J. G., Hennen, J. A., & Cutter, C. J. (2006) · Journal of Personality Disorders · doi:10.1521/pedi.2006.20.5.482 · Cited by 125 · see citing works
A preliminary, randomized trial of psychoeducation for women with borderline personality disorder
Zanarini, M. C., & Frankenburg, F. R. (2008) · Journal of Personality Disorders · doi:10.1521/pedi.2008.22.3.284 · Cited by 122 · see citing works
Social problem-solving plus psychoeducation for adults with personality disorder
Huband, N., McMurran, M., Evans, C., & Duggan, C. F. (2007) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.106.023341 · Cited by 105 · see citing works
Cognitive-Behavioral Treatment
Rapee, R. M., & Barlow, D. H. (1988) · Psychiatric Annals · doi:10.3928/0048-5713-19880801-09 · Cited by 93 · see citing works
Bos, E. H., van Wel, E. B., Appelo, M. T., & Verbraak, M. J. P. M. (2010) · Journal of Nervous & Mental Disease · doi:10.1097/nmd.0b013e3181d619cf · Cited by 85 · see citing works
An Integrative Perspective on Psychotherapeutic Treatments for Borderline Personality Disorder
de Groot, E. R., Verheul, R., & Trijsburg, R. W. (2008) · Journal of Personality Disorders · doi:10.1521/pedi.2008.22.4.332 · Cited by 55 · see citing works
Dedicated community-based services for adults with personality disorder: Delphi study
Crawford, M. J., Price, K., Rutter, D., Moran, P., Tyrer, P., Bateman, A., Fonagy, P., Gibson, S., & Weaver, T. (2008) · British Journal of Psychiatry · doi:10.1192/bjp.bp.107.043042 · Cited by 54 · see citing works
Self-citationDoig, I., & Doig, C. (1972) · Medical Entomology and Zoology · Cited by 42 · see citing works
Price, K., Gillespie, S., Rutter, D., Dhillon, K., Gibson, S. L., Faulkner, A., Weaver, T. D., & Crawford, M. (2009) · Journal of Mental Health · doi:10.3109/09638230902968191 · Cited by 15 · see citing works
Self-citationChanging Ideas About the Treatment of Borderline Personality Disorder
Livesley, W. J. (2004) · Journal of Contemporary Psychotherapy · doi:10.1023/b:jocp.0000036697.03467.27 · Cited by 14 · see citing works
Levy, K. N., Yeomans, F. E., Denning, F. I., & Fertuck, E. A. (2010) · Personality and Mental Health · doi:10.1002/pmh.119 · Cited by 3 · see citing works
Tyrer, P. J., & Haigh, R. (2010) · Personality and Mental Health · doi:10.1002/pmh.118 · Cited by 1 · see citing works
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Cited by
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Oud, M., Arntz, A., Hermens, M., Verhoef, R. E. J., & Kendall, T. (2018) · Australian and New Zealand journal of psychiatry (Print) · doi:10.1177/0004867418791257 · Cited by 128 · see citing works
“Also a recent meta-analysis on the treatment of BPD found that psychological interventions that were offered more than once a week and those that included group sessions had significantly greater improvements in social functioning and reduction in self-injury and depression than those that consisted of one session per…”
BackgroundMethodEuropean guidelines for personality disorders: past, present and future
Simonsen, S., Bateman, A., Bohus, M., Dalewijk, H. J., Doering, S., Kaera, A., Moran, P., Renneberg, B., Ribaudi, J. S., Taubner, S., et al. (2019) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-019-0106-3 · Cited by 147 · see citing works
Rameckers, S. A., Verhoef, R. E. J., Grasman, R. P. P. P., Cox, W. R., van Emmerik, A. A. P., Engelmoer, I. M., & Arntz, A. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10235622 · Cited by 63 · see citing works
“These important treatment factors are treatment format [14–16] and setting [17], but also treatment duration.”
Tiemens, B. G., Kloos, M., Spijker, J., Ingenhoven, T., Kampman, M., & Hendriks, G. (2019) · BMC Psychiatry · doi:10.1186/s12888-019-2214-4 · Cited by 50 · see citing works
Spong, A. J., Clare, I. C. H., Galante, J., Crawford, M. J., & Jones, P. B. (2021) · Clinical Psychology Review · doi:10.1016/j.cpr.2020.101937 · Cited by 31 · see citing works
Self-citationService user experiences of mentalisation-based treatment for borderline personality disorder.
Lonargáin, D. Ó., Hodge, S., & Line, R. (2017) · Mental Health Review Journal · doi:10.1108/mhrj-04-2016-0008 · Cited by 23 · see citing works
Crawford, M., Thana, L., Parker, J., Turner, O., Carney, A., McMurran, M., Moran, P., Weaver, T. D., Barrett, B. M., Roberts, S. L. E., et al. (2020) · BJPsych Open · doi:10.1192/bjo.2020.7 · Cited by 19 · see citing works
Self-citationMcMurran, M., Crawford, M., Reilly, J. G., Delport, J., McCrone, P., Whitham, D., Tan, W., Duggan, C. F., Montgomery, A. A., Williams, H. C., et al. (2016) · Health Technology Assessment · doi:10.3310/hta20520 · Cited by 17 · see citing works
Self-citationMcMurran, M., Day, F., Reilly, J. G., Delport, J., McCrone, P., Whitham, D., Tan, W., Duggan, C. F., Montgomery, A. A., Williams, H. C., et al. (2017) · Journal of Personality Disorders · doi:10.1521/pedi_2017_31_286 · Cited by 16 · see citing works
Self-citationLamph, G., Baker, J. A., Dickinson, T., & Lovell, K. (2019) · Personality and Mental Health · doi:10.1002/pmh.1454 · Cited by 17 · see citing works
Zavlis, O. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1270926 · Cited by 10 · see citing works
Crawford, M., Thana, L., Parker, J., Turner, O., Xing, K. P., McMurran, M., Moran, P., Weaver, T. D., Barrett, B. M., Claringbold, A., et al. (2018) · Trials · doi:10.1186/s13063-018-2920-0 · Cited by 10 · see citing works
Self-citationParis, J. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-811421-6.00005-3 · Cited by 8 · see citing works
Kim, Y.-R., An, Z., Han, S. W., Ko, J. K., & Hwa Kwag, K. (2024) · BJPsych Open · doi:10.1192/bjo.2023.647 · Cited by 1 · see citing works
“…behaviours and increasing effective emotion regulation, mindful-based techniques and recovery stories (cid:129) The vodcasts were viewed using a portable movie player (cid:129) Personalised weekly feedback via text messages was provided with weekly support via brief telephone calls with a mentor 4.”
BackgroundMethodBasic mechanisms of, and treatment planning/targets for, personality disorders
Saunders, K. E. A., & Pearce, S. (2020) · doi:10.1093/med/9780198713005.003.0118
- Authors
- Omar, H., Tejerina-Arreal, M., & Crawford, M. J.
- Affiliations
- Central and North West London NHS Foundation Trust (GB)
- Facultad de Psicología; Universidad de Murcia; Mucia Spain
- Centre for Mental Health (GB)
- Corresponding author
- Crawford, Mike J.
- ORCID
- Crawford, Mike J.
- Venue
- Personality and Mental Health
- Publisher
- Wiley
- Published
- 2014-07-02
- Volume
- 8
- Issue
- 3
- Pages
- 228-237
- ISSN
- 1932-8621 (ISSN-L)
- OpenAlex
- W1819346599
- Cited by
- 15
- References
- 32
- Citations by year
- 2024: 1 · 2023: 1 · 2021: 1 · 2020: 3 · 2019: 3 · 2018: 2 · 2017: 3 · 2016: 1
- FWCI
- 0.20
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Personality and Mental Health (publishedVersion)
- PubMed (publishedVersion)
- Spiral (Imperial College London) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Keywords
- borderline personality disorder, psychological intervention, treatment duration, individual psychotherapy, depression, self-harm, social functioning, general mental health
- MeSH terms
- Adolescent, Adult, Aged, Mental Disorders, Borderline Personality Disorder, Depressive Disorder, Humans, Middle Aged, Psychotherapy, Psychotherapy, Group, Social Behavior, Time Factors, Randomized Controlled Trials as Topic, Self-Injurious Behavior, Treatment Outcome, Practice Guidelines as Topic, Young Adult
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