EVALUATION OF THREE TREATMENTS FOR BORDERLINE PERSONALITY DISORDER: A MULTIWAVE STUDY

Authors:

John F. Kennedy Clarkin, Ph.D., Kenneth N. Levy, Ph.D. Mark F. Kennedy Lenzenweger, Ph.D., Otto F. Kernberg, M. D.

First publication: The American Journal of Psychiatry 2007; 164:922 —928

Original article in English: https://www.researchgate.net/publication/6295389_Evaluating_Three_Treatments_for_Borderline_Personality_Disorder_A_Multiwave_Study

The authors examined three methods of outpatient treatment of borderline personality disorder over the course of a year, namely: dialectical behavioral therapy, transfer-focused psychotherapy, and psychodynamic supportive treatment.

Ninety patients diagnosed with borderline personality disorder were randomly divided into three groups. Each of the groups underwent one of three types of therapy, receiving, if necessary, drug treatment according to indications. Before the start of treatment and at 4-month intervals for 1 year, independent experts evaluated suicidal behavior, aggression, impulsivity, anxiety, depression, social adaptation of patients, etc.

The analysis showed that in all three groups, patients showed significant positive changes in the above indicators. Both transference-focused psychotherapy and dialectical behavioral therapy have contributed to the reduction of patients' suicidal intentions. Only transfer-focused psychotherapy (TFP), and supportive treatment were associated with a reduction in anger status. TFP and supportive treatment showed improvement in aspects of impulsivity. Only the TFP treatment group showed significant changes regarding the aspect of irritability and verbal and direct attacks.

The main finding of this study was that transfer-focused psychotherapy, dialectical behavior therapy, and supportive treatment showed a significant association with positive changes in many areas during 1 year of outpatient treatment. This pattern suggests that these structured treatments are broadly equivalent with respect to broad positive changes in borderline personality disorder. However, some differences between the three treatments were still found.

For primary outcome variables, both transfer-focused psychotherapy and dialectical behavior therapy were reliably associated with improvement in suicidal behavior status. Transference-focused psychotherapy and supportive treatment have shown good performance in anger suppression. It should be noted that only transfer-focused psychotherapy reliably predicted symptom improvement on Barratt, Barratt Impulsiveness Scale (impulsivity, irritability, verbal aggression, and direct attack), and supportive treatment showed improvement in impulsivity symptoms on the factor of verbal aggression.

Each of the three treatments reliably predicted the rate of change in the positive direction with respect to depression, anxiety, global functioning, and social adaptation. Overall, transfer-focused psychotherapy showed significant improvement in 10 out of 12 variables in six areas, dialectical behavior therapy in 5 out of 12, and supportive treatment in 6 out of 12.

Comparative analysis suggests that transfer-focused psychotherapy and dialectical behavioral therapy are two treatments that have been more effective than psychodynamic supportive psychotherapy in reducing suicidal behavior in patients with borderline personality disorder.

The overall characterization of the results of the three treatments studied suggests that there may be different pathways to change symptoms in patients with borderline personality disorder. Unlike dialectical behavioral therapy (which focuses directly on skills that help the patient regulate emotions and reduce symptoms), transfer-focused psychotherapy focuses on developing greater self-control through the integration of self-image and others'.

Also, it should be added that this study combines both a complete theoretical analysis and a treatment analysis, and thus proves both the internal and external validity of the study. Patients from three states were participants in this study and their inclusions/exclusions were based on criteria used in clinical practice.

The full text of the article is available to participants of the Transference-Focused Psychotherapy training course.

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(c) Natalia Esmurzaeva,

Ukrainian Association of Transfer-Focused Psychotherapy

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