Dutch Study Shows Promise

Here’s an article published in JAMA journal the Archives of
General Psychiatry (http://archpsyc.ama-assn.org/) on June 5th, 2006:

Recovery possible for Borderline Patients

Dutch investigators prove effectiveness of new treatment.

For the first time in history it has been proven that Borderline
Personality Disorder can be effectively treated in its full range.
Investigators of Maastricht University, Vrije Universiteit Amsterdam, and Leiden University published in the June 2006 issue of the JAMA journal the Archives of General Psychiatry a study into the effectiveness of two psychotherapies for borderline patients. The study demonstrates that Schema focused therapy leads to complete recovery in about 50% of the patients, and in two-thirds to a significant improvement. The success of the therapies is strongly related to their duration and intensity (two sessions a week for three years). The results clearly contradict common ideas that borderline personality disorder cannot be fully cured, and that prolonged psychotherapy is useless.

Borderline Personality Disorder is generally known as “untreatable” and is quite common in the general population: 1 to 2.5 % of the population suffers from it. Characteristics are chronic instability, emotional dysregulation, self-mutilation, suicidal behaviour, impulsivity, abandonment fears, anger attacks, identity problems, and low stress tolerance. The medical and societal costs are high, and many of these people cannot participate in the labour process, or don’t function at levels that could be expected given their intellectual capacities. Usual care is limited in effectiveness, and even the best treatments so far can only successfully address a minority of the borderline problems.

Dr. Josephine Giesen-Bloo, Dr. Arnoud Arntz (projectleader), Dr. Philip Spinhoven, Dr. Richard van Dyck and other investigators of the universities mentioned above compared in the study two treatments for borderline personality disorder: Schema focused therapy (SFT) and
Transference focused psychotherapy (TFP). 86 patients recruited in 4 mental health institutes in the Netherlands (Maastricht, Amsterdam, The Hague, and Leiden) received two sessions SFT or TFP a week for 3 years. The effects of the treatments were assessed with 4 criteria:
borderline-symptoms (BPDSI-IV-score), general psychopathological symptoms, personality characteristics, and quality of life. During the 3 years assessments were conducted every 3 months. In 24% (TFP) and 46% (SFT) of the patients treatment led to full recovery. One year later the percentages even increased to 52% (SFT) and 29% (TFP). In the SFT condition two-thirds of the patients improved to a significant degree. On the other 3 criteria effects were also positive and in favour of SFT.

Positive effects became apparent after one year, with continuing
improvement in years 2-4. The investigators conclude that both
treatments have positive effects, with a clearly higher effectivity of SFT. Moreover, the lower dropout rate indicates that SFT induces a higher treatment allegiance in the patients than TFP.

SFT is a cognitive-behavioral therapy, in which patients acquire
insights in the patterns that underlie their problems. For borderline personality disorders these are classified into 4 standardized patterns, called schemas. By means of behavioural, cognitive and experiential techniques the disorder is treated. The treatment focuses on the relationship with the therapist, on daily life outside of therapy, and on traumatic childhood experiences (which are very common in this disorder).

TFP is a psychodynamic therapy. At start, a treatment contract is agreed upon, which remains at the centre during treatment. By continuous analysis and interpretation of the mutual relationship a structural change in personality of the patient is brought about.

Thus, both treatments address the problems at the level of the personality, whereas most common treatments are restricted to the reduction of specific symptoms of the disorder (i.e., self-destructive
behaviors).

The investigators plead for the recognition of SFT as an evidenced based treatment of borderline personality disorder. Despite the high number of sessions and the long duration, they observed that the treatment is cost-effective, as it leads to an immediate cost-reduction for society of 4500 Euros per patient per year, already during treatment. The common idea that prolonged psychotherapy is unjustified is, at least in the case of SFT for borderline personality disorder, incorrect.