Outpatient psychotherapy for borderline personality disorder: randomized trial of schema-focused therapy vs transference-focused psychotherapy.
BACKGROUND
Borderline personality disorder is a severe and chronic psychiatric condition, prevalent throughout health care settings. Only limited effects of current treatments have been documented.


OBJECTIVE
To compare the effectiveness of schema-focused therapy (SFT) and psychodynamically based transference-focused psychotherapy (TFP) in patients with borderline personality disorder.


METHODS
A multicenter, randomized, 2-group design.


METHODS
Four general community mental health centers.


METHODS
Eighty-eight patients with a Borderline Personality Disorder Severity Index, fourth version, score greater than a predetermined cutoff score.


METHODS
Three years of either SFT or TFP with sessions twice a week.


METHODS
Borderline Personality Disorder Severity Index, fourth version, score; quality of life; general psychopathologic dysfunction; and measures of SFT/TFP personality concepts. Patient assessments were made before randomization and then every 3 months for 3 years.


RESULTS
Data on 44 SFT patients and 42 TFP patients were available. The sociodemographic and clinical characteristics of the groups were similar at baseline. Survival analyses revealed a higher dropout risk for TFP patients than for SFT patients (P = .01). Using an intention-to-treat approach, statistically and clinically significant improvements were found for both treatments on all measures after 1-, 2-, and 3-year treatment periods. After 3 years of treatment, survival analyses demonstrated that significantly more SFT patients recovered (relative risk = 2.18; P = .04) or showed reliable clinical improvement (relative risk = 2.33; P = .009) on the Borderline Personality Disorder Severity Index, fourth version. Robust analysis of covariance (ANCOVA) showed that they also improved more in general psychopathologic dysfunction and measures of SFT/TFP personality concepts (P<.001). Finally, SFT patients showed greater increases in quality of life than TFP patients (robust ANCOVAs, P=.03 and P<.001).


CONCLUSIONS
Three years of SFT or TFP proved to be effective in reducing borderline personality disorder-specific and general psychopathologic dysfunction and measures of SFT/TFP concepts and in improving quality of life; SFT is more effective than TFP for all measures.
Giesen-Bloo
Josephine
J
Department of Medical Psychology, Academic Hospital Maastricht, Maastricht, The Netherlands.
van Dyck
Richard
R
Spinhoven
Philip
P
van Tilburg
Willem
W
Dirksen
Carmen
C
van Asselt
Thea
T
Kremers
Ismay
I
Nadort
Marjon
M
Arntz
Arnoud
A
D000553:Ambulatory Care; D001883:Borderline Personality Disorder / Q000523:psychology / Q000628:therapy*; D002908:Chronic Disease; D003155:Community Mental Health Centers; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D011569:Psychiatric Status Rating Scales; D011575:Psychoanalytic Therapy / Q000379:methods; D011613:Psychotherapy / Q000379:methods*; D011788:Quality of Life; D012720:Severity of Illness Index; D016019:Survival Analysis; D014167:Transference, Psychology; D016896:Treatment Outcome