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Psychotherapies for borderline personality disorder: a focused systematic review and meta-analysis
Open accessAbstract
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 [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]
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Metadata
- 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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