Psychoeducation and Problem Solving (PEPS) Therapy for Adults With Personality Disorder: A Pragmatic Randomized-Controlled Trial

Abstract

We compared psychoeducation and problem solving (PEPS) therapy against usual treatment in a multi-site randomised controlled trial. The primary outcome was social functioning. We aimed to recruit 444 community-dwelling adults with personality disorder; however, safety concerns led to an early cessation of recruitment. 154 people were randomised to PEPS and 152 to usual treatment. Follow up at 72 weeks was completed for 68%. PEPS therapy was no more effective than usual treatment for improving social functioning (adjusted difference in mean Social Functioning Questionnaire scores = -0·73; 95% CI -1·83 to 0·38; P=0·19). PEPS therapy is not an effective treatment for improving social functioning of adults with personality disorder living in the community.3

Psychological Support for Personality (PSP) versus treatment as usual: study protocol for a feasibility randomized controlled trial of a low intensity intervention for people with personality disorder

“…We have decided not to include a more formal examination of personality disorders, because validated semi-structured instruments designed to make these assessments are lengthy (often taking > 1 h to complete). Furthermore, in a previous trial of problem-solving therapy for people with personality disorders in a secondary care setting, we found that nearly all those referred to the trial (650/682, 95.3%) met the criteria for personality disorders; those that did not still had significant personality pathology [ 47 ].…”

“…By including the patient version of the CGI Scale in the follow-up interview we will be able to examine whether the two treatment conditions are associated with negative as well as positive changes for participants. This information, together with the qualitative data we will be collecting, will enable us to examine concerns about possible negative effects of short-term interventions for people with personality disorders [ 4 , 47 ].…”

The Development of the ICD-11 Classification of Personality Disorders: An Amalgam of Science, Pragmatism, and Politics

“…Our expectation, which needs testing in further trials, is that individuals with mild personality disorder will display largely negative affective symptoms, whereas those with more severe disturbance will also have disinhibited and dissocial behaviors. There is already some indication that most patients with borderline personality disorder who are formally diagnosed and in psychiatric care have greater severity and pathology across several domains (Crawford et al 2018, McMurran et al 2017).…”

Is social function a good proxy measure of personality disorder?

“…These studies suggest that many of these populations may have had personality disorder also. But in this context, the data from studies of specific populations with personality disorder show much higher mean SFQ scores, including Davidson et al (2006) (mean 13), Huband et al (2007) (mean 12–14) and McMurran et al (2017) (mean 13–15), suggesting that in the other clinical populations, the personality disturbance is of a milder degree. In studies of major mental illness such as schizophrenia and bipolar disorder, the relationship with personality disorder may not be the same as impaired social function may be of a different nature in these conditions (Birchwood et al, 1990).…”