San Juan de Dios Psychiatric Centre, Málaga, Spain.
University Regional Hospital of Málaga. Mental Health Unit. Biomedical Research Institute of Málaga (IBIMA, Málaga, Spain.
BMC Psychiatry. 2022 Mar 29;22(1):224. doi: 10.1186/s12888-022-03862-x.
Iconic therapy (IT) is a new therapy that uses images to teach skills with the aim of improving the symptoms of borderline personality disorder. Preliminary results are promising, and there is indication that IT may be effective. The purpose of this preliminary study was to test the effectiveness of IT compared to a psychological supportive intervention (SI).
The study was carried out at the University Regional Hospital of Malaga. Young patients (N = 40; 15-30 years) with suicidal or parasuicidal behavior and borderline personality traits were randomized into IT (N = 20) or SI (N = 20). The main outcome variable was a change in the symptoms of borderline personality disorder (BSL-23) at the end of treatment. The secondary outcome variables were suicidal ideation and behavior, self-harm, the need for medication, the number of visits to mental health professionals, maladaptive behavior, satisfaction with therapy and perceived improvement, both at the end of the intensive treatment and at the 12-month follow-up.
As expected, the two therapies produced a reduction in BPD symptoms at 10 weeks post-treatment and at the 12-month follow-up. Contrary to expectation, there were no statistically significant differences in the effectiveness of the two therapies (p > 0.05). However, at the 12-month follow-up, the effect sizes for the difference between the effectiveness of the two therapy groups on BSL-23 scores (d = 0.33) and on maladjustment to daily life (d = 0.39) was found to exceed the commonly used convention for a small effect (d = 0.20). Besides, participants in the IT group showed greater satisfaction with therapy than those who received SI. The mean difference between groups was statistically significant after the 10-week treatment period (p < .01), with a large effect size (d = 1.11). Nevertheless, this difference was not maintained at the 12-month follow-up (p > .05), although the effect size for this analysis (d = 0.34) was found to exceed a small effect.
This preliminary study did not find a statistically significant difference in the effectiveness of the two therapies, probably due to the small sample of participants, but there are some indicators (effect sizes) suggesting that perhaps IT may be superior for reducing BPD symptoms and maladjustment in daily life. Future studies with larger samples and comparisons with established treatments for borderline personality disorder are necessary to confirm that IT effects are significant and persistent in the long term.
ClinicalTrials.gov identifier: NCT03011190 . First posted 05/01/2017. Last update posted 15/05/2018.
标志性治疗（IT）是一种新的治疗方法，它使用图像来教授技能，旨在改善边缘型人格障碍的症状。初步结果很有希望，并且有迹象表明 IT 可能是有效的。本初步研究的目的是测试 IT 与心理支持干预（SI）相比的有效性。
该研究在马拉加地区大学医院进行。有自杀或准自杀行为和边缘型人格特征的年轻患者（N=40；15-30 岁）被随机分为 IT 组（N=20）或 SI 组（N=20）。主要结局变量是治疗结束时边缘型人格障碍症状（BSL-23）的变化。次要结局变量是自杀意念和行为、自残、药物需求、心理健康专业人员就诊次数、适应不良行为、治疗满意度和感知改善，均在强化治疗结束时和 12 个月随访时进行评估。
正如预期的那样，两种疗法在治疗后 10 周和 12 个月随访时均降低了 BPD 症状。出乎意料的是，两种疗法的疗效没有统计学上的显著差异（p>0.05）。然而，在 12 个月随访时，发现两组治疗效果差异的效应量（BSL-23 评分的 d=0.33 和日常生活适应不良的 d=0.39）超过了通常用于小效应的约定（d=0.20）。此外，接受 IT 治疗的患者比接受 SI 治疗的患者对治疗的满意度更高。组间的平均差异在 10 周治疗期后具有统计学意义（p<.01），具有较大的效应量（d=1.11）。然而，在 12 个月随访时，这种差异并不显著（p>.05），尽管这种分析的效应量（d=0.34）被发现超过了小效应。
本初步研究未发现两种疗法的疗效存在统计学显著差异，可能是由于参与者样本较小所致，但有一些指标（效应量）表明，IT 可能更有利于减轻 BPD 症状和日常生活适应不良。未来需要更大样本的研究，并与边缘型人格障碍的既定治疗方法进行比较，以确认 IT 效果在长期内是显著且持久的。
ClinicalTrials.gov 标识符：NCT03011190。首次发布日期：2017 年 5 月 1 日。最后更新日期：2018 年 5 月 15 日。
