Abstract
BackgroundPsychotherapy for borderline personality disorder is often lengthy and resource-intensive. However, the current length of outpatient treatments is arbitrary and based on trials that never tested if the treatment intensity could be reduced. As a result, there is insufficient evidence to inform the decision between short-term and long-term psychotherapy for borderline personality disorder. Mentalization-based therapy is one treatment option for borderline personality disorder and consists traditionally of an 18-month treatment program.Methods/designThis trial is an investigator-initiated single-center randomized clinical superiority trial of short-term (20 weeks) compared to long-term (14 months) mentalization-based therapy for outpatients with subthreshold or diagnosed borderline personality disorder. Participants will be recruited from the Outpatient Clinic for Personality Disorders at Stolpegaard Psychotherapy Centre, Mental Health Services, Capital Region of Denmark. Participants will be included if they meet a minimum of four DSM-V criteria for borderline personality disorder. Participants will be assessed before randomization, and at 8, 16, and 24 months after randomization. The primary outcome is severity of borderline symptomatology assessed with the Zanarini Rating Scale for borderline personality disorder. Secondary outcomes include self-harm incidents, functional impairment (Work and Social Adjustment Scale, Global Assessment of Functioning) and quality of life (Short-Form Health Survey 36). Severity of psychiatric symptoms (Symptom Checklist 90-R) will be included as an exploratory outcome. Measures of personality functioning, attachment, borderline symptoms, group alliance, and mentalization skills will be included to explore potential predictors and mechanisms of change.DiscussionThis trial will provide evidence of the beneficial and harmful effects of short-term compared to long-term mentalization-based therapy for outpatients with subthreshold or diagnosed borderline personality disorder.Trial registrationClinicalTrials.gov, NCT03677037. Registered on September 19, 2018.
Highlights
Psychotherapy for borderline personality disorder is often lengthy and resource-intensive
This trial will provide evidence of the beneficial and harmful effects of short-term compared to longterm mentalization-based therapy for outpatients with subthreshold or diagnosed borderline personality disorder
These have recently been evaluated in a systematic review and meta-analysis exploring the efficacy of psychotherapies for borderline personality disorder, in which it was concluded that dialectical behavior therapy and psychodynamic therapies significantly improved borderline-relevant outcomes [12]
Summary
This trial will provide evidence of the beneficial and harmful effects of short-term compared to long-term MBT for outpatients with subthreshold or diagnosed borderline personality disorder. Gaining more information on how different lengths of treatment work for specific subtypes of patients may help to minimize the potential burden from long-term psychotherapy for some, while at the same time it may identify subtypes of patients for whom short-term psychotherapy is contraindicated. This knowledge may enhance the cost-effectiveness of treatment options for borderline personality disorder. The long-term MBT intervention, which is 14 months of treatment in this trial, diverges in intensity (both duration and exposure) from the original 18-month program [13] This is due to the fixed length of the treatment packages, which have been implemented in the Danish mental health care system.
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