Psychotherapies for the treatment of borderline personality disorder: A systematic review.
Level 1 - systematic review of randomized trials
Systematic review of randomized and controlled trials evaluating psychotherapies for borderline personality disorder.
PubMed 37902689 · doi:10.1037/ccp0000833
What was done
Authors conducted a systematic review searching MEDLINE, EMBASE, Cochrane Library, and APA PsycINFO through July 14, 2022. Inclusion criteria were randomized or nonrandomized trials and controlled observational studies evaluating commonly used psychotherapies against treatment as usual (TAU) or another psychotherapy in patients aged 13 years and older diagnosed with borderline personality disorder (BPD). Dual independent screening was performed, and evidence certainty was evaluated using GRADE.
What was found
A total of 25 studies with 2,545 participants were included (17 comparing nine psychotherapies to TAU; nine comparing eight psychotherapies against another psychotherapy). Both active psychotherapies and TAU improved BPD severity and symptoms. Systems training for emotional predictability and problem solving (STEPPS) was more effective than TAU based on moderate-certainty evidence. Dialectical behavior therapy, schema therapy, transference-focused psychotherapy, acceptance and commitment therapy, manual-assisted cognitive therapy, and cognitive behavioral therapy were more effective than TAU based on low-certainty evidence. Head-to-head comparisons were limited to single studies yielding very low to low certainty, showing no strong evidence that one modality is superior to another. Specific numeric effect estimates were not reported in the abstract.
Why it matters
While multiple structured psychotherapies effectively reduce BPD severity compared to usual care, existing evidence does not support prioritizing one specific psychotherapeutic modality over others.
Limits
The abstract reports no numerical effect sizes or confidence intervals. Evidence for most individual modalities versus TAU is low certainty, head-to-head trials are sparse and limited to single studies, and the review included nonrandomized and observational designs alongside randomized trials.
Cited by
- supports The gold standard treatment for borderline personality disorder is a long course of psychotherapy, such as Dialectical Behavior Therapy (DBT) over approximately a year.