A Randomized Trial of Dynamic Deconstructive Psychotherapy in Iran for Borderline Personality Disorder

Majdara, Elahe; Rahimmian, Issac; Talepassand, Siavash; Gregory, Robert J.

doi:10.1177/0003065119891390

Cited by 5 publications

(5 citation statements)

References 9 publications

(11 reference statements)

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“…Most interventions were delivered face-to-face ( n = 34), but nine studies added phone coaching to their face-to-face treatments. The study of Majdara et al ( 2019 ) used different formats for each study arm: intervention was delivered in individual format, and the control condition was executed in group format. The number of sessions ranged widely from 3 sessions to a maximum of 312 sessions (median = 52.0).…”

Section: Resultsmentioning

confidence: 99%

Which psychotherapy is most effective and acceptable in the treatment of adults with a (sub)clinical borderline personality disorder? A systematic review and network meta-analysis

et al. 2023

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A broad range of psychotherapies have been proposed and evaluated in the treatment of borderline personality disorder (BPD), but the question which specific type of psychotherapy is most effective remains unanswered. In this study, two network meta-analyses (NMAs) were conducted investigating the comparative effectiveness of psychotherapies on (1) BPD severity and (2) suicidal behaviour (combined rate). Study drop-out was included as a secondary outcome. Six databases were searched until 21 January 2022, including RCTs on the efficacy of any psychotherapy in adults (⩾18 years) with a diagnosis of (sub)clinical BPD. Data were extracted using a predefined table format. PROSPERO ID:CRD42020175411. In our study, a total of 43 studies (N = 3273) were included. We found significant differences between several active comparisons in the treatment of (sub)clinical BPD, however, these findings were based on very few trials and should therefore be interpreted with caution. Some therapies were more efficacious compared to GT or TAU. Furthermore, some treatments more than halved the risk of attempted suicide and committed suicide (combined rate), reporting RRs around 0.5 or lower, however, these RRs were not statistically significantly better compared to other therapies or to TAU. Study drop-out significantly differed between some treatments. In conclusion, no single treatment seems to be the best choice to treat people with BPD compared to other treatments. Nevertheless, psychotherapies for BPD are perceived as first-line treatments, and should therefore be investigated further on their long-term effectiveness, preferably in head-to-head trials. DBT was the best connected treatment, providing solid evidence of its effectiveness.

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Section: Resultsmentioning

confidence: 99%

Which psychotherapy is most effective and acceptable in the treatment of adults with a (sub)clinical borderline personality disorder? A systematic review and network meta-analysis

et al. 2023

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“…However, sensitivity analyses of the 2020 Cochrane review revealed no substantial difference in effect estimates observed by comparisons with TAU or waiting list/no treatment, 8 supporting the joint analysis of corresponding effect estimates in the same analysis. It seems that comparisons with TAU in older studies 25–27 (where typical care for individuals with BPD was certainly poorer than today) or in countries where TAU is of lower quality 62 might be associated with larger effect estimates, whereas more recent comparisons of the same treatments and outcomes 28,41,56,60,65 or studies in higher-income countries 40 result in smaller effects. However, a recent meta-analysis found evidence that participants allocated to TAU in general tend to improve to a limited extent, with possible reasons being the disclosure of the diagnosis, involvement of a concerned healthcare professional and time effects.…”

Section: Discussionmentioning

confidence: 99%

“…The highest number of individual RCTs was available for standard DBT (n = 10 studies 25,26,[28][29][30]32,38,53,56,67 ), followed by MBT (n = 4 studies 27,41,60,65 ). For each of the remaining standalone treatments under test, two RCTs were identified (CBT, 39,54 DDP, 40,62 IPT-BPD 63,64 ). All effect estimates are displayed in Table 2, along with the number of comparisons, participants, the 95% confidence intervals, P-values and I 2 scores that indicate the percentage of the variability in effect estimates resulting from heterogeneity rather than sampling error (or chance) alone.…”

Section: Effects Of Interventions: Standalone Psychotherapiesmentioning

confidence: 99%

“…To rule out the effects of the specific experimental interventions, most trials provided TAU (n = 20) [25][26][27][28][29][32][33][34][35][38][39][40][53][54][55][56][57][58][59] or expert TAU, meaning that control participants were referred to usual treatment for BPD in that specific area or health system (n = 2) 30,41 . In other trials, supportive treatment (n = 4) 39,[60][61][62] or clinical management (n = 3) [63][64][65] was provided. Others put the participants who had been assigned to the control group on a waiting list where they were free to use any treatment besides the treatment under test or no treatment at all (n = 2), 36,66 or provided no treatment (n = 2).…”

