Supervised team management, with or without structured psychotherapy, in heavy users of a mental health service with borderline personality disorder: a two-year follow-up preliminary randomized study

Federico Amianto,Andrea Pierò,Barbara Simonelli,Giovanni Abbate-Daga,Giuseppe Rocca,Simona Fassina,Secondo Fassino,Elisabetta Cairo,Andrea Ferrero

doi:10.1186/1471-244x-11-181

Federico Amianto, Andrea Pierò + Show 7 more

Open Access

https://doi.org/10.1186/1471-244x-11-181

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Abstract

BackgroundIndividuals affected by severe Borderline Personality Disorder (BPD) are often heavy users of Mental Health Services (MHS). Short-term treatments currently used in BPD therapy are useful to target disruptive behaviors but they are less effective in reducing heavy MHS use. Therefore, alternative short-term treatments, less complex than long-term psychodynamic psychotherapies but specifically oriented to BPD core problems, need to be developed to reduce MHS overuse. This study aimed to evaluate the efficacy of adding Sequential Brief Adlerian Psychodynamic Psychotherapy (SB-APP) to Supervised Team Management (STM) in BPD treatment compared to STM alone in a naturalistic group of heavy MHS users with BPD. Effectiveness was evaluated 6 times along a two-year follow-up.MethodsThirty-five outpatients who met inclusion criteria were randomly assigned to two treatment groups (STM = 17; SB-APP = 18) and then compared. Clinical Global Impression (CGI) and CGI-modified (CGI-M) for BPD, Global Assessment of Functioning (GAF), State-Trait Anger Expression Inventory (STAXI), and Symptom Checklist-90 Revised (SCL-90-R) were administered at T1, T3, T6, T12, T18 and T24. At T12 the Working Alliance Inventory-Short Form (WAI-S) was also completed. At the one-year follow-up, SB-APP group did not receive any additional individual psychological support. MHS team was specifically trained in BPD treatment and had regular supervisions.ResultsAll patients improved on CGI, GAF, and STAXI scores after 6 and 12 months, independently of treatment received. SB-APP group showed better outcome on impulsivity, suicide attempts, chronic feelings of emptiness, and disturbed relationships. We found a good stabilization at the one year follow-up, even after the interruption of brief psychotherapy in the SB-APP group.ConclusionsAlthough STM for BPD applied to heavy MHS users was effective in reducing symptoms and improving their global functioning, adding a time-limited and focused psychotherapy was found to achieve a better outcome. In particular, focusing treatment on patients' personality with a specific psychotherapeutic approach (i.e. SB-APP) seemed to be more effective than STM alone.Trial RegistrationClinicalTrials.gov: NCT1356069

Highlights

Individuals affected by severe Borderline Personality Disorder (BPD) are often heavy users of Mental Health Services (MHS)
Three main results emerged from this study: 1) the branch of the study including specific MHS team supervision in addition to treatment-as-usual (STM) showed an improvement in the symptoms and functioning compared to baseline, even though a structured psychotherapy was not applied; 2) the improvement was found to be stable over time; 3) a time-limited psychodynamic psychotherapy focused on patients’ level of personality functioning (SB-APP) was more effective than Supervised Team Management (STM) with respect to some core psychopathological characteristics of BPD and working alliance
The hypothesis raised by the present research is that specific team training supervision and support on BPD psychopathology improve the outcome of MHS heavy users with respect to team management

Summary

Introduction

Individuals affected by severe Borderline Personality Disorder (BPD) are often heavy users of Mental Health Services (MHS). Short-term treatments currently used in BPD therapy are useful to target disruptive behaviors but they are less effective in reducing heavy MHS use. This study aimed to evaluate the efficacy of adding Sequential Brief Adlerian Psychodynamic Psychotherapy (SB-APP) to Supervised Team Management (STM) in BPD treatment compared to STM alone in a naturalistic group of heavy MHS users with BPD. Individuals affected by severe BPD are often heavy users of psychiatric and medical services [2], entailing high costs for Mental Health Services (MHS). Other studies sustain that the management of heavy MHS users could be improved by training MHS team about psychological core dimensions of BPD [5]

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