McLaughlin, S.P.B., Barkowski, S., Burlingame, G.M., Strauss, B., & Rosendahl, J. (2019). Group psychotherapy for borderline personality disorder: A meta-Analysis of randomized-controlled trials. Psychotherapy. Advance online publication. http://dx.doi.org/10.1037/pst0000211
Borderline personality disorder (BPD) is characterized by fear of abandonment, unstable intense relationships, rapid changes in identity and self-image, impulsivity, wide mood swings, periods of intense anger, and ongoing feelings of emptiness. These symptoms sometimes lead to suicidal behavior or non-suicidal self-injury. Often, those with BPD report a very stressful childhood that included sexual and/or physical abuse, and neglect. Borderline personality disorder is the most common of the personality disorders and is associated with severe social psychological impairment such that those with BPD often have unstable employment, are involved in abusive relationships, and engage in risky behaviors. A diagnosis of BPD is also associated with a high rate of mortality due to suicide. Practice guidelines indicate that psychotherapy is a key component to the treatment of BPD. Two psychological treatment approaches that incorporate group interventions are dialectical behavior therapy (DBT) and mentalization-based treatment (MBT). In DBT patients learn specific skills to alter maladaptive ways of regulating emotions in a group context. In MBT, an attachment-based treatment, the focus is on building trust in others through group interactions that generalize to other social relationships. In this meta-analysis, McLaughlin and colleagues reviewed 24 studies that compared group treatment for BPD to treatment as usual, which included a variety of interventions like supportive groups, pharmacotherapy, individual therapy, and others. Some of the treatments for BPD were stand-alone groups and some groups were part of a larger comprehensive program. Participants attended between 12 and 130 sessions, and group size ranged from 4 to 12 members. The meta-analysis revealed that group treatment for BPD versus treatment as usual resulted in moderate to large effect on BPD symptoms: g = .72, CI: [.41, 1.04], p < .001. The effects of group treatment versus treatment as usual on suicidality produced a moderate effect, g = .46, CI: [.22, .71], p < .001. The authors reported similar results for secondary outcomes like depression, anxiety, and general mental health. Drop-out rates were similar between group treatments (26.26%) and treatment as usual (28.26%). There were no differences in the effects of group therapy orientations on any of the outcomes or on drop-out rates.
The results of this meta-analysis indicated the value of group treatment for BPD not only for core symptoms and suicidality, but also for symptoms related to quality of life (depression, anxiety). Theoretical orientation did not explain any of the findings, suggesting that treatments like DBT and MBT in a group format are equally effective. Therapists and patients can feel confident that group treatment for BPD are among the most effective treatments available.
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