A Systematic Review of Dialectical Behaviour Therapy, Mentalisation-Based Treatment and Internal Family Systems Therapy for Borderline Personality Disorder with Comorbid Depression and/or Anxiety
Description
Borderline Personality Disorder (BPD) is highly comorbid with depression and anxiety, creating additional difficulty in treating the conditions and poorer prognosis than BPD alone. Dialectical behaviour therapy (DBT) and Mentalisation-Based Treatment (MBT) are specialised psychotherapies for BPD that have demonstrated positive effects for reducing BPD symptoms and scores on depression and anxiety measures. Although developed for treating PTSD, Internal Family Systems (IFS) therapy is effective for addressing past trauma that is also common in BPD. This systematic review investigated the effectiveness of DBT, MBT and IFS for treating BPD with comorbid depression and/or anxiety (BPD+D/A). Using the PRISMA protocol, five academic databases were searched for relevant studies and relevant treatment outcomes. Findings were extracted from 12 included studies. This review found that DBT and MBT demonstrated significant reductions in BPD and depressive/anxious symptomatology, emotional and interpersonal difficulties, and impulsive behaviours. These therapