Psychotherapies for borderline personality disorder: a focused systematic review and meta-analysis
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Background: A recently updated Cochrane review supports the efficacy of psychotherapy for borderline personality disorder (BPD). Aims: To evaluate the effects of standalone and add-on psychotherapeutic treatments more concisely. Method: We applied the same methods as the 2020 Cochrane review, but focused on adult samples and comparisons of active treatments and unspecific control conditions. Standalone treatments (i.e. necessarily including individual psychotherapy as either the sole or one of several treatment components) and add-on interventions (i.e. complementing any ongoing individual BPD treatment) were analysed separately. Primary outcomes were BPD severity, self-harm, suicide-related outcomes and psychosocial functioning. Secondary outcomes were remaining BPD diagnostic criteria, depression and attrition. Results: Thirty-one randomised controlled trials totalling 1870 participants were identified. Among standalone treatments, statistically significant effects of low overall certainty were observed for dialectical behaviour therapy (self-harm: standardised mean difference (SMD) −0.54, P = 0.006; psychosocial functioning: SMD −0.51, P = 0.01) and mentalisation-based treatment (self-harm: risk ratio 0.51, P < 0.0007; suicide-related outcomes: risk ratio 0.10, P < 0.0001). For adjunctive interventions, moderate-quality evidence of beneficial effects was observed for DBT skills training (BPD severity: SMD −0.66, P = 0.002; psychosocial functioning: SMD −0.45, P = 0.002), and statistically significant low-certainty evidence was observed for the emotion regulation group (BPD severity: mean difference −8.49, P < 0.00001), manual-assisted cognitive therapy (self-harm: mean difference −3.03, P = 0.03; suicide-related outcomes: SMD −0.96, P = 0.005) and the systems training for emotional predictability and problem-solving (BPD severity: SMD −0.48, P = 0.002). Conclusions: There is reasonable evidence to conclude that psychotherapeutic interventions are helpful for individuals with BPD. Replication studies are needed to enhance the certainty of findings.
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Several types of MBT for BPD are empirically supported.
“Several types of MBT for BPD are empirically supported [40–42].”
From The (cost-)effectiveness of early intervention (MBT-early) versus standard protocolized treatment (CBT) for emerging borderline personality disorder in adolescents (the EARLY study): a study protocol for a randomized controlled trial (2024) · cites this paper as [40]
The Effects of interventions: standalone psychotherapies section reports that MBT was assessed in four studies and significantly reduced self-harm and suicidal behaviour. It does not establish that several distinct types of MBT are supported; the Completeness of the evidence section says that studies of comorbidity-specific MBT adaptations lack replication. Page numbers are not available in our copy. (LLM, conf=0.84)
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Efficacy of mentalization‐based therapy in treating self‐harm: A systematic review and meta‐analysis
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Borderline Personality Disorder: Updates in a Postpandemic World
Choi-Kain, L. W., Şahin, Z., & Traynor, J. M. (2022) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/appi.focus.20220057 · Cited by 18 · see citing works
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MDMA-assisted psychotherapy for borderline personality disorder
Traynor, J. M., Roberts, D. E., Ross, S., Zeifman, R., & Choi-Kain, L. (2022) · Focus · doi:10.1176/appi.focus.20220056 · Cited by 15 · see citing works
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Khasho, D., van Alphen, S. P. J., Ouwens, M. A., Arntz, A. R., Heijnen-Kohl, S., & Videler, A. C. (2023) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2900 · Cited by 16 · see citing works
The Hypothalamus-Pituitary-Adrenal Axis and Social Cognition in Borderline Personality Disorder
Kulakova, E., Graumann, L., & Wingenfeld, K. (2023) · Current Neuropharmacology · doi:10.2174/1570159x21666230804085639 · Cited by 13 · see citing works
Flechsig, A., Bernheim, D., Buchheim, A., Domín, M., Mentel, R., & Lotze, M. (2023) · Brain Sciences · doi:10.3390/brainsci13071001 · Cited by 12 · see citing works
Bozzatello, P., Blua, C., Marin, G., Rocca, P., & Bellino, S. (2023) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2023.10.049 · Cited by 11 · see citing works
Dialectical Behavior Therapy in Autism
Weiner, L., Bemmouna, D., Costache, M. E., & Martz, É. (2025) · Current Psychiatry Reports · doi:10.1007/s11920-025-01596-7 · Cited by 10 · see citing works
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Personal agency and borderline personality disorder: a longitudinal study of outcomes
Hashworth, T., Reis, S. L., Townsend, M. L., O.’Garr, J., & Grenyer, B. F. S. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-04214-5 · Cited by 10 · see citing works
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Azzam, S., Almari, R., Khattab, K., Badr, A., Balawi, A. R., Haddad, R., Almasri, R., & Varrassi, G. (2024) · Cureus · doi:10.7759/cureus.75893 · Cited by 12 · see citing works
Psychotherapies for the treatment of personality disorders: the state of the art
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Mermin, S. A., Steigerwald, G., & Choi-Kain, L. W. (2024) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000417 · Cited by 8 · see citing works
What impact can brain stimulation interventions have on borderline personality disorder?
