Abstract
BackgroundBorderline personality disorder (BPD) is associated with an intensive use of mental health services, even in the absence of a full diagnosis. Early symptom detection and intervention may help alleviate adverse long-term outcomes. Iconic Therapy is an innovative manual-driven psychotherapy that treats BPD symptoms in a specific and intensive manner. Preliminary results are promising and the indication is that Iconic Therapy may be effective in reducing BPD symptoms. The aim of this study is to assess how effective Iconic Therapy is compared to Structured Support Therapy in a real clinical setting.Methods/DesignOur study will be a controlled 12-month pragmatic, two-armed RCT. A total of 72 young people (15 to 25 years old) with suicidal ideation/self-injuring behaviour and BPD traits and symptoms will participate in the study. The subjects will be randomised into two groups: Iconic Therapy or Structured Support Therapy. The participants will be assigned to either group on a 1:1 basis. Both the Iconic Therapy and the Structured Support Therapy programmes consist of 11 weekly sessions delivered by two trained psychologists in a group format of between 8 to 12 outpatients. The primary outcome will be measured by the change in symptom severity. Secondary outcomes include changes in suicidal ideation/ behaviour, non-suicidal self-injury, maladjustment to daily life and cost-effective analysis. The primary outcome will be a decrease in the severity of BPD symptoms as assessed by the Borderline Symptom List (BSL-23). For the clinical evaluation, three study assessments will take place: at baseline, after treatment and at 12-month follow-up. We hypothesise that patients attending the Iconic Therapy group will show a significantly higher reduction in symptoms than those in the Structured Support Therapy group. Data will be analysed using generalised estimating equation (GEE) models.DiscussionBy responding to the need for briefer and more comprehensive therapies for BPD, we foresee that Iconic Therapy may provide an alternative treatment whose specific therapeutic principles, visually represented on icons, will overcome classical Structured Support Therapy at reducing BPD symptoms.Trial registrationNCT03011190
Highlights
Borderline personality disorder (BPD) is associated with an intensive use of mental health services, even in the absence of a full diagnosis
By responding to the need for briefer and more comprehensive therapies for BPD, we foresee that Iconic Therapy may provide an alternative treatment whose specific therapeutic principles, visually represented on icons, will overcome classical Structured Support Therapy at reducing BPD symptoms
Primary outcome measure Severity of borderline personality disorder We will use the Spanish version of the Borderline Symptom List (BSL-23) [44]; it replicates the one factor structure of the original and shows high reliability (α = .95) as well as good test-retest stability when checked in a subsample of 74 patients (r = .73 p < .01)
Summary
Borderline personality disorder (BPD) is associated with an intensive use of mental health services, even in the absence of a full diagnosis. The characteristics of Borderline Personality Disorder (BPD) are dysregulation of emotional, behavioural and interpersonal relations [1]. With a diagnosis rate ranging from 0.5 to 31.2% among this young population [3], BPD is a disorder with a high social and economic impact, of which the most severe consequence is suicide. Mood instability, has been defined as rapid oscillations of an intense affect with a difficulty in regulating said oscillations or their behavioural consequences [4] and is a key factor in the development and maintenance of BPD [5]. Personality traits are more malleable and sensitive to change during adolescence [16, 17] and for that reason, early detection and intervention of self-injury behaviour is a unique opportunity to prevent an aggravation of emotional instability, BPD diagnosis and suicidal acts
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