Combinations of individual psychotherapy, clinical service models effective for BPD

Effective early intervention for borderline personality disorder did not rely upon availability of BPD psychotherapy, according to results of a randomized clinical trial published in JAMA Psychiatry.

“The Monitoring Outcomes of Borderline Personality Disorder in Youth (MOBY) randomized clinical trial aimed to clarify the degree of complexity of treatment required for effective early intervention for BPD by examining three combinations of individual psychotherapy and clinical service model: (1) the Helping Young People Early (HYPE) dedicated BPD service model for young people combined with weekly cognitive analytic therapy (CAT); (2) HYPE combined with a weekly befriending psychotherapy-control condition; and (3) a general youth mental health service (YMHS) model combined with befriending,” Andrew M. Chanen, MBBS(Hons), PhD, of the Centre for Youth Mental Health at the University of Melbourne in Australia, and colleagues wrote. “Therefore, the three treatment arms were HYPE + CAT, HYPE + befriending, and YMHS + befriending.”

The researchers recruited young people between March 17, 2011, and Sept. 30, 2015, into parallel groups at two government-funded youth mental health services in Australia. They included in the intent-to-treat analysis 128 participants aged 15 to 25 years (81.3% girls and women; mean age, 19.1 years) who provided postbaseline data, had a recent BPD diagnosis according to DSM-IV-TR criteria and had never received evidence-based BPD treatment.

They balanced participants based on sex, age and depressive symptomatology. Chanen and colleagues randomly assigned participants in a 1:1:1 ratio both to one treatment arm and to a clinician. Psychosocial functioning according to the Inventory of Interpersonal Problems Circumplex Version and the Social Adjustment Scale Self-report served as the main outcome.

Results showed a mean of 19.3% to 23.8% improvement in the primary outcomes and 40.7% to 52.7% in all secondary outcomes, aside from severity of substance use and client satisfaction, between baseline and 12 months, regardless of group. When comparing YMHS + befriending vs. HYPE and HYPE + CAT vs. befriending, the researchers found that neither the service model nor the psychotherapy intervention correlated with a superior rate of change in psychosocial functioning at 12 months. They noted superiority of the HYPE service model compared with YMHS + befriending for treatment attendance and treatment completion. HYPE + CAT exhibited superiority compared with befriending for treatment attendance and treatment completion.

“Essential elements of care appear to include a model for understanding BPD, clinical case management and treatment of cooccurring functional, physical and psychopathological difficulties,” Chanen and colleagues wrote. “How these elements might work remains an open question for further investigation.

“Early intervention for BPD does not appear to be reliant on availability of specialist psychotherapy, and the role and timing of such treatments needs further study,” they added. “With appropriate funding, services could be scaled up immediately, via existing national mental health platforms for young people or similar services globally.”