Transference-Focused Psychotherapy vs Dialectical Behaviour Therapy for the treatment of Borderline Personality Disorder: Α review of the current RCT-based literature. (original) (raw)
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DOAJ (DOAJ: Directory of Open Access Journals), 2021
Borderline personality disorder (BPD) is a persistent pattern of instability in terms of emotion regulation, impulsivity, self-image, interpersonal relationships with extreme 'splitting' between idealisation and devaluation of others, including also stress-related paranoid ideation and dissociative symptoms. Self-harming behaviour is also common amongst BPD patients. The manifestation of these symptoms may lead to serious disturbances of quality of life for patients, families and their significant others along with problems in professional and personal development. Several evidence-based psychotherapeutic approaches have been developed to address these issues. In this review two of them were put into scrutiny; Dialectical Behaviour Therapy or DBT, and Transference-Focused Psychotherapy or TFP. These were reviewed by examining RCT studies published in Cochrane and Clinicaltrials.gov databases. The efficacy of these two interventions was examined on similar outcomes, such as therapy dropout, general BPD symptoms, global functioning, self-harm, and social adaptation. No prominent superiority for either of the treatments in comparison was identified, however both TFP and DBT show greater efficacy when compared to other, non-BPD specific psychotherapeutic approaches.
2021
Borderline personality disorder (BPD) is a persistent pattern of instability in terms of emotion regulation, impulsivity, self-image, interpersonal relationships with extreme ‘splitting’ between idealisation and devaluation of others, including also stress-related paranoid ideation and dissociative symptoms. Self-harming behaviour is also common amongst BPD patients. The manifestation of these symptoms may lead to serious disturbances of quality of life for patients, families and their significant others along with problems in professional and personal development. Several evidence-based psychotherapeutic approaches have been developed to address these issues. In this review two of them were put into scrutiny; Dialectical Behaviour Therapy or DBT, and Transference-Focused Psychotherapy or TFP. These were reviewed by examining RCT studies published in Cochrane and Clinicaltrials.gov databases. The efficacy of these two interventions was examined on similar outcomes, such as therapy d...
British Journal of Psychiatry, 2010
Transference-focused psychotherapy was developed by Otto F. Kernberg and is based on his model of borderline personality disorder. 1,2 The efficacy of transference-focused psychotherapy has been evaluated in two randomised controlled trials (RCTs) to date. A 1-year RCT 3 with 90 participants with borderline personality disorder compared transference-focused psychotherapy with dialectical behaviour therapy 4 and psychodynamic supportive therapy. All three groups showed significant positive change in depression, anxiety, global functioning and social adjustment in a multiwave design. Transference-focused psychotherapy and dialectical behaviour therapy were associated with a significant improvement in suicidality, transference-focused psychotherapy and supportive therapy improved facets of impulsivity and only the former yielded a significant improvement in anger, irritability and verbal and direct assault. Moreover, only those individuals in the transference-focused psychotherapy group improved significantly in their reflective function and their attachment style. 5 Giesen-Bloo et al 6,7 compared transference-focused psychotherapy to schema-focused therapy 8 in a 3-year RCT with 88 participants with borderline personality disorder. The transference-focused psychotherapy revealed a significantly higher drop-out rate (51.2% v. 26.7%) and -despite improvements in all domains of outcome -significantly smaller treatment effects. The American Psychological Association (Division 12) evaluated transference-focused psychotherapy as having controversial research support. Thus, more research is needed before transference-focused psychotherapy can be considered to have modest or strong research support. The present study aims to bring clarity to the field and to determine whether transference-focused psychotherapy can be regarded as empirically supported treatment according to the American Psychological Association (Division 12) criteria. 10 This investigation examines the efficacy of transference-focused psychotherapy for borderline personality disorder in an RCT comparing those randomised to transference-focused psychotherapy with those randomised to a group treated by experienced psychotherapists in the community.
