Evaluating Three Treatments for Borderline Personality Disorder: A Multiwave Study

Cornell University, Итак, New York, United States
American Journal of Psychiatry (Impact Factor: 13.56). 07/2007; 164(6):922-8. DOI: 10.1176/appi.ajp.164.6.922
Source: PubMed

ABSTRACT The authors examined three yearlong outpatient treatments for borderline personality disorder: dialectical behavior therapy, transference-focused psychotherapy, and a dynamic supportive treatment.
Ninety patients who were diagnosed with borderline personality disorder were randomly assigned to transference-focused psychotherapy, dialectical behavior therapy, or supportive treatment and received medication when indicated. Prior to treatment and at 4-month intervals during a 1-year period, blind raters assessed the domains of suicidal behavior, aggression, impulsivity, anxiety, depression, and social adjustment in a multiwave study design.
Individual growth curve analysis revealed that patients in all three treatment groups showed significant positive change in depression, anxiety, global functioning, and social adjustment across 1 year of treatment. Both transference-focused psychotherapy and dialectical behavior therapy were significantly associated with improvement in suicidality. Only transference-focused psychotherapy and supportive treatment were associated with improvement in anger. Transference-focused psychotherapy and supportive treatment were each associated with improvement in facets of impulsivity. Only transference-focused psychotherapy was significantly predictive of change in irritability and verbal and direct assault.
Patients with borderline personality disorder respond to structured treatments in an outpatient setting with change in multiple domains of outcome. A structured dynamic treatment, transference-focused psychotherapy was associated with change in multiple constructs across six domains; dialectical behavior therapy and supportive treatment were associated with fewer changes. Future research is needed to examine the specific mechanisms of change in these treatments beyond common structures.

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Article: Evaluating Three Treatments for Borderline Personality Disorder: A Multiwave Study

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    • "One of the key contributions of this author is the theoretical development and the clinical proposals related to the so-called " borderline personality organizations " (Kernberg et al., 2008). As a therapeutic approach to this complex clinical problem, Kernberg proposes his so-called transference-focused psychotherapy (TFP), a psychoanalytic psychotherapy, empirically validated by Doering et al. (2010) and Clarkin, Levy, Lenzenweger, and Kernberg (2007). "
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    • "In an RCT (Clarkin et al., 2007; Levy et al., 2006), 90 clinically referred patients were randomized to one of the three treatments: TFP, DBT, and a psychodynamic supportive psychotherapy (SPT; Appelbaum, 2005). "
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    • "In agreement with Bateman and Fonagy (1999), who reported significant group differences in the improvements in depression in BPD outpatients in mentalizationbased therapy, we found a significant decrease in depressive symptoms in the DST group. This contrasts with the majority of RCTs of specific BPD outpatient treatments , where no group differences in depression were reported (Clarkin et al., 2007; Doering et al., 2010; Linehan, Armstrong, Suarez, Allmon, & Heard, 1991; Linehan et al., 2006; Verheul et al., 2003). Our findings cannot be attributed to a high severity of depressive illness as Doering et al. (2010) do for the Bateman and Fonagy study, in which patients started with a BDI score of 36.0. "
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