Combination Treatment Holds Promise for Borderline Personality Disorder

A study published in the journal Psychotherapy and Psychosomatics shows that a combination of individualized therapy and good psychiatric management may improve treatment of borderline personality disorder (BPD). The study was led by Ueli Kramer, Ph.D., a visiting professor at the University of Windsor and a researcher/clinician at the hospital of the University of Lausanne. Dr. Kramer and his team enrolled 85 patients with confirmed diagnoses of BPD in their study, and then further divided the 85 patients into two groups to evaluate the outcomes of two different treatment approaches.

Understanding Borderline Personality Disorder

Like other personality disorders and many forms of mental illness, there is much that experts do not know about BPD. It has been recognized as a distinct condition since 1980, when standardized criteria for diagnosis were put in place by the third edition of the Diagnostic and Statistical Manual of Mental Disorders. However, the causes of BDP are not well understood, and research is still working to identify the most effective methods of treating this illness. People with BDP often have a very unstable sense of self, which can change frequently and rapidly. These rapid changes also make relationships volatile because individuals with BPD may change their opinions of other people and their behavior around other people frequently as their sense of identity transforms. Those with BPD also tend to view things in black-and-white terms, which contributes to the extreme changes in their views of themselves and other people. Symptoms of BPD include violent mood swings, impulsive behavior, self-hatred, fear of being alone, serious but short-term episodes of depression or anxiety, self-injury or even suicidal behavior. Frequent relationship changes, career changes and aspiration changes are common in people with BPD.

Combining Individualized Therapy With Good Psychiatric Management

The two groups of patients in the new study were each given 10 therapy sessions employing the principles of good psychiatric management (GPM). GPM is an approach to treating BPD that was developed by Dr. John G. Gunderson and Dr. Paul Links. In addition to GPM, one of the two groups was given personalized intervention, employing a technique known as the motive-oriented therapeutic relationship (MOTR). For this group, MOTR techniques were introduced in the second therapy session and maintained until the 10th and final session. Although GPM has been found to produce fairly good results for many BPD patients, the researchers wanted to test the hypothesis that individualized therapy would improve on those results. One of the challenges of BPD is that patients who display the same outward behaviors may be acting from different motivations, which means an effective approach to treating one individual may not be effective in treating another.

General Symptoms Improved by Personalized Approach

The results of the study showed that both sets of patients generally improved during their courses of treatment. Both the GPM patients and the GPM plus MOTR patients showed similar rates of reduction in their borderline symptoms. However, the patients who received sessions with MOTR showed more significant reductions in their general symptoms, which include depression, anxiety, emotional volatility and poor interpersonal relations. The researchers concluded that the use of MOTR over 10 sessions was effective at mitigating general symptoms but did not impact borderline symptoms more than the standard GMP approach. The researchers believe it is possible that the MOTR approach would begin to impact borderline symptoms if applied for longer than 10 sessions. Both patients and therapists were also asked to assess their relationships and collaboration using a version of the Working Alliance Inventory. Interestingly, the patients and therapists had different interpretations of the improvements offered by the MOTR approach. The patients who received the GPM-only therapy rated their sessions just as highly as the patients who received the GPM and MOTR sessions. However, the therapists who conducted the MOTR sessions reported higher levels of engagement and cooperation between themselves and their patients.

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