Treatment modifiers of interpersonal functioning in psychotherapy for people with borderline personality disorder: Systematic review with meta-analyses of individual participant data

IF 11.2 1区心理学 Q1 PSYCHOLOGY, CLINICAL

Clinical Psychology Review Pub Date : 2026-03-01 Epub Date: 2026-01-27 DOI:10.1016/j.cpr.2026.102707

Johanne Pereira Ribeiro , Jutta Stoffers-Winterling , Mie Sedoc Jørgensen , Sophie Juul , Minoo Matbouriahi , David Fisher , Wouter van Ballegooijen , Mickey Kongerslev , Erik Simonsen , Eirini Karyotaki , Pim Cuijpers , Anthony Bateman , Jan Philipp Klein , Federico Amianto , Peter Fonagy , Katherine Dixon-Gordon , Alexander L. Chapman , Kathleen Thomaes , Gitta A. Jacob , Ueli Kramer , Ole Jakob Storebø

{"title":"Treatment modifiers of interpersonal functioning in psychotherapy for people with borderline personality disorder: Systematic review with meta-analyses of individual participant data","authors":"Johanne Pereira Ribeiro , Jutta Stoffers-Winterling , Mie Sedoc Jørgensen , Sophie Juul , Minoo Matbouriahi , David Fisher , Wouter van Ballegooijen , Mickey Kongerslev , Erik Simonsen , Eirini Karyotaki , Pim Cuijpers , Anthony Bateman , Jan Philipp Klein , Federico Amianto , Peter Fonagy , Katherine Dixon-Gordon , Alexander L. Chapman , Kathleen Thomaes , Gitta A. Jacob , Ueli Kramer , Ole Jakob Storebø","doi":"10.1016/j.cpr.2026.102707","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Borderline personality disorder (BPD) is often accompanied by interpersonal dysfunction. Psychotherapy can improve interpersonal functioning, but individual characteristics may moderate outcomes. This systematic review used individual participant data meta-analysis (IPD-MA) to examine such moderators.</div></div><div><h3>Method</h3><div>A literature search up to 26 November 2025 across 10 databases (including PubMed, Medline, Embase, PsychINFO, CINAHL, Web of Science, and Cochrane CENTRAL) identified randomised clinical trials (RCTs) investigating the effects of psychotherapy on interpersonal functioning in individuals with BPD compared to treatment as usual (TAU) or clinical management control interventions (CM). Authors of included trials were contacted to retrieve IPD. IPD-MAs employed a one-stage random-effects approach to estimate treatment effects on interpersonal functioning and potential moderators in bivariate linear mixed-effects models. The study was registered with PROSPERO (CRD42021210688).</div></div><div><h3>Results</h3><div>Out of 23,735 identified records, 32 RCTs (2762 participants) met inclusion criteria. Individual participant data (IPD) were available for 17 trials (1431 participants). All trials were rated as having either high risk of bias or some concerns. Missing data were common, with 321 out of 1431 participants (23%) lost to follow-up. Meta-analyses of both aggregate data and IPD yielded comparable effect estimates, though statistical significance differed (IPD-MA: β = −0.21, CI: −0.45 to −0.02, SE = 0.12, <em>p</em> = 0.0778; 17 trials, 1071 participants). In unadjusted analyses, the presence of co-occurring anxiety disorder(s) (β = −0.40, 95% CI: −0.73 to −0.08) and a higher number of co-occurring disorders (β = −0.08, 95% CI: −0.15 to −0.01) were associated with larger treatment effects (not significant after alpha correction).</div></div><div><h3>Conclusion</h3><div>Psychotherapy appears to be effective for individuals with BPD. Although moderator effects did not remain statistically significant after alpha correction, unadjusted analyses suggested larger treatment effects in individuals with co-occurring anxiety and greater clinical complexity. Importantly, these findings indicate that such comorbidities may not be a contraindication for psychotherapy for BPD.</div></div>","PeriodicalId":48458,"journal":{"name":"Clinical Psychology Review","volume":"124 ","pages":"Article 102707"},"PeriodicalIF":11.2000,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Psychology Review","FirstCategoryId":"102","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0272735826000164","RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/1/27 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"PSYCHOLOGY, CLINICAL","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Borderline personality disorder (BPD) is often accompanied by interpersonal dysfunction. Psychotherapy can improve interpersonal functioning, but individual characteristics may moderate outcomes. This systematic review used individual participant data meta-analysis (IPD-MA) to examine such moderators.

