Cognitive Therapy versus Rogerian Supportive Therapy in Borderline Personality Disorder

Abstract

Background: To date, there have been no studies comparing cognitive therapy (CT) with Rogerian supportive therapy (RST) in borderline personality disorder. Method: Sixty-five DSM-IV borderline personality disorder outpatients were recruited at 2 centres: Lyon and Marseille. Thirty-three patients were randomly allocated to CT and 32 to RST. The therapists were the same in both groups. Both treatments shared the same duration (1 year) and amount of therapy. Assessment by independent evaluators utilised the Clinical Global Impression (CGI) Scale, the Hamilton Depression Scale, Beck Depression Inventory, Beck Anxiety Inventory, Hopelessness Scale, Young Schema Questionnaire II, Eysenck Impulsivity Venturesomeness Empathy (IVE) Inventory, a self-harming behaviours checklist and scales measuring quality of life and the therapeutic relationship. The response criterion was a score of 3 or less on the CGI, associated with a Hopelessness Scale score of <8. Results: No patient committed suicide during the trial. Fifty-one patients were evaluated at week 24, 38 at week 52 and 21 at week 104. Cognitive therapy retained the patients in therapy for a longer time. The response criterion found no significant between-group differences at any measurement point in the completers. However, at week 24, CT was better than RST on the Hopelessness Scale, IVE scale and regarding the therapeutic relationship. At week 104, the CGI improvement (patient and evaluator) was significantly better in CT than in RST. High baseline depression and impulsivity predicted dropouts. Conclusions: CT retained the patients in therapy longer, showed earlier positive effects on hopelessness and impulsivity, and demonstrated better long-term outcomes on global measures of improvement.

Does the Therapeutic Relationship Predict Outcomes of Psychiatric Treatment in Patients with Psychosis? A Systematic Review

“…One may also develop and test interventions compared to an appropriate control [25], influencing patient-clinician communication directly to improve both the TR and outcomes. An example of the latter is the DIALOG intervention [26], which is a computer-mediated method of structuring the communication in a patient-centred and forward-looking manner and has been found to be associated with better treatment outcomes in community mental health care [27,28]. Many clinicians may intuitively agree with the assumption that the quality of the TR is relevant for outcomes of complex psychiatric treatments in patients with psychosis, and that the overall effect of the TR on outcomes is limited within the complex interplay of all specific pharmacological, psychological and social interventions.…”

Effectiveness of Outpatient, Day Hospital, and Inpatient Psychotherapeutic Treatment for Patients with Cluster B Personality Disorders

“…However, no study has directly compared outpatient, day hospital, and inpatient treatment within one patient sample. The available published studies have focused either on the development of specific treatment manuals and their evaluation [20,21,22,23,24,25,26,27,28,29] or on the comparison of different theoretical schools within outpatient settings [30,31,32]. Another focus of psychotherapy outcome research was the effectiveness of specific treatment ingredients, such as transference interpretations [33,34] or crisis support outside office hours [35].…”

Intervenções Psicológicas na Perturbação Borderline da Personalidade: Uma Revisão das Terapias de Base Cognitivo-Comportamental

“…Os vários formatos de terapia cognitivo-comportamental apresentaram benefícios clínicos, quer ao nível da redução da psicopatologia geral e específica da PBP, 35,37 quer ao nível comportamental, com redução da frequência e gravidade dos comportamentos autolesivos, [11][12][13][14][15][16][17][18][19]31,33,40 quer ainda a nível funcional, com melhoria do funcionamento interpessoal, 19,26 social e global. 8,[11][12][13][14][15]26,31,36 Apesar de existirem diferenças entre as intervenções psicoterapêuticas analisadas nesta revisão, quer ao nível do formato (individual versus grupo), quer na duração (breve versus prolongada), estrutura da terapia, estratégias e técnicas aplicadas, todas demonstraram serem capazes de produzir benefícios clínicos.…”

“…Por outro lado, a TCC tradicional apresenta um reduzido número de estudos testando o seu impacto no tratamento da PBP, o que não permite retirar conclusões definitivas sobre a sua eficácia no tratamento desta perturbação. De qualquer modo, os estudos realizados 31,33 constataram haver benefícios clínicos com esta modalidade de intervenção, tendo sido observada uma redução da ansiedade, da angústia associada aos sintomas, dos esquemas mal--adaptativos e do número de tentativas de suicídio nos indivíduos com PBP.…”