Section: Description Of Studies and Risk Of Biasmentioning

confidence: 99%

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Psychotherapies for borderline personality disorder: a focused systematic review and meta-analysis

et al. 2022

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Background A recently updated Cochrane review supports the efficacy of psychotherapy for borderline personality disorder (BPD). Aims To evaluate the effects of standalone and add-on psychotherapeutic treatments more concisely. Method We applied the same methods as the 2020 Cochrane review, but focused on adult samples and comparisons of active treatments and unspecific control conditions. Standalone treatments (i.e. necessarily including individual psychotherapy as either the sole or one of several treatment components) and add-on interventions (i.e. complementing any ongoing individual BPD treatment) were analysed separately. Primary outcomes were BPD severity, self-harm, suicide-related outcomes and psychosocial functioning. Secondary outcomes were remaining BPD diagnostic criteria, depression and attrition. Results Thirty-one randomised controlled trials totalling 1870 participants were identified. Among standalone treatments, statistically significant effects of low overall certainty were observed for dialectical behaviour therapy (self-harm: standardised mean difference (SMD) −0.54, P = 0.006; psychosocial functioning: SMD −0.51, P = 0.01) and mentalisation-based treatment (self-harm: risk ratio 0.51, P < 0.0007; suicide-related outcomes: risk ratio 0.10, P < 0.0001). For adjunctive interventions, moderate-quality evidence of beneficial effects was observed for DBT skills training (BPD severity: SMD −0.66, P = 0.002; psychosocial functioning: SMD −0.45, P = 0.002), and statistically significant low-certainty evidence was observed for the emotion regulation group (BPD severity: mean difference −8.49, P < 0.00001), manual-assisted cognitive therapy (self-harm: mean difference −3.03, P = 0.03; suicide-related outcomes: SMD −0.96, P = 0.005) and the systems training for emotional predictability and problem-solving (BPD severity: SMD −0.48, P = 0.002). Conclusions There is reasonable evidence to conclude that psychotherapeutic interventions are helpful for individuals with BPD. Replication studies are needed to enhance the certainty of findings.

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“…For limitations, many identified small samples sizes [19,20,23,[26][27][28] and durations of follow-up [22,23,26,29], lack of randomization, lack of a control group, or study methodology was identified as a limitation in three of the studies [20,22,30]. Three studies mentioned their lack of long-term follow up as a limitation [31][32][33] The treatment group had lower scores on the BPDSI and 3 subscales of the GHQ-28, and higher scores on 5 subscales of the PRQC one month after the end of treatment.…”

Section: Adverse Effects Acceptability Suicidal Ideationmentioning

confidence: 99%

Psychosocial and pharmacological interventions for personality disorders in low- and middle-income countries: A systematic review

Hedemann,

de Pencier,

Rodak

et al. 2023

PLOS Glob Public Health

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Personality disorders (PDs) have a global prevalence of 7.8% and are associated with increased rates of morbidity and mortality. Most research on PDs has been conducted in High Income Countries (HICs). We conducted a systematic review to investigate the effectiveness of psychosocial and pharmacological interventions for personality disorders (PDs) in individuals from Low- and Middle-Income Countries (LMICs.) We systematically searched MEDLINE, Embase, APA PsycInfo, Web of Science, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and The Cochrane Library from inception to January 5, 2023. Inclusion criteria were quantitative studies and grey literature where participants received a psychosocial or pharmacological intervention for PD. Exclusion criteria were qualitative studies, review articles, studies in which PD was not the primary condition, and articles not available in English. The Cochrane Risk of Bias tool version 2.0 and Joanna Briggs Institute instruments were used to measure risk of bias. Studies were pooled by type of study, PD investigated, type of intervention, assessment methods, and outcomes. Sixteen studies met inclusion criteria and were included. Fifteen were intervention studies related to borderline PD. Only one studied mixed PDs. Twelve studies were of psychotherapy, one pharmacotherapy, one combination of both, and two neurostimulation. Most of the studies showed improvement in symptoms though data was largely collected using self-report measures. There were only six RCTs. There is a dearth of literature on interventions for PDs in LMICs and funding bodies should prioritize research in LMICs. Systematic Review Registration Number: PROSPERO CRD42021233415.

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A Randomized Trial of Dynamic Deconstructive Psychotherapy in Iran for Borderline Personality Disorder

Cited by 5 publications

References 9 publications

Which psychotherapy is most effective and acceptable in the treatment of adults with a (sub)clinical borderline personality disorder? A systematic review and network meta-analysis

Which psychotherapy is most effective and acceptable in the treatment of adults with a (sub)clinical borderline personality disorder? A systematic review and network meta-analysis

Psychotherapies for borderline personality disorder: a focused systematic review and meta-analysis

Psychosocial and pharmacological interventions for personality disorders in low- and middle-income countries: A systematic review

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