Budge, S.L., Moore, J.T., Del Re, A.C., Wampold, B.E., Baardseth, T.P., & Nienhuis, J.B. (2013). The effectiveness of evidence-based treatments for personality disorders when comparing treatment-as-usual and bona fide treatments. Clinical Psychology Review, 33, 1057-1066.
Personality disorders (PD) are more stable and enduring than other mental disorders and are characterized by pervasive, serious, and rigid self-destructive patterns in affect, cognition, interpersonal relations, and impulse control that reduce psychological well-being. PD are associated with higher rates of self injury, suicide, and health care costs. The prevalence of PD in the population ranges from 6% to 13%. The presence of PD in a patient often reduces the effectiveness of psychological treatments for Axis I disorders (e.g., depression, anxiety) that the patient may have. Psychotherapy may be more effective than other interventions, such as pharmacotherapy, for treating PD. In their meta analysis, Budge and colleagues (2013) addressed two questions. First, are manualized evidence-based treatments (EBT) as provided in clinical trials superior to treatment as usual (TAU), presumably as offered in naturalistic settings, for treating PD? Second, are there differences between bona fide treatments (i.e., psychotherapy administered by trained therapists and based on sound psychological theories) for PD? (A note about meta analyses: meta analyses are a statistical method to combine the findings of a large number of studies while accounting for the sample sizes, quality of the studies, and size of the effects. Meta analyses provide us with much more dependable results than any single study could provide). Regarding the first question, 30 studies were included in the meta analysis. Evidence-based treatments included psychodynamic therapies, cognitive behavioral therapies, and dialectical behavior therapy, among others. Overall, EBTs were more effective than TAUs, and the effect was medium sized. The positive effects in favor of EBT over TAU were larger for patients with borderline personality disorder. For the second study comparing bona fide treatments, only 12 studies were found and included in the meta analysis. Only three of the studies indicated that one bona fide therapy was more effective than another. It is also important to note that the average duration of treatment in the EBT studies was 1 year and peaked at 40 sessions.
As Budge and colleagues (2013) concluded, with sufficient training, supervision, and dose hours, it appears that evidence based treatments (EBT) are more effective than treatments as usual (TAU) for personality disorders (PD). The results of the meta analysis suggested that training in evidence based psychotherapies may be necessary to achieve the best possible outcomes for patients with PD, especially those with borderline personality disorder. Are there differences in between EBTs for PD? The literature on this issue is quite small, so that 12 studies are not enough to make many conclusions. There is previous evidence that psychodynamic therapies and CBT yield very large effects for PD. The pervasiveness and complexity of PD symptoms make it so that effective treatments are necessarily longer term, which is consistent with previous research on this topic.