Method

A literature search up to 26 November 2025 across 10 databases (including PubMed, Medline, Embase, PsychINFO, CINAHL, Web of Science, and Cochrane CENTRAL) identified randomised clinical trials (RCTs) investigating the effects of psychotherapy on interpersonal functioning in individuals with BPD compared to treatment as usual (TAU) or clinical management control interventions (CM). Authors of included trials were contacted to retrieve IPD. IPD-MAs employed a one-stage random-effects approach to estimate treatment effects on interpersonal functioning and potential moderators in bivariate linear mixed-effects models. The study was registered with PROSPERO (CRD42021210688).

Results

Out of 23,735 identified records, 32 RCTs (2762 participants) met inclusion criteria. Individual participant data (IPD) were available for 17 trials (1431 participants). All trials were rated as having either high risk of bias or some concerns. Missing data were common, with 321 out of 1431 participants (23%) lost to follow-up. Meta-analyses of both aggregate data and IPD yielded comparable effect estimates, though statistical significance differed (IPD-MA: β = −0.21, CI: −0.45 to −0.02, SE = 0.12, p = 0.0778; 17 trials, 1071 participants). In unadjusted analyses, the presence of co-occurring anxiety disorder(s) (β = −0.40, 95% CI: −0.73 to −0.08) and a higher number of co-occurring disorders (β = −0.08, 95% CI: −0.15 to −0.01) were associated with larger treatment effects (not significant after alpha correction).

Conclusion

Psychotherapy appears to be effective for individuals with BPD. Although moderator effects did not remain statistically significant after alpha correction, unadjusted analyses suggested larger treatment effects in individuals with co-occurring anxiety and greater clinical complexity. Importantly, these findings indicate that such comorbidities may not be a contraindication for psychotherapy for BPD.

查看原文本刊更多论文

边缘型人格障碍患者心理治疗中人际功能的治疗修饰因素：个体参与者数据荟萃分析的系统回顾

边缘型人格障碍（BPD）常伴有人际关系障碍。心理治疗可以改善人际功能，但个体特征可能会缓和结果。本系统综述使用个体参与者数据荟萃分析（IPD-MA）来检查这些调节因子。方法通过截至2025年11月26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，确定了随机临床试验（rct），研究心理治疗与常规治疗（TAU）或临床管理控制干预（CM）相比对BPD患者人际功能的影响。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治疗对人际功能的影响以及双变量线性混合效应模型中的潜在调节因子。该研究已在PROSPERO注册（CRD42021210688）。结果在23,735条确定的记录中，32项rct（2762名受试者）符合纳入标准。17项试验（1431名受试者）的个体参与者数据（IPD）可用。所有的试验都被评为具有高偏倚风险或存在一些问题。数据丢失很常见，1431名参与者中有321名（23%）失去了随访。汇总数据和IPD的荟萃分析产生了可比较的效应估计，尽管具有统计学意义（IPD- ma: β = - 0.21, CI: - 0.45至- 0.02,SE = 0.12, p = 0.0778； 17项试验，1071名受试者）。在未调整的分析中，共存焦虑症（β = - 0.40, 95% CI: - 0.73至- 0.08）和共存焦虑症（β = - 0.08, 95% CI: - 0.15至- 0.01）的存在与更大的治疗效果相关（α校正后无显著性）。结论心理治疗对BPD患者有效。虽然在alpha校正后，调节效应在统计上并不显著，但未经调整的分析表明，在同时发生焦虑和更大临床复杂性的个体中，治疗效果更大。重要的是，这些发现表明，这些合并症可能不是BPD心理治疗的禁忌症。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical Psychology Review PSYCHOLOGY, CLINICAL-

CiteScore

23.10

自引率

1.60%

发文量

期刊介绍： Clinical Psychology Review serves as a platform for substantial reviews addressing pertinent topics in clinical psychology. Encompassing a spectrum of issues, from psychopathology to behavior therapy, cognition to cognitive therapies, behavioral medicine to community mental health, assessment, and child development, the journal seeks cutting-edge papers that significantly contribute to advancing the science and/or practice of clinical psychology. While maintaining a primary focus on topics directly related to clinical psychology, the journal occasionally features reviews on psychophysiology, learning therapy, experimental psychopathology, and social psychology, provided they demonstrate a clear connection to research or practice in clinical psychology. Integrative literature reviews and summaries of innovative ongoing clinical research programs find a place within its pages. However, reports on individual research studies and theoretical treatises or clinical guides lacking an empirical base are deemed inappropriate for publication.