Step-down versus outpatient psychotherapeutic treatment for personality disorders: 6-year follow-up of the Ullevål personality project

Abstract

BackgroundAlthough psychotherapy is considered the treatment of choice for patients with personality disorders (PDs), there is no consensus about the optimal level of care for this group of patients. This study reports the results from the 6-year follow-up of the Ullevål Personality Project (UPP), a randomized clinical trial comparing outpatient individual psychotherapy with a long-term step-down treatment program that included a short-term day hospital treatment followed by combined group and individual psychotherapy.MethodsThe UPP included 113 patients with PDs. Outcome was evaluated after 8 months, 18 months, 3 years and 6 years and was based on a wide range of clinical measures, such as psychosocial functioning, interpersonal problems, symptom severity, and axis I and II diagnoses.ResultsAt the 6-year follow-up, there were no statistically significant differences in outcome between the treatment groups. Effect sizes ranged from medium to large for all outcome variables in both treatment arms. However, patients in the outpatient group had a marked decline in psychosocial functioning during the period between the 3- and 6-year follow-ups; while psychosocial functioning continued to improve in the step-down group during the same period. This difference between groups was statistically significant.ConclusionsThe findings suggest that both hospital-based long-term step-down treatment and long-term outpatient individual psychotherapy may improve symptoms and psychosocial functioning in poorly functioning PD patients. Social and interpersonal functioning continued to improve in the step-down group during the post-treatment phase, indicating that longer-term changes were stimulated during treatment.Trial registrationNCT00378248.

Favourable outcome of long-term combined psychotherapy for patients with borderline personality disorder: Six-year follow-up of a randomized study

“…The present study focused solely on BPD. In contrast to previously published results from the total mixed PD sample showing no overall difference in outcome after six years (Antonsen et al, 2014), the BPD patients in the CP achieved significantly lower symptomatic distress after six years compared to patients allocated to the less intensive OIP. Thus, the study suggests that the use of intensive combination treatment may be especially beneficial for patients with BPD.…”

“…At six-year follow-up, differences between the two treatment conditions were below levels of significance, although different trends were observable (Antonsen et al, 2014). These results were contrary to our original hypothesis that patients would benefit more from the CP.…”

“…The parameters of main interest were the fixed effect interaction terms between group and time, prior to and following the knot, describing whether the patients in the two treatment conditions changed differently across the observation period. Assumptions about drop-out (missing at random (MAR)) and selection bias were as described previously (Antonsen et al, 2014). Although it is impossible to test the MAR assumption, a comparison with a complete case analysis (participants without dropout) is informative and was conducted in this study.…”

“…Originally, UPP was a study including a mixed PD sample, and we have previously reported results for the total sample from the follow-up investigations at 8 months, 18 months, 3 years, and 6 years after the initial random assignment (Antonsen et al, 2014;Arnevik et al, 2009Arnevik et al, , 2010Gullestad et al, 2012). At six-year follow-up, differences between the two treatment conditions were below levels of significance, although different trends were observable (Antonsen et al, 2014).…”

Is reflective functioning associated with clinical symptoms and long-term course in patients with personality disorders?

“…The patients were evaluated on a wide range of outcome variables at baseline and later follow up investigations at 8 months, 18 months, and 3 and 6 years after the initial random assignment. The analyses at the 6-year follow-up showed no difference in outcome between treatment conditions in the total mixed PD sample, although the clinical course did differ between treatments [45]. In the previous 3-year follow-up investigation, differentiating between patients with low and medium pretreatment RF levels yielded significant results [46].…”