RTI International.
Department for Evidence-based Medicine and Evaluation, Danube University Krems.
J Consult Clin Psychol. 2024 May;92(5):275-295. doi: 10.1037/ccp0000833. Epub 2023 Oct 30.
Borderline personality disorder (BPD) is the most common personality disorder, affecting 1.8% of the general population, 10% of psychiatric outpatients, and 15%-25% of psychiatric inpatients. Practice guidelines recommend psychotherapies as first-line treatments. However, psychotherapies commonly used for the treatment of BPD are numerous, and little is known about the comparative effectiveness of each individual psychotherapy versus treatment as usual (TAU) or other psychotherapies. To systematically assess the comparative effectiveness of commonly used psychotherapies versus TAU or versus other psychotherapies for BPD treatment.
We conducted systematic literature searches in MEDLINE, EMBASE, the Cochrane Library, and APA PsycINFO up to July 14, 2022, and searched reference lists of pertinent articles and reviews. Inclusion criteria were (a) patients 13 years or older with a diagnosis of BPD, (b) treatment with commonly used psychotherapies, (c) comparison with TAU or another psychotherapy, (d) assessment of relevant BPD-related health outcomes, and (e) randomized or nonrandomized trials or controlled observational studies. Two investigators independently screened abstracts and full-text articles and graded the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach.
We found 25 psychotherapy studies meeting inclusion criteria with data on 2,545 participants. Seventeen studies compared nine psychotherapies with TAU and nine studies compared eight psychotherapies with another psychotherapy for the treatment of BPD. Overall, both TAU and included psychotherapies were effective in treating the severity and symptoms of BPD. Moderate certainty of evidence suggests that systems training for emotional predictability and problem solving is more effective than TAU for the treatment of BPD; low certainty of evidence suggests that dialectical behavior therapy, schema therapy, transference-focused psychotherapy, acceptance and commitment therapy, manual-assisted cognitive therapy, and cognitive behavioral therapy are more effective than TAU for treating BPD. We were unable to draw conclusions from head-to-head comparisons of psychotherapies, which were limited to single studies with very low to low certainty of evidence.
All commonly used psychotherapies improve BPD severity, symptoms, and functioning. Our assessment found no strong evidence suggesting that any one psychotherapy is more beneficial than another. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
边缘型人格障碍（BPD）是最常见的人格障碍，影响 1.8%的普通人群、10%的精神科门诊患者和 15%-25%的精神科住院患者。实践指南推荐心理治疗作为一线治疗方法。然而，常用于治疗 BPD 的心理治疗方法众多，对于每种心理治疗方法与常规治疗（TAU）或其他心理治疗方法相比的比较有效性知之甚少。本研究旨在系统评估常用于治疗 BPD 的心理治疗方法与 TAU 或与其他心理治疗方法相比的比较有效性。
我们在 MEDLINE、EMBASE、Cochrane 图书馆和 APA PsycINFO 中进行了系统文献检索，检索时间截至 2022 年 7 月 14 日，并检索了相关文章和综述的参考文献列表。纳入标准为：（a）年龄在 13 岁及以上的 BPD 患者；（b）接受常用心理治疗；（c）与 TAU 或另一种心理治疗比较；（d）评估与 BPD 相关的健康结局；（e）随机或非随机试验或对照观察性研究。两名研究者独立筛选摘要和全文，并使用推荐评估、制定与评估分级方法评估证据质量等级。
我们发现了 25 项符合纳入标准的心理治疗研究，共纳入了 2545 名参与者的数据。17 项研究比较了 9 种心理治疗与 TAU，9 项研究比较了 8 种心理治疗与另一种心理治疗，用于治疗 BPD。总体而言，TAU 和纳入的心理治疗均能有效治疗 BPD 的严重程度和症状。中等质量证据表明，情绪可预测性和解决问题的系统训练比 TAU 更有效治疗 BPD；低质量证据表明，辩证行为疗法、图式疗法、转移焦点心理治疗、接纳与承诺疗法、手册辅助认知疗法和认知行为疗法比 TAU 更有效治疗 BPD。由于缺乏高质量证据，我们无法从心理治疗的头对头比较中得出结论，这些比较仅限于单一研究。
所有常用的心理治疗方法都能改善 BPD 的严重程度、症状和功能。我们的评估没有发现强有力的证据表明任何一种心理治疗方法比另一种更有益。
