Short review of borderline personality disorder treatment
March 13, 2017 at 9:33 pm
(This post was last modified: March 13, 2017 at 9:33 pm by brewer.)
Came across the news feed. Just in case your might know someone with BPD (MH definitely has some characteristics).
Is There a Best Psychotherapy for Borderline Personality Disorder?
Steven Dubovsky, MD Reviewing Fonagy P et al., JAMA Psychiatry 2017 Mar 1;
Specifically designed psychotherapies performed only somewhat better than nonspecific ones, perhaps because of improvements in treatment as usual.
To determine the effectiveness of the different psychotherapies developed purposely for borderline personality disorder (BPD), European investigators conducted a meta-analysis of 33 randomized trials (2256 adults) involving dialectical behavioral therapy (DBT), cognitive-behavioral therapy (CBT), psychodynamic psychotherapies (including mindfulness and transference-focused psychotherapy), or other specific therapies.
Psychotherapy in general, and psychodynamic therapy and DBT in particular, were significantly more effective than treatment as usual (TAU) for BPD-specific features (BPD symptoms, self-harm, suicide) and for general features (e.g., psychopathology and health service use). However, effect sizes were small to moderate, and heterogeneity in outcome variables was high to moderate. CBT was not superior to TAU, but very few studies examined CBT. There was publication bias against negative trials. Twenty-two studies involved stand-alone comparisons (comparing a specific therapy to TAU or to a nonspecific therapy), and 11 studies were add-on (comparing a specific therapy plus TAU to TAU alone); treatment effects were somewhat stronger in studies with stand-alone designs.
Comment
Editorialists astutely point out that the lack of a dramatic difference between specific, manual-based therapies and less structured treatments may indicate that TAU has evolved. Where unstructured approaches once involved reliving and abreaction without resolution, TAU now emphasizes the same coherence, consistency, continuity, and reorganization of thinking that characterizes BPD-specific therapies. Mindfulness-based therapies are usually more focused and emphasize boundaries more than transference-focused psychotherapy; therefore, combining these two psychotherapies for analysis may have obscured the discrete benefits of mindfulness. Clinicians may wish to adopt the specific factors of mindfulness and DBT and to limit methods that promote regression or escalate affective arousal.
Is There a Best Psychotherapy for Borderline Personality Disorder?
Steven Dubovsky, MD Reviewing Fonagy P et al., JAMA Psychiatry 2017 Mar 1;
Specifically designed psychotherapies performed only somewhat better than nonspecific ones, perhaps because of improvements in treatment as usual.
To determine the effectiveness of the different psychotherapies developed purposely for borderline personality disorder (BPD), European investigators conducted a meta-analysis of 33 randomized trials (2256 adults) involving dialectical behavioral therapy (DBT), cognitive-behavioral therapy (CBT), psychodynamic psychotherapies (including mindfulness and transference-focused psychotherapy), or other specific therapies.
Psychotherapy in general, and psychodynamic therapy and DBT in particular, were significantly more effective than treatment as usual (TAU) for BPD-specific features (BPD symptoms, self-harm, suicide) and for general features (e.g., psychopathology and health service use). However, effect sizes were small to moderate, and heterogeneity in outcome variables was high to moderate. CBT was not superior to TAU, but very few studies examined CBT. There was publication bias against negative trials. Twenty-two studies involved stand-alone comparisons (comparing a specific therapy to TAU or to a nonspecific therapy), and 11 studies were add-on (comparing a specific therapy plus TAU to TAU alone); treatment effects were somewhat stronger in studies with stand-alone designs.
Comment
Editorialists astutely point out that the lack of a dramatic difference between specific, manual-based therapies and less structured treatments may indicate that TAU has evolved. Where unstructured approaches once involved reliving and abreaction without resolution, TAU now emphasizes the same coherence, consistency, continuity, and reorganization of thinking that characterizes BPD-specific therapies. Mindfulness-based therapies are usually more focused and emphasize boundaries more than transference-focused psychotherapy; therefore, combining these two psychotherapies for analysis may have obscured the discrete benefits of mindfulness. Clinicians may wish to adopt the specific factors of mindfulness and DBT and to limit methods that promote regression or escalate affective arousal.
I don't have an anger problem, I have an idiot problem.
