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

Antonsen, Bjørnar Torske; Kvarstein, Elfrida Hartveit; Urnes, Øyvind; Hummelen, Benjamin; Karterud, Sigmund; Wilberg, Theresa

doi:10.1080/10503307.2015.1072283

Cited by 20 publications

(17 citation statements)

References 47 publications

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“…groups who received a combination of day hospital and outpatient treatment [19,20]. The hours of formal therapy fluctuated between 60 and over 600 h, the latter reported by the MBT trial [20].…”

Section: Treatment Interventionsmentioning

confidence: 99%

“…In addition to naturalistic research, clinical trials of psychotherapeutic interventions for BPD have recently shown greater interest in their long-term outcomes, reporting follow-up data for five years or more [19, 20, 21, 22, 23]. This longitudinal perspective on efficacy studies underlines the relevance of treatment as a potential factor of change over time.…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, findings are controversial among studies with respect to a differential impact of specialised therapies in comparison to treatment as usual (TAU) on diagnostic change and social functioning in the long-term. Bateman and Fonagy reported significant differences on remission favouring mentalisation-based treatment (MBT) over TAU (86% vs. 13%), but this effect was not found for other specialised therapies [19, 20, 21]. Antonsen et al reported better outcomes for the social functioning of a specialised therapy for personality disorders compared to TAU, in contrast to findings in the Boscot trial indicating a similar impact of treatment interventions [19, 21].…”

Section: Introductionmentioning

confidence: 99%

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Long-term clinical and functional course of borderline personality disorder: A meta-analysis of prospective studies

et al. 2018

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Background:This meta-analytic review is the first to synthesise findings from prospective research on the long-term course of borderline personality disorder in adult clinical populations.Methods:Systematic searches were conducted in Medline, PsycINFO, PsycArticles, PubMed and Scopus within the period 1990-2017. Inclusion criteria were: (1) adult BPD sample diagnosed by a validated, semi-structured interview; (2) at least two prospective assessments of outcomes; and (3) follow-up period ≥ 5 years. Quality of evidence was rated with the Systematic Assessment of Quality in Observational Research (SAQOR). Four outcomes were meta-analysed using mixed-effect methods: remission from BPD diagnosis, completed suicide, depressive symptoms, and functioning. Potential moderators regarding the natural course and the initial treatment received were studied.Results:Eleven studies met the inclusion criteria, with 837 participants from nine countries being followed. Between 50% and 70% of the BPD patients achieved remission in the long-term. Significant reductions in depression and functional impairment were also found. Mean suicide rate ranged from 2% to 5%. Younger age was associated with higher likelihood for remission. Being female was correlated with lower functional improvement. Despite some positive trends, there were no significant associations between treatment moderators and the long-term outcome.Conclusions:Findings suggest that the course of BPD is characterised by symptomatic amelioration and a slight functional improvement in the long-term. Age and gender modulate the long-term prognosis and should be considered to adapt treatment resources. Further research is required to draw robust conclusions on the long-term effects of psychotherapeutic interventions.

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Section: Treatment Interventionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Long-term clinical and functional course of borderline personality disorder: A meta-analysis of prospective studies

et al. 2018

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“…Evidence-based treatments for BPD, e.g., dialectical-behavioral therapy (DBT), schema-focused therapy (SFT), and mentalization-based therapy (MBT) utilize group components. Its beneficial effects on social perception and interpersonal skills in various settings, e.g., outpatient and inpatient treatment, have been outlined ( Farrell et al, 2009 ; Bateman and Fonagy, 2010 ; Bloom et al, 2012 ; Karterud and Bateman, 2012 ; Laurenssen et al, 2014 ; Kvarstein et al, 2015 ; Linehan and Wilks, 2015 ; Dimaggio and Brune, 2016 ; Fassbinder et al, 2016 ; Kramer et al, 2016 ; Antonsen et al, 2017 ; Edel et al, 2017 ).…”

