TY - JOUR
T1 - Which psychotherapy is most effective and acceptable in the treatment of adults with a (sub)clinical borderline personality disorder?
T2 - A systematic review and network meta-analysis
AU - Setkowski, Kim
AU - Palantza, Christina
AU - van Ballegooijen, Wouter
AU - Gilissen, Renske
AU - Oud, Matthijs
AU - Cristea, Ioana A.
AU - Noma, Hisashi
AU - Furukawa, Toshi A.
AU - Arntz, Arnoud
AU - van Balkom, Anton J. L. M.
AU - Cuijpers, Pim
PY - 2023/6
Y1 - 2023/6
N2 - 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.
AB - 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.
KW - Borderline personality disorder
KW - mental healthcare
KW - network meta-analysis
KW - psychotherapy
KW - suicidal behaviour
KW - DIALECTICAL BEHAVIOR-THERAPY
KW - RANDOMIZED-CONTROLLED-TRIAL
KW - DELIBERATE SELF-HARM
KW - FOLLOW-UP
KW - COGNITIVE THERAPY
KW - CLINICAL-TRIAL
KW - WOMEN
KW - MANAGEMENT
KW - SUICIDE
KW - SKILLS
U2 - 10.1017/S0033291723000685
DO - 10.1017/S0033291723000685
M3 - (Systematic) Review article
C2 - 37203447
SN - 0033-2917
VL - 53
SP - 3261
EP - 3280
JO - Psychological Medicine
JF - Psychological Medicine
IS - 8
ER -