Assessing the efficacy of a stepped-care group treatment programme for borderline personality disorder: study protocol for a pragmatic trial

Abstract

Background Borderline personality disorder (BPD) is a high prevalence and serious mental health disorder that has historically challenged the finite resources of health services. Despite empirical evidence supporting structured psychological therapy as the first line of treatment, there remains significant barriers in providing timely access to evidence-based treatment for this population. The primary aim of this study is to evaluate the effectiveness of providing a stepped-care structured psychological group treatment to individuals with BPD within local mental health services. The secondary aims of the study are to identify the variables that predict the need to step up or down in care and the effectiveness of treatment on psychosocial functioning. Methods Participants seeking treatment at two community mental health services will be invited to participate. Randomised controlled trial assignment will be to either (i) group skills treatment or (ii) treatment as usual. Group treatment will be offered via a stepped-care pathway with participants initially attending a 12-week group with the option of a subsequent 16-week group. The criteria for inclusion in continuing treatment includes meeting > 4 BPD diagnostic criteria or severity on GAF (< 65) at the completion of the 12-week group. Data will be collected at baseline and at five follow-up time points over a 12-month period. Discussion This pragmatic trial will provide valuable information regarding the effectiveness of a progressive stepped-care group treatment for individuals with BPD in the real-world setting of a community mental health service. It will further the current understanding of variables that predict treatment dose and duration. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12618000477224. Registered on 3 April 2018

Salivary testosterone and cortisol levels in borderline personality disorder before and after a 12-week group dialectical behavior therapy intervention

“…Due to missing data the final sample comprised of 33 participants in the BPD group ( n = 28, 84.8% female) between the ages of 18 and 59. The BPD group were participating in a longitudinal study examining the efficacy of a stepped care treatment model (Pickard et al, 2021 ) and were invited to participate in a sub-study investigating hormone levels. Recruitment for the BPD group occurred via the local community mental health central intake line.…”

“…Participants provided their written consent and were randomized to the treatment condition, where they were offered a 12-week group treatment at the local community mental health service (which was step 1 of the larger stepped care treatment program), or continued their treatment as usual (TAU). The full inclusion and exclusion criteria and randomization protocol of the original study are published elsewhere (Pickard et al, 2021 ). The present study utilized questionnaire data collected during the group treatment, for those participants who also consented to participate in the saliva sub-study.…”

“…Participants with BPD were clinically assessed pre and post treatment as previously reported (Pickard et al, 2021 ) and specific measures in this study are as follows.…”