Efficacy of cognitive rehabilitation on psychosocial functioning in Borderline Personality Disorder: a randomized controlled trial.
BACKGROUND
Follow-up studies revealed that subjects with borderline personality disorder (BPD) present high rates of clinical remission, although psychosocial functioning often remains impaired. The aim of this study is to evaluate the efficacy of a cognitive rehabilitation intervention versus a psychoeducational program on psychosocial functioning in subjects with BPD.


METHODS
A multicenter, randomized, and positive-controlled clinical trial was conducted. Seventy outpatients with BPD were randomized to cognitive rehabilitation or psychoeducational group interventions. Participants were evaluated after completion of the intervention period (16 weeks) and after the follow-up period (6 months). Psychosocial functioning, clinical and neuropsychological outcomes were evaluated.


RESULTS
No main effects of group or group x time were observed on functionality but a significant effect of time was found. Post-hoc analyses showed that only cognitive rehabilitation increased psychosocial functioning significantly at endpoint. Psychoeducation showed a significant enhancement of depressive symptoms.


CONCLUSIONS
Cognitive rehabilitation and psychoeducational interventions appeared to show good efficacy in improving disabilities in daily life in subjects with BPD. These interventions are easily implemented in mental health settings and have the advantage of improving general functioning and clinical symptoms.


BACKGROUND
Clinicaltrials.gov: NCT02033044. Registered 9 January 2014.
Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. jpascual@santpau.cat.|Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica - Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, Av. Sant Antoni Ma Claret 167, 08025, Barcelona, Spain. jpascual@santpau.cat.
Juan C
JC
Pascual
Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain. nereapalomares@gmail.com.|Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Departamento de Psiquiatría, Universidad Complutense, Madrid, Spain. nereapalomares@gmail.com.
Nerea
N
Palomares
Department of Psychiatry, Universitary Hospital Ramón y Cajal, CIBERSAM, IRYCIS, Madrid, Spain. aibanez.hrc@gmail.com.|Department of Psychiatry, Universidad de Alcalá, Madrid, Spain. aibanez.hrc@gmail.com.
Ángela
Á
Ibáñez
Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. mportella@santpau.cat.|Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica - Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, Av. Sant Antoni Ma Claret 167, 08025, Barcelona, Spain. mportella@santpau.cat.
Maria J
MJ
Portella
Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain. rocioarza@hotmail.com.|Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Departamento de Psiquiatría, Universidad Complutense, Madrid, Spain. rocioarza@hotmail.com.
Rocío
R
Arza
FIBio-HRC, Universitary Hospital Ramón y Cajal, Madrid, Spain. raquel.reyto@gmail.com.
Raquel
R
Reyes
Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. afelius@santpau.cat.|Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica - Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, Av. Sant Antoni Ma Claret 167, 08025, Barcelona, Spain. afelius@santpau.cat.
Albert
A
Feliu-Soler
Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain. mdiazm.hcsc@salud.madrid.org.|Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Departamento de Psiquiatría, Universidad Complutense, Madrid, Spain. mdiazm.hcsc@salud.madrid.org.
Marina
M
Díaz-Marsá
Department of Psychiatry, Universitary Hospital Ramón y Cajal, CIBERSAM, IRYCIS, Madrid, Spain. jsaiz@psiquiatria.com.|Department of Psychiatry, Universidad de Alcalá, Madrid, Spain. jsaiz@psiquiatria.com.
Jerónimo
J
Saiz-Ruiz
Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. jsolerri@santpau.cat.|Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica - Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, Av. Sant Antoni Ma Claret 167, 08025, Barcelona, Spain. jsolerri@santpau.cat.
Joaquim
J
Soler
Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain. jcarrasco.hcsc@salud.madrid.org.|Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Departamento de Psiquiatría, Universidad Complutense, Madrid, Spain. jcarrasco.hcsc@salud.madrid.org.
Jose L
JL
Carrasco
D000328:Adult; D000553:Ambulatory Care; D001883:Borderline Personality Disorder / Q000523:psychology / Q000534:rehabilitation*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000534:rehabilitation; D056344:Executive Function / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008568:Memory / Q000502:physiology; D010353:Patient Education as Topic / Q000379:methods; D016896:Treatment Outcome