title: Efficacy of Psychotherapies for Borderline Personality Disorder: A Systematic Review and Meta-analysis.
abstract: OBJECTIVE
  Borderline personality disorder (BPD) is a debilitating condition, but several psychotherapies are considered effective.
  
  
  OBJECTIVE
  To conduct an updated systematic review and meta-analysis of randomized clinical trials to assess the efficacy of psychotherapies for BPD populations.
  
  
  METHODS
  Search terms were combined for borderline personality and randomized trials in PubMed, PsycINFO, EMBASE, and the Cochrane Central Register of Controlled Trials (from database inception to November 2015), as well as the reference lists of earlier meta-analyses.
  
  
  METHODS
  Included were randomized clinical trials of adults with diagnosed BPD randomized to psychotherapy exclusively or to a control intervention. Study selection differentiated stand-alone designs (in which an independent psychotherapy was compared with control interventions) from add-on designs (in which an experimental intervention added to usual treatment was compared with usual treatment alone).
  
  
  METHODS
  Data extraction coded characteristics of trials, participants, and interventions and assessed risk of bias using 4 domains of the Cochrane Collaboration Risk of Bias tool (independent extraction by 2 assessors). Outcomes were pooled using a random-effects model. Subgroup and meta-regression analyses were conducted.
  
  
  METHODS
  Standardized mean differences (Hedges g) were calculated using all outcomes reported in the trials for borderline symptoms, self-harm, suicide, health service use, and general psychopathology at posttest and follow-up. Differential treatment retention at posttest was analyzed, reporting odds ratios.
  
  
  RESULTS
  Thirty-three trials (2256 participants) were included. For borderline-relevant outcomes combined (symptoms, self-harm, and suicide) at posttest, the investigated psychotherapies were moderately more effective than control interventions in stand-alone designs (g = 0.32; 95% CI, 0.14-0.51) and add-on designs (g = 0.40; 95% CI, 0.15-0.65). Results were similar for other outcomes, including stand-alone designs: self-harm (g = 0.32; 95% CI, 0.09-0.54), suicide (g = 0.44; 95% CI, 0.15-0.74), health service use (g = 0.40; 95% CI, 0.22-0.58), and general psychopathology (g = 0.32; 95% CI, 0.09-0.55), with no differences between design types. There were no significant differences in the odds ratios for treatment retention (1.32; 95% CI, 0.87-2.00 for stand-alone designs and 1.01; 95% CI, 0.55-1.87 for add-on designs). Thirteen trials reported borderline-relevant outcomes at follow-up (g = 0.45; 95% CI, 0.15-0.75). Dialectical behavior therapy (g = 0.34; 95% CI, 0.15-0.53) and psychodynamic approaches (g = 0.41; 95% CI, 0.12-0.69) were the only types of psychotherapies more effective than control interventions. Risk of bias was a significant moderator in subgroup and meta-regression analyses (slope β = -0.16; 95% CI, -0.29 to -0.03; P = .02). Publication bias was persistent, particularly for follow-up.
  
  
  CONCLUSIONS
  Psychotherapies, most notably dialectical behavior therapy and psychodynamic approaches, are effective for borderline symptoms and related problems. Nonetheless, effects are small, inflated by risk of bias and publication bias, and particularly unstable at follow-up.
authors.affiliation: Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj-Napoca, Romania2Department of General Psychology, University of Padova, Padova, Italy3Meta-Research Innovation Center at Stanford, Stanford University, Stanford, California.
authors.forename: Ioana A
authors.initials: IA
authors.lastname: Cristea
authors.affiliation: Department of General Psychology, University of Padova, Padova, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Gentili
authors.affiliation: Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj-Napoca, Romania.
authors.forename: Carmen D
authors.initials: CD
authors.lastname: Cotet
authors.affiliation: Department of General Psychology, University of Padova, Padova, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Palomba
authors.affiliation: Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Barbui
authors.affiliation: Department of Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, the Netherlands.
authors.forename: Pim
authors.initials: P
authors.lastname: Cuijpers
mesh_terms: D001521:Behavior Therapy; D001883:Borderline Personality Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D006801:Humans; D011613:Psychotherapy; D064889:Psychotherapy, Psychodynamic; D016032:Randomized Controlled Trials as Topic; D016728:Self-Injurious Behavior / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D013405:Suicide / Q000523:psychology; D016896:Treatment Outcome; D000092864:Suicide Prevention