Efficacy of psychotherapies for borderline personality disorder - A meta-analysis of randomized controlled trials

Abstract

Introduction: Psychotherapeutic therapies play an important role in borderline personality disorder (BPD) treatment. Pharmacotherapy can be helpful for some symptom clusters, but overall psychotherapy remains the most promising approach to treat persons with BPD. In the last two decades, disorder-specific psychotherapeutic approaches have been developed and evaluated. Aims: To systematically identify, integrate and review the current evidence on treatment efficacy using systematic Cochrane Collaboration review methodology. Methods: Thorough literature searches were done to identify all available randomized controlled trials (RCTs) on psychotherapy in adult BPD patients. Retrievals were assessed by two reviewers independently in terms of matching the inclusion criteria and fulfilling a pre-defined study quality standard. Data were analyzed according to standards of the Cochrane Collaboration. Outcome variables were BPD pathology, associated psychopathology, and treatment compliance in terms of attrition. Results: Included RCTs comprised both comparisons of specific treatments (among others, dialectical behavior therapy, mentalization-based therapy, schema-focused therapy, transference-focused therapy, systems training for emotional predictability and problem solving, interpersonal therapy) vs. unspecific control conditions (such as treatment as usual or standard care) and head-to-head comparisons of specific treatments. Conclusions: Most beneficial effects were found for BPD-specific psychotherapies, whereas effects of non-specific treatments were marginal. Short-time interventions yielded some promising findings, but sustainability remains questionable. Findings will be discussed in terms of evidence robustness and data quality as well as applicability to real-world settings.