Section: Introductionmentioning

confidence: 99%

Exclusion-Proneness in Borderline Personality Disorder Inpatients Impairs Alliance in Mentalization-Based Group Therapy

et al. 2018

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Interpersonal sensitivity, particularly threat of potential exclusion, is a critical condition in borderline personality disorder (BPD) which impairs patients’ social adjustment. Current evidence-based treatments include group components, such as mentalization-based group therapy (MBT-G), in order to improve interpersonal functioning. These treatments additionally focus on the therapeutic alliance since it was discovered to be a robust predictor of treatment outcome. However, alliance is a multidimensional factor of group therapy, which includes the fellow patients, and may thus be negatively affected by the exclusion-proneness of BPD patients. The aim of this pilot study was to examine the predictive value of threat of social exclusion for the therapeutic alliance in MBT-G. In the first part of the study, social exclusion was experimentally induced in 23 BPD inpatients and 28 healthy subjects using the Cyberball paradigm, a virtual ball tossing game. The evoked level of threat was measured with the Need-Threat Scale (NTS) which captures four dimensions of fundamental human needs, i.e., the need for belongingness, for self-esteem, for control, and for a meaningful existence. In the second part of the study, therapeutic alliance was measured on three dimensions, the therapists, the fellow patients and the group as a whole, using the Group-Questionnaire (GQ-D). BPD patients scored higher in their level of threat according to the NTS in both, the inclusion and the exclusion condition. The level of threat after exclusion predicted impairments of the therapeutic alliance in MBT-G. It was associated with more negative relationships, lower positive bonding and a lower positive working alliance with the fellow patients and lower positive bonding to the group as a whole whilst no negative prediction of the alliance to the therapists was found. Consequently, our translational study design has shown that Cyberball is an appropriate tool to use as an approach for clinical questions. We further conclude that exclusion-proneness in BPD is a critical feature with respect to alliance in group treatments. In order to neutralize BPD patients’ exclusion bias, therapists may be advised to provide an “inclusive stance,” especially in initial sessions. It is also recommendable to strengthen patient to patient relations.

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“…Groups focused on insight and interpersonal work can help patients learn about maladaptive self‐states and relational patterns that may hinder their adjustment to various social roles. Programmes with groups targeting reflective abilities (e.g., regarding underlying mental states and relational dynamics) have been found to produce positive effects for improved social functioning (Popolo et al, ), including at long‐term follow‐up (Antonsen et al, ).…”

Section: Introductionmentioning

confidence: 99%

Improving social functioning and life satisfaction among patients with personality dysfunction: Connectedness and engagement in integrative group treatment

Kealy

Doorn

Ehrenthal

et al. 2020

Clin Psychology and Psychoth

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Reduced social impairment and improved life satisfaction are important objectives in group treatment for patients with personality dysfunction. Knowledge regarding patient characteristics and group treatment processes that contribute to these outcomes, however, remains limited. Dispositional connectedness, the valuing of interpersonal connections, may be an important patient factor that influences patients' experience of group treatment in ways that facilitate therapeutic benefits. The present study investigated the roles of dispositional connectedness and group engagement in contributing to improvement in social functioning and life satisfaction through integrative group treatment for personality dysfunction. Seventy-nine patients who completed an integrative group treatment programme were assessed for dispositional connectedness at baseline and social functioning and life satisfaction at pretreatment and posttreatment; each also provided ratings of group engagement during treatment. Regression analyses using bootstrap confidence intervals found significant indirect effects for dispositional connectedness regarding improvement in both social functioning and life satisfaction, through the mediating effect of group engagement. Thus, patients who entered treatment with tendencies towards interpersonal connectedness perceived a higher level of engagement in the group environment. Group engagement in turn contributed to greater improvement in social functioning and to greater improvement in life satisfaction following treatment. The findings indicate dispositional connectedness as a salient characteristic in selecting patients for group treatment and highlight the role of an engaged interpersonal climate in facilitating improvement in social functioning and life satisfaction. K E Y W O R D S connectedness, engagement, group treatment, life satisfaction, social functioning

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

Cited by 20 publications

References 47 publications

Long-term clinical and functional course of borderline personality disorder: A meta-analysis of prospective studies

Long-term clinical and functional course of borderline personality disorder: A meta-analysis of prospective studies

Exclusion-Proneness in Borderline Personality Disorder Inpatients Impairs Alliance in Mentalization-Based Group Therapy

Improving social functioning and life satisfaction among patients with personality dysfunction: Connectedness and engagement in integrative group treatment

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