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Bibliometric analysis of global research on dialectical behavior therapy from 1987 to 2024
Shi, K., Zhang, L.-Y., Gao, B., Qian, Y., Huang, X., & Yue, J.-L. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1450497 · Cited by 6 · see citing works
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The Management of Perinatal Borderline Personality Disorder
Williams, A. S., & Hill, R. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12216850 · Cited by 5 · see citing works
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Psychosocial functioning in personality disorders
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Aydın, E. F., & Laçin, T. K. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1444583 · Cited by 4 · see citing works
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A Neural Signature of Touch Aversion and Interpersonal Problems in Borderline Personality Disorder
Voelter, J., Postin, D., Croy, I., Hurlemann, R., & Scheele, D. (2025) · Psychotherapy and Psychosomatics · doi:10.1159/000545973 · Cited by 4 · see citing works
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“Several types of MBT for BPD are empirically supported [40–42].”
BackgroundTransference-Focused Psychotherapy (TFP) Informed Psychoeducation
Rentrop, M., Gerra, M. L., & Panfilis, C. D. (2024) · Springer eBooks · doi:10.1007/978-3-031-68062-5_3 · Cited by 3 · see citing works
Reinforcing Gaps? A Rapid Review of Innovation in Borderline Personality Disorder (BPD) Treatment
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Time to put aside the false dichotomy between personality disorders and psychotic symptoms
Leclerc, P., Gamache, D., & Cailhol, L. (2024) · Journal of Clinical Psychology · doi:10.1002/jclp.23655 · Cited by 3 · see citing works
Vertrauen schaffen in der Psychotherapie
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Commentary: Special Issue on Interpersonal Trust
Fonagy, P., Campbell, C., Allison, E., & Luyten, P. (2024) · Journal of Personality Disorders · doi:10.1521/pedi.2024.38.1.10 · Cited by 3 · see citing works
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Multimodal approaches to the treatment of personality disorder
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The Relationship Between Borderline Personality Disorder Symptoms and Mindfulness: A Meta-Analysis
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Dialectical Behavior Therapy vs Schema Therapy for Patients With Borderline Personality Disorder
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Psychometric Properties of the FAB2 for Borderline Personality Disorder: A Swiss Validation
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Atypical semantic cognition in schizotypal personality disorder and borderline personality disorder
Petersen, L. S., Vestergaard, M., Meisner, M. W., Foldager, M., & Simonsen, E. H. (2024) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/13803395.2024.2340813 · Cited by 2 · see citing works
Self-citationNarcissistic personality disorder: an opinionated review of the efficacy of psychotherapy
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Abwehrmechanismen als methodenübergreifender Wirkfaktor von Psychotherapie?
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Contemporary neuroscientific concepts and psychotherapy: possibilities for integration
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Current Neuroscientific Concepts and Psychotherapy: Possibilities for Integration
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Actualización del trastorno límite de la Personalidad: una revisión de tema
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Efeitos da psicoterapia no transtorno de personalidade borderline
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Zur Aufnahme von Patient*innen mit Borderline Persönlichkeitsstörung in die ambulante Psychotherapie
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Simonsen, E. H., & Paris, J. (2025) · doi:10.1093/9780191964343.003.0005 · Cited by 1 · see citing works
Self-citationBaggio, T., Teti, A., Rizzi, R., Grecucci, A., & Messina, I. (2026) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2026.1787003
Freund und Feind in der Therapie von Persönlichkeitsstörungen – die »Allgemeinpsychiatrie«
Severus, W. E., & Großkopf, C. M. (2022) · PTT - Persönlichkeitsstörungen: Theorie und Therapie · doi:10.21706/ptt-26-3-296
- Authors
- Stoffers-Winterling, J. M., Storebø, O. J., Kongerslev, M. T., Faltinsen, E., Todorovac, A., Sedoc Jørgensen, M., Sales, C. P., Edemann Callesen, H., Pereira Ribeiro, J., Völlm, B. A., Lieb, K., & Simonsen, E.
- Affiliations
- University Medical Center of the Johannes Gutenberg University Mainz (DE)
- University of Southern Denmark (DK)
- Region Zealand (DK)
- Nottinghamshire Healthcare NHS Foundation Trust (GB)
- University of Copenhagen (DK)
- Corresponding author
- Stoffers-Winterling, Jutta M.
- ORCID
- Venue
- The British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2022-01-28
- Volume
- 221
- Issue
- 3
- Pages
- 538-552
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W4210629065
- Cited by
- 156
- References
- 93
- Citations by year
- 2026: 44 · 2025: 44 · 2024: 42 · 2023: 18 · 2022: 8
- FWCI
- 4.67
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, cc-by)
- University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion, cc-by)
- 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, psychotherapy, dialectical behavior therapy, mentalization-based treatment, DBT skills training, self-harm, suicide, psychosocial functioning, BPD severity, add-on intervention
- MeSH terms
- Dialectical Behavior Therapy, Adult, Borderline Personality Disorder, Humans, Psychotherapy, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Self-Injurious Behavior
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