Cited by 156Personality Disorders and PsychopathologyPsychotherapy Techniques and ApplicationsBipolar Disorder and Treatment

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Psychotherapies for borderline personality disorder: a focused systematic review and meta-analysis

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Stoffers-Winterling, Jutta M., Storebø, Ole Jakob, Kongerslev, Mickey T., Faltinsen, Erlend, Todorovac, Adan, Sedoc Jørgensen, Mie, Sales, Christian P., Edemann Callesen, Henriette, Pereira Ribeiro, Johanne, Völlm, Birgit A., Lieb, Klaus, Simonsen, Erik·2022·The British Journal of Psychiatry

DOI 10.1192/bjp.2021.204

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Abstract

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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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: Stoffers-Winterling, Jutta M.
Storebø, Ole Jakob
Kongerslev, Mickey T.
Faltinsen, Erlend
Sales, Christian P.
Lieb, Klaus
Simonsen, Erik
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
DOI: 10.1192/bjp.2021.204
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
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (unspecified)
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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Psychotherapies for borderline personality disorder: a focused systematic review and meta-analysis

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