Studies in Medical Sciences, 2020
Background & Aims: The purpose of the present study was to investigate the changes in borderline personality structure at different time serials of treatment. Materials & Methods: The present study is a quasi-experimental and single-subject (A/B) study. The sample of study was a 35-year-old man who was selected as a borderline personality disorder among the patients referred to Health Center through a preliminary clinical interview and performing Millon clinical multiaxial inventory -III (MCMI-III) by available sampling method. The interview with the Semi-Structured Interview of the Personality Organization (STIPO) was conducted in four stages including one pre-test and three post-tests after time series treatment. Single-Subject was studied for 11 months in a format of 51 sessions of transference focused psychotherapy. Results: The findings showed that the mean scores of personality structure (identity, dimensions of object relations, aggression, personality rigidity, deference mechanisms, and morality) in the first post-test were not significantly different from the pre-test; but there was a significant clinical difference in the mean scores of personality structure at the second and third post-tests compared to the pre-test. Conclusion: Based on the results, this treatment has significant effect in improving the personality dimensions of borderline patients, especially in advanced stages of treatment.
Psychodynamic Psychotherapy Research, 2011
It is generally believed that psychoanalytically or dynamically oriented clinicians are not interested in research for a host of reasons ranging from the challenges of designing a randomized controlled trial that would demonstrate the effi cacy of a psychoanalytic approach to epistemological and philosophical disagreements about the nature of science (see debates for an illustration). Although many in the psychoanalytic community have in the past been cautious regarding the value of research, some of the earliest psychotherapy research was performed by psychoanalysts . Additionally, psychoanalyst and psychodynamic clinicians are increasingly becoming interested in testing psychodynamic hypotheses and establishing a stronger evidence base for treatments based on psychodynamic ideas . This increased interest in psychotherapy outcome research has been particularly fruitful with regard to the study of borderline personality disorder. Severe personality disorders such as borderline personality disorder are increasingly seen as the mainstay of psychoanalytic clinical work.
Behaviour Research and Therapy, 2015
Knowing what predicts discontinuation or success of psychotherapies for Borderline Personality Disorder (BPD) is important to improve treatments. Many variables have been reported in the literature, but replication is needed and investigating what therapy process underlies the findings is necessary to understand why variables predict outcome. Using data of an RCT comparing Schema Therapy and Transference Focused Psychotherapy as treatments for BPD, variables derived from the literature were tested as predictors of discontinuation and treatment success. Participants were 86 adult outpatients (80 women, mean age 30.5 years) with a primary diagnosis of BPD who had on average received 3 previous treatment modalities. First, single predictors were tested with logistic regression, controlling for treatment type (and medication use in case of treatment success). Next, with multivariate backward logistic regression essential predictors were detected. Baseline hostility and childhood physical abuse predicted treatment discontinuation. Baseline subjective burden of dissociation predicted a smaller chance of recovery. A second study demonstrated that in-session dissociation, assessed from session audiotapes, mediated the observed effects of baseline dissociation on recovery, indicating that dissociation during sessions interferes with treatment effectiveness. The results suggest that specifically addressing high hostility, childhood abuse, and in-session dissociation might reduce dropout and lack of effectiveness of treatment.
European Journal of Interdisciplinary Studies, 2018
This literature review aims to evaluate the evidence in the extant literature of practical and evidence-based psychotherapy methods for overcoming personality disorders and to compare them with one another. For a systematic review, we used the following databases: ScienceDirect, ResearchGate, Cochrane, PsyNet, CrossRef, PubMed. As a result, 33 articles were selected. Dialectic Behavioral Therapy (DBT), Mentalization-based Therapy (MBT) and Schema-focused Therapy (SFT) have better evidence-based efficacy in the context of therapeutic effects on reducing the severity of diagnostic criteria and comorbid states. In the context of application in an outpatient setting the highest positive effect and compliances are demonstrated by DBT and SFT. The majority of trials of DBT and TFP showed the effectiveness of psychotherapy with a treatment duration of at least 12 months. The longest term without recurrence of comorbid states and drop out (36 months) was observed with the use of Transfer-focused Psychotherapy (TFP) and SFT, which in the context of the long-term therapeutic effect may give people benefits along with other therapies. The present review shows initial evidence that long-term psychotherapy can be a useful and evidence-based intervention for people with borderline personality disorder. These results provide promising evidence to support people who suffer from a personality disorder. DBT, MBT, and SFT can be proposed as methods of the first line as a nonpharmacological intervention.