Effectiveness of psychological treatments for borderline personality disorder and predictors of treatment outcomes: A multivariate multilevel meta-analysis of data from all design types
Open accessAbstract
We examined the effectiveness of psychotherapies for adult Borderline Personality Disorder (BPD) in a multilevel meta-analysis, including all trial types (PROSPERO ID: CRD42020111351). We tested several predictors, including trial- and outcome type (continuous or dichotomous), setting, BPD symptom domain and mean age. We included 87 studies (N = 5881) from searches between 2013 and 2019 in four databases. We controlled for differing treatment lengths and a logarithmic relationship between treatment duration and effectiveness. Sensitivity analyses were conducted by excluding outliers and by prioritizing total scale scores when both subscale and total scores were reported. Schema Therapy, Mentalization-Based Treatment and reduced Dialectical Behavior Therapy were associated with higher effect sizes than average, and treatment-as-usual with lower effect sizes. General severity and affective instability showed the strongest improvement, dissociation, anger, impulsivity and suicidality/self-injury the least. Treatment effectiveness decreased as the age of participants increased. Dichotomous outcomes were associated to larger effects, and analyses based on last observation carried forward to smaller effects. Compared to the average, the highest reductions were found for certain specialized psychotherapies. All BPD domains improved, though not equally. These findings have a high generalizability. However, causal conclusions cannot be drawn, although the design type did not influence the results.
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ST and its trauma processing component ImRs are effective for disorders resulting from interpersonal trauma in childhood, including complex PTSD and personality disorders.
“First, ST as a whole, as well as its trauma processing component, Imagery Rescripting (ImRs), are effective for disorders that result from interpersonal trauma in childhood, including complex PTSD and personality disorders [e.g., (13–17)].”
From Schema therapy for Dissociative Identity Disorder: a case report (2023) · cites this paper as [16]
The Discussion reports that schema therapy (ST) was associated with relatively large improvements in borderline personality disorder outcomes. It does not establish the effectiveness of Imagery Rescripting (ImRs), address complex PTSD, or link the studied outcomes specifically to childhood interpersonal trauma. The claim therefore extends beyond the BPD treatment findings reported here. (LLM, conf=0.87)
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- Authors
- 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.
- Affiliations
- University of Amsterdam (NL)
- Utrecht University (NL)
- Department of Clinical Psychology, University of Amsterdam, 1018 WS Amsterdam, The Netherlands
- De Viersprong (NL)
- Corresponding author
- Rameckers, Sophie A.
- Venue
- Journal of Clinical Medicine
- Publisher
- MDPI AG
- Published
- 2021-11-29
- Volume
- 10
- Issue
- 23
- Pages
- 5622
- ISSN
- 2077-0383 (ISSN-L)
- PMC
- PMC8658126
- OpenAlex
- W3216210008
- Cited by
- 63
- References
- 53
- Citations by year
- 2026: 12 · 2025: 14 · 2024: 16 · 2023: 10 · 2022: 10 · 2013: 1
- FWCI
- 1.20
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Clinical Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UvA-DARE (University of Amsterdam) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- 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 effectiveness, predictors of treatment outcome, schema therapy, mentalization-based treatment, dialectical behavior therapy, usual care, symptom domains, neuroticism, dissociation, impulsivity, suicidality, self-harm, age effects, trial design
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