Efficacy of Time-limited Psychodynamic Psychotherapy and Informed Clinical Management in BPD High MHS Users
Condition: Heavy MHS Use; General Psychopathology; Working Alliance
Study type: Interventional

Summary: 
      Subjects affected with severe Borderline Personality Disorder (BPD) are often heavy users of
      Mental Health Services (MHS). This study evaluates the efficacy of the addition of Sequential
      Brief Adlerian Psychodynamic Psychotherapy (SB-APP) to the treatment-as-usual (TAU) for BPD
      compared to the TAU alone for a naturalistic group of heavy MHS users with BPD. The efficacy
      was evaluated after at 6 time points along a two years of follow-up.

      Thirty-five outpatients eligible for the study were randomly assigned to two treatment groups
      (TAU=17; SB-APP=18). The Clinical Global Impression (CGI) and the CGI-modified (CGI-M) for
      BPD, the Global Assessment of Functioning (GAF), the State-Trait Anger Expression Inventory
      (STAXI), and the Symptom Checklist-90 Revised (SCL-90-R) were administered at T1, T3, T6,
      T12, T18, and T24. At T12 also the Working Alliance Inventory-Short Form (WAI-S) was
      filled-in by participants and compared between groups. In the one-year follow-up the SB-APP
      group did not receive any individual psychological support. MHS was specifically trained in
      BPD treatment and had regular supervisions.

      Scores of the CGI, GAF, and STAXI improved after 6 and 12 months, irrespective of treatment.
      SB-APP group displayed a better outcome for impulsivity, suicide attempts, chronic feelings
      of emptiness and disturbed relationships. The results displayed a good stabilization during
      follow-up year even after the interruption of psychotherapy in the SB-APP group.

      Even though the TAU for BPD applied to heavy MSH users displayed some efficacy in reducing
      symptom expression and improving global functioning, the adjunct of a specific time-limited
      and focused psychotherapeutic treatment reached a better outcome. In particular the
      possibility of a focus on patients' personality functioning (SB-APP) with a specific
      psychotherapeutic approach seemed to be more effective than the general support to social
      impairment offered by the TAU approach.
    


Intervention name(s): SB-APP; treatment as usual
Intervention type(s): Other; Other
Intervention description(s): SB-APP, derived from Brief-Adlerian Psychodynamic Psychotherapy (B-APP) is a time-limited (40 weekly sessions) psychodynamic psychotherapy based on Alfred Adler's theory and delivered in sequential and repeatable modules.
SB-APP is focused specifically on four personality functioning levels (PFL). These are assessed by the therapists on the basis of symptoms, quality of interpersonal relationships, overall social behaviors, cognitive and emotional patterns, and defense mechanisms; This treatment consisted in a combination of medication, unstructured psychological support focused on socio-relational impairment and rehabilitative interventions provided by nurses and educators.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Health Services Research
Keywords: BPD; MHS; heavy users; sequential psychotherapy