DBT for Co-morbid Borderline Personality Disorder and Substance use Disorder Without Drug Replacement in Egyptian Outpatient Settings: A Non-randomized Trial

BackgroundDialectical behavior therapy has demonstrated effectiveness for patients suffering from co-morbid borderline personality and substance use disorder. The current study tries to replicate results of previous studies in a mixed gender sample of Egyptian outpatients.AimThe aim of the current study was to examine the effectiveness of DBT without drug replacement relative to treatment as usual “TAU” in improving behavioral outcomes related to SUD and BPD, and improving emotional regulation.MethodsForty outpatients with co-morbid BPD and SUD in Alexandria and Cairo were assigned for one year either to comprehensive DBT program (20 patients), or TAU defined as ongoing outpatient psychotherapeutic treatment from referring center (20 patients). Patients were assessed at baseline and follow up assessment at 4, 8, 12 and 16 months was done using Arabic version of Difficulties in Emotion Regulation Scale (DERS), urine multidrug screen and time line follow-back method for assessment of alcohol and substance use history.ResultsFollowing one year of treatment, DBT group showed significantly lower doses of drugs used, DERS score, rates of hospital admission, ER visits, suicidal attempts and episodes of NSSI. Also, DBT patients showed markedly increased retention in treatment and longer duration of total alcohol abstinence and other drugs of abuse. Positive outcomes were maintained for four months post-treatment.ConclusionDBT demonstrated superior efficacy in comparison to TAU for treatment of Egyptian patients suffering from co-morbid borderline personality and substance use disorder across behavioral domains of SUD, BPD and reduction hospital admission, emergency room visits and DERS score.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Effectiveness of Psychological Treatments for Borderline Personality Disorder and Predictors of Treatment Outcomes: A Multivariate Multilevel Meta-Analysis of Data from All Design Types

Journal of Clinical Medicine ◽

10.3390/jcm10235622 ◽

2021 ◽

Vol 10 (23) ◽

pp. 5622

Author(s):

Sophie A. Rameckers ◽

Rogier E. J. Verhoef ◽

Raoul P. P. P. Grasman ◽

Wouter R. Cox ◽

Arnold A. P. van Emmerik ◽

...

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Dialectical Behavior Therapy ◽

Treatment Effectiveness ◽

Meta Analysis ◽

Borderline Personality ◽

Effect Sizes ◽

Sensitivity Analyses ◽

Treatment As Usual ◽

Logarithmic Relationship

We examined the effectiveness of psychotherapies for adult Borderline Personality Disorder (BPD) in a multilevel meta-analysis, including all trial types (PROSPERO ID: CRD42020111351). We tested several predictors, including trial- and outcome type (continuous or dichotomous), setting, BPD symptom domain and mean age. We included 87 studies (N = 5881) from searches between 2013 and 2019 in four databases. We controlled for differing treatment lengths and a logarithmic relationship between treatment duration and effectiveness. Sensitivity analyses were conducted by excluding outliers and by prioritizing total scale scores when both subscale and total scores were reported. Schema Therapy, Mentalization-Based Treatment and reduced Dialectical Behavior Therapy were associated with higher effect sizes than average, and treatment-as-usual with lower effect sizes. General severity and affective instability showed the strongest improvement, dissociation, anger, impulsivity and suicidality/self-injury the least. Treatment effectiveness decreased as the age of participants increased. Dichotomous outcomes were associated to larger effects, and analyses based on last observation carried forward to smaller effects. Compared to the average, the highest reductions were found for certain specialized psychotherapies. All BPD domains improved, though not equally. These findings have a high generalizability. However, causal conclusions cannot be drawn, although the design type did not influence the results.

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Specialized psychotherapies for adults with borderline personality disorder: A systematic review and meta-analysis

Australian & New Zealand Journal of Psychiatry ◽

10.1177/0004867418791257 ◽

2018 ◽

Vol 52 (10) ◽

pp. 949-961 ◽

Cited By ~ 21

Author(s):

Matthijs Oud ◽

Arnoud Arntz ◽

Marleen LM Hermens ◽

Rogier Verhoef ◽

Tim Kendall

Keyword(s):

Systematic Review ◽

Borderline Personality Disorder ◽

Personality Disorder ◽

Confidence Interval ◽

Dialectical Behavior Therapy ◽

Borderline Personality ◽

Medium Effect ◽

Treatment As Usual ◽

Standardized Mean Difference ◽

Quality Evidence

Objective: Borderline personality disorder affects up to 2% of the population and is associated with poor functioning, low quality of life and increased mortality. Psychotherapy is the treatment of choice, but it is unclear whether specialized psychotherapies (dialectical behavior therapy, mentalization-based treatment, transference-focused therapy and schema therapy) are more effective than non-specialized approaches (e.g. protocolized psychological treatment, general psychiatric management). The aim of this systematic review is to investigate the effectiveness of these psychotherapies. Methods: PubMed, PsycINFO, CINAHL, EMBASE and CENTRAL were searched from inception to November 2017. Included randomized controlled trials were assessed on risk of bias and outcomes were meta-analyzed. Confidence in the results was assessed using the Grading of Recommendations Assessment, Development and Evaluation method. The review has been reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: A total of 20 studies with 1375 participants were included. Specialized psychotherapies, when compared to treatment as usual or community treatment by experts, were associated with a medium effect based on moderate quality evidence on overall borderline personality disorder severity (standardized mean difference = –0.59 [95% confidence interval: –0.90, –0.28]), and dialectical behavior therapy, when compared to treatment as usual, with a small to medium effect on self-injury (standardized mean difference = –0.40 [95% confidence interval: –0.66, –0.13]). Other effect estimates were often inconclusive, mostly due to imprecision. Conclusion: There is moderate quality evidence that specialized psychotherapies are effective in reducing overall borderline personality disorder severity. However, further research should identify which patient groups profit most of the specialized therapies.

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