BPD compass: A randomized controlled trial of a short-term, personality-based treatment for borderline personality disorder.

Abstract

Borderline personality disorder (BPD) is a heterogeneous condition that is particularly associated with three broad personality dimensions: neuroticism (i.e., high negative affectivity), agreeableness (i.e., low antagonism), and conscientiousness (i.e., low disinhibition). The purpose of the present study was to explore whether treatment with BPD Compass, a novel personality-based intervention for BPD, results in greater reductions in BPD symptoms, neuroticism, agreeableness, and conscientiousness compared to a waitlist control (WLC) condition. We also aimed to characterize within-treatment effects for participants assigned to the BPD Compass condition and evaluate patients' satisfaction with treatment. Participants (N = 51; M age = 28.38; 83.3% female; 93.8% White; 54.2% sexual minority) meeting DSM-5 criteria for BPD were enrolled in a randomized controlled trial to evaluate the efficacy of BPD Compass. Patients were randomly assigned to receive 18 sessions of BPD Compass or complete an 18-week waiting period. BPD Compass led to larger reductions in BPD symptoms (assessor-rated [β = −0.47] and self-reported [β = −0.62]) and neuroticism (β = −0.37), but not agreeableness (β = 0.08) or conscientiousness (β = 0.10), compared to the WLC condition. Within the BPD Compass condition, pre-to posttreatment improvements in BPD symptoms, neuroticism, and conscientiousness were significant and large in magnitude (Hedges' gs: −1.38 to −1.08). Patients were highly satisfied with BPD Compass and generally perceived it to be an appropriate length. Thus, BPD Compass may be an accessible and useful complement to more specialty or intensive treatments for BPD.

Conceptual development and case data for a modular, personality-based treatment for borderline personality disorder.

“…Another important consideration for maximizing widespread dissemination of an intervention is the burden placed on clinicians to deliver it. BPD Compass is a manualized cognitive–behavioral treatment (CBT) with a patient workbook (Sauer-Zavala et al, 2020) and therapist guide (Sauer-Zavala et al, 2021). By providing clear guidance on the application of this treatment for clinicians in a familiar format (i.e., workbook chapters corresponding to session-by-session material), any mental health provider that is inclined to work through BPD Compass with their patients will be able to more quickly learn and apply it.…”

Different Routes to the Same Destination? Comparing Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Section II- and Alternative Model of Personality Disorder-Defined Borderline Personality Disorder

“…All study procedures were approved by the University of Kentucky Institutional Review DSM-5 SECTION II-AND AMPD-DEFINED BPD Board, and the parent study was registered at clinicaltrials.gov (NCT04587518; Sauer-Zavala et al, 2023a). This study's design, analyses, and hypotheses were preregistered; see https://osf.io/gx4yk/?view_only=62a151ac5c0143dc912a4044431b0519 (Hines et al, 2024).…”

“…All sessions were video-recorded, and 20% were also randomly selected for review by treatment developers and rated on a 5-point scale. Average treatment fidelity was high (97.32%, SD = 11.42), and average competence was adequate-to-good (M = 3.61, SD = .99; Sauer-Zavala et al, 2023a).…”

BPD Compass is an accessible alignment of dimensional assessment and treatment.

“…As Crowell and colleagues suggest, BPD is a dimensional construct and, perhaps, a greater proportion of individuals with this condition could respond to short-term treatment. Preliminary data from our efficacy trial suggests that 18 weeks of treatment with BPD Compass is associated with significant reductions in BPD symptoms, with effects of comparable magnitude to more intensive treatments (and with comparable levels of dropout; Sauer-Zavala et al, 2021). All patients in our trial met DSM–5 criteria for BPD, most endorsed substantial comorbidity, and exclusion criteria were minimal (uncontrolled psychotic or manic symptoms).…”