Treatment moderators of symptom severity in psychotherapy for people with borderline personality disorder: Systematic review with meta-analyses of individual participant data.

IF 9 1区医学 Q1 PSYCHIATRY

Psychotherapy and Psychosomatics Pub Date : 2025-10-24 DOI:10.1159/000548417

Johanne Pereira Ribeiro,Jutta Stoffers-Winterling,Mie Sedoc Jørgensen,Sophie Juul,Minoo Matbouriahi,David Fisher,Wouter van Ballegooijen,Mickey T Kongerslev,Erik Simonsen,Eirini Karyotaki,Pim Cuijpers,Anthony Bateman,Jan Philipp Klein,Federico Amianto,Peter Fonagy,Richard Porter,Katherine Dixon-Gordon,Alexander L Chapman,Kathleen Thomaes,Gitta A Jacob,Ueli Kramer,Björn Philips,Johan Franck,Elahe Majdara,Stefan Priebe,Andrew Chanen,Katie Nicol,Kim T Mueser,David Carlyle,Mary C Zanarini,Donald W Black,Shelley McMain,Jack Dekker,Ole Jakob Storebø

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引用次数: 0

Abstract

BACKGROUND Borderline personality disorder (BPD) is a complex and heterogeneous condition. Psychotherapy reduces symptom severity; however, characteristics of the individual may influence treatment outcomes. This systematic review examined whether specific baseline variables moderate the effect of psychotherapy on BPD severity through individual participant data meta-analysis (IPD-MA). METHODS A literature search up to 12 May 2025 across 10 databases (including PubMed, Medline, Embase, PsychINFO, CINAHL, Web of Science, and Cochrane CENTRAL) identified randomised clinical trials (RCTs) comparing psychotherapy to treatment as usual (TAU) or clinical management control interventions (CM) for BPD. Authors of included trials were contacted to retrieve IPD. IPD-MAs employed a one-stage random-effects approach to estimate treatment effects and potential moderators in bivariate linear mixed-effects models. The study was registered with PROSPERO (CRD42021210688). RESULTS Out of 33696 records identified, 42 RCTs (3848 participants) were eligible. IPD was obtained from 19 trials (1482 participants). All trials had an overall high risk of bias. There was a high rate of missing data across trials (378/1482, 25.1%). IPD-MA showed that psychotherapy significantly reduced BPD severity compared to TAU/CM (β: -.25, 95% CI: -.43 to -.07, SE: .09, p = .0065; 19 trials, 1104 participants). Significant negative moderators were co-occurring depressive disorder(s) (β: .31, 95% CI: .03 to .59) and exposure to sexual trauma (β: .60, 95% CI: .16 to 1.04). While positive moderators were co-occurring anxiety disorder(s) (β -.34, 95% CI: -.64 to -.03) and alcohol-use disorder(s) (AUD) (β -.34, 95% CI: -.67 to -.01). CONCLUSION Psychotherapy may be especially beneficial for BPD with co-occurring anxiety. Patients with co-occurring AUD should not be excluded from treatment; rather, treatment motivation should be emphasised. Further, clinicians should prioritise trauma-informed care.

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边缘型人格障碍患者心理治疗中症状严重程度的调节因素：个体参与者数据荟萃分析的系统回顾。

边缘型人格障碍（BPD）是一种复杂的异质性疾病。心理治疗减轻了症状的严重程度；然而，个体的特征可能会影响治疗结果。本系统综述通过个体参与者数据荟萃分析（IPD-MA）检验了特定基线变量是否能调节心理治疗对BPD严重程度的影响。方法通过截至2025年5月12日的10个数据库（包括PubMed、Medline、Embase、PsychINFO、CINAHL、Web of Science和Cochrane CENTRAL）的文献检索，确定了比较心理治疗与常规治疗（TAU）或临床管理控制干预（CM）治疗BPD的随机临床试验（rct）。我们联系纳入试验的作者检索IPD。IPD-MAs采用一阶段随机效应方法来估计双变量线性混合效应模型中的治疗效果和潜在调节因子。该研究已在PROSPERO注册（CRD42021210688）。结果在确定的33696条记录中，42项rct（3848名参与者）符合条件。IPD来自19项试验（1482名受试者）。所有试验的偏倚风险总体较高。所有试验的数据缺失率很高（378/1482,25.1%）。IPD-MA显示，与TAU/CM相比，心理治疗显著降低了BPD的严重程度(β: - 0.25, 95% CI: - 0.43至- 0.07,SE：。09, p = .0065；19项试验，1104名受试者)。显著负向调节因子为共发抑郁障碍(β：。31, 95% ci：。03到。59)和暴露于性创伤(β：。60, 95% ci：。16到1.04)。而正向调节因子是共发生的焦虑障碍（β - 0.34, 95% CI: - 0.64至- 0.03）和酒精使用障碍（AUD）（β - 0.34, 95% CI: - 0.67至- 0.01）。结论心理治疗对伴发焦虑的BPD尤其有效。合并AUD的患者不应被排除在治疗之外；相反，应该强调治疗动机。此外，临床医生应该优先考虑创伤知情护理。

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来源期刊

Psychotherapy and Psychosomatics 医学-精神病学

CiteScore

29.40

自引率

6.10%

发文量

期刊介绍： Psychotherapy and Psychosomatics is a reputable journal that has been published since 1953. Over the years, it has gained recognition for its independence, originality, and methodological rigor. The journal has been at the forefront of research in psychosomatic medicine, psychotherapy research, and psychopharmacology, and has contributed to the development of new lines of research in these areas. It is now ranked among the world's most cited journals in the field. As the official journal of the International College of Psychosomatic Medicine and the World Federation for Psychotherapy, Psychotherapy and Psychosomatics serves as a platform for discussing current and controversial issues and showcasing innovations in assessment and treatment. It offers a unique forum for cutting-edge thinking at the intersection of medical and behavioral sciences, catering to both practicing clinicians and researchers. The journal is indexed in various databases and platforms such as PubMed, MEDLINE, Web of Science, Science Citation Index, Social Sciences Citation Index, Science Citation Index Expanded, BIOSIS Previews, Google Scholar, Academic Search, and Health Research Premium Collection, among others.