Question: In adults with borderline personality disorder, which is the most effective psychological intervention (excluding CBT and DBT), in improving patient outcomes?

Answer:

Data from RCTs suggest that psychotherapies are effective in treatment patients with BPD, but there is insufficient evidence to determine which psychological intervention (excluding CBT and DBT) is the most effective in improving patient outcomes. Most treatments were only evaluated in single studies, and there are some concerns regarding the risk of bias in these studies. There are very few direct comparisons of different treatments. Data from single studies support the effectiveness of mentalisation-based treatment in a partial hospitalisation setting (MBT-PH), outpatient MBT (MBT-out), transference-focused therapy (TFP), interpersonal therapy for BPD (IPT-BPD), psychic representation focused psychotherapy (PRFP), emotion regulation group therapy (ERG), schema-focused group therapy (SFT-G), systems training for emotional predictability and problem solving for borderline personality disorder (STEPPS), STEPPS plus individual therapy (STEPPS+IT), manual-assisted cognitive treatment (MACT) and psychoeducation (PE). There was no RCT evidence on cognitive analytical therapy (CAT). Interpersonal psychotherapy was only effective in the treatment of associated depression. No statistically significant effects were found for DDP interventions. Direct comparisons suggest that DBT may be more effective than CCT and SFT more effective than TFP. There is a need for further high quality studies providing direct comparisons of the different available psychological treatments for patients with BPD.