Evaluating Three Treatments for Borderline Personality Disorder: A Multiwave Study
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
- "The focus of this treatment is on systematic interpretations of object relations as they manifest through transference reactions in the here-and-now therapeutic encounter . RCTs have demonstrated that transferencefocused therapy is superior to control conditions (Doering et al., 2010) and is as effective as alternative treatments (dialectical–behavioral therapy and supportive treatment; Clarkin et al., 2007) for BPD. "
Chapter: Psychodynamic TheoriesAPA handbook of clinical psychology: Vol. 2. Theory and research, Edited by J. C. Norcross, G. R. VandenBos, D. K. Freedheim, 01/2016: pages ???-????; American Psychological Association.
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- "Zanarini et al. (2010) found at a twoyear follow-up 34.9% of patients had achieved remission (defined as not meeting criteria for a two-year period), and at a ten year followup 93% no longer met criteria for the disorder. The most prominent evidence-based treatments for BPD are Dialectical Behavioral Therapy (DBT) (see Linehan, 2001, 1987, 1993), Mentalization Based Therapy (see Choi-Kain and Gunderson, 2008; Bateman and Fonagy, 2009) and Transference-Focused Psychotherapy (see Clarkin et al., 2007). Nonetheless, 3e10% of patients with a BPD diagnosis die from suicide (Soloff and Chiappetta, 2012) and one study found more than 70% attempted suicide (Soloff et al., 2000). "
ABSTRACT: A diagnosis of Borderline Personality Disorder (BPD) often signals the quintessential "difficult patient" status to clinicians, with at least one scholar arguing the condition itself was created to name and group difficult patients. While patients who are deemed difficult are often dispreferred for care, does this have an impact on their overall status as medicalized patients who have successfully achieved a sick role? This study relies on (n = 22) in-depth interviews with mental health clinicians in the United States from 2012 to evaluate how they describe patients with BPD, how the diagnosis of BPD affects the treatment clinicians are willing to provide, and the implications for patients. My findings suggest patients with BPD are routinely labeled "difficult," and subsequently routed out of care through a variety of direct and indirect means. This process creates a functional form of demedicalization where the actual diagnosis of BPD remains de jure medicalized, but the de facto or treatment component of medicalization is harder to secure for patients. Copyright © 2015 Elsevier Ltd. All rights reserved.Social Science [?] Medicine 08/2015; 142:82-89. DOI:10.1016/j.socscimed.2015.08.008 · 2.89 Impact Factor
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- "Clearly, psychoanalytic ideas and research have contributed to this shift and have also paved the way for new treatment approaches. Today, psychotherapy represents the recommended primary intervention for patients with a PD (e.g., Clarkin, Levy, Lenzenweger, & Kernberg, 2007) as expressed in a growing evidence for the efficacy and effectiveness of psychotherapy in the treatment of these patients (e.g., Bartak et al., 2011; Bateman & Fonagy, 1999, 2001, 2008; Binks et al., 2006; Chiesa, Fonagy, & Gordon, 2009; Clarkin, Levy, Lenzenweger, & Kernberg, 2007; Levy & Scott, 2006; Linehan et al., 2006; Vermote et al., 2009, 2010; Zanarini, Frankenburg, Reich, & Fitzmaurice, 2010). These findings have led to increased optimism about the treatability of PDs, and borderline personality disorder (BPD), in particular (Fonagy & Bateman, 2006; Levy & Scott, 2006; Linehan et al., 2006). "
ABSTRACT: This study presents a model of psychic change in personality disorders focusing on three dimensions: felt safety, mentalization and self-object relations. Based upon this model a hospitalization-based therapy program was created. Four scales to measure these three dimensions on the Object Relation Interview are discussed: the Felt Safety Scale, the Reflective Functioning Scale and the Bion Grid Scale and the Differentiation-Relatedness Scale. A naturalistic symptom outcome study of the program showed a large effect on both symptoms and personality functioning. Furthermore, trajectory based on pre-treatment patient characteristics (i.e., anaclitic versus introjective personality styles). Importantly, we also found a relation between symptomatic and personality change and change in felt safety and object relations. At 5-year follow-up, patients showed sustained improvement in symptomatic distress and further improvement in terms of personality and interpersonal functioning. Copyright © 2015 Institute of Psychoanalysis.The International Journal of Psychoanalysis 06/2015; 96(3):817-43. DOI:10.1111/1745-8315.12394 · 0.86 Impact Factor