A Schema Therapy–Based eHealth Program for Patients with Borderline Personality Disorder (priovi): Naturalistic Single-Arm Observational Study

Abstract

BackgroundElectronic health (eHealth) programs have been found to be effective in treating many psychological conditions. However, regarding borderline personality disorder (BPD), only a few eHealth programs have been tested, involving small interventions based on the dialectical behavior therapy treatment approach. We investigated priovi, a program based on the schema therapy (ST) approach. priovi is considerably more comprehensive than prior programs, offering broad psychoeducation content and many therapeutic exercises.ObjectiveWe tested the acceptability and feasibility of priovi in 14 patients with BPD as an add-on to individual face-to-face ST.MethodsPatients received weekly individual ST and used priovi over a period of 12 months. We assessed BPD symptom severity using self-reported and interview-based measures. Qualitative interviews were conducted with both patients and therapists to assess their experiences with priovi.ResultsBPD symptoms improved significantly (Cohen d=1.0). Overall, qualitative data showed that priovi was positively received by both patients and therapists. Some exercises provoked mild anxiety; however, no serious threat to safety was detected.Conclusionspriovi is a potentially helpful and safe tool that could support individual ST. It needs to be further tested in a randomized controlled study.Trial RegistrationGerman Clinical Trials Register DRKS00011538; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00011538 (Archived by WebCite at http://www.webcitation.org/74jb0AgV8)

Therapeutic Relationship in eHealth—A Pilot Study of Similarities and Differences between the Online Program Priovi and Therapists Treating Borderline Personality Disorder

“…This study emerged from a pilot study concerning the feasibility and safety of priovi in conjunction with face-to-face ST at the Department of Psychiatry and Psychotherapy, University of Lübeck, Germany, in cooperation with GAIA AG (Hamburg, Germany), the company that developed priovi [ 15 , 20 ]. Approval was granted by the Ethics Committee of the University of Lübeck (AZ 14-038).…”

“…Priovi also provides some other features like a glossary explaining the most important terms around BPD and ST or a “mode toolbox” where exercises can be stored and revisited. A more detailed description of priovi can be found elsewhere [ 15 , 20 ].…”

“…For BPD, research on internet interventions is also promising, but still in its infancy since most studies are still in early stages. One randomized controlled trial (N = 80) on an internet-based psychoeducation-tool for women with BPD [ 12 ] and several pilot studies on smartphone applications [ 13 , 14 , 15 , 16 ] showed to be efficient in reducing BPD or specifically targeted symptoms. These studies have also shown that patients perceived the apps as user-friendly and helpful [ 13 , 14 , 15 ].…”

“…One randomized controlled trial (N = 80) on an internet-based psychoeducation-tool for women with BPD [ 12 ] and several pilot studies on smartphone applications [ 13 , 14 , 15 , 16 ] showed to be efficient in reducing BPD or specifically targeted symptoms. These studies have also shown that patients perceived the apps as user-friendly and helpful [ 13 , 14 , 15 ]. A recent meta-analysis which included data from twelve studies of ten smartphone applications targeting BPD symptoms found no significant effect on reduction in BPD symptoms of those apps compared to face-to-face therapy or waitlist and concludes that more research is needed to determine if and how such apps could be implemented in providing mental health care for BPD [ 17 ].…”

“…A feasibility study of priovi in conjunction with individual face-to-face ST showed improvement in BPD symptoms in the participating patients. Also, qualitative data revealed that priovi was positively received by both patients and therapists [ 15 ]. A randomized controlled trial comparing priovi plus care as usual to care as usual alone is currently ongoing [ 19 ].…”