Unified protocol vs mentalization-based therapy for adolescents with borderline personality disorder: A randomized controlled trial

Abstract

BACKGROUND: Despite several treatments, e.g., mentalization-based therapy (MBT) and Unified Protocol (UP), being adapted to treat adolescents with borderline personality disorder (BPD), there exists a dearth of literature regarding their relative efficacy. In this study modified forms of MBT and UP - MBT-A and UP-A respectively-were compared in their ability to reduce borderline symptoms in a sample of 91 Iranian adolescents (two-thirds female) with a BPD diagnosis. METHODS: Individuals randomly allocated to one of two treatment groups, MBT-A (N = 45) or UP-A (N = 46) were followed up across 36 months following treatment. A MIXED ANCOVA was applied to compare the effectiveness of these interventions in reducing severity of borderline symptoms (the primary outcome), impulsivity, self-harm, emotion dysregulation and anger (secondary outcomes). The trial was retrospectively registered at IRCT20231106059970N1. RESULTS: Both primary outcomes and secondary outcomes decreased significantly following both MBT-A and UP-A. In comparison with MBT-A, UP-A was more effective in reducing emotional dysregulation, but levels of remission declined progressively up to 36 months of follow-up following both treatments. CONCLUSIONS: UP-A appears to be more effective than MBT-A in reducing emotional dysregulation in adolescents with BPD, despite being a shorter and less intensive treatment. An important caveat is that the treatment induced changes were largely limited to the emotion dysregulation aspect of BPD; other aspects (interpersonal and identity disturbances) were largely unchanged by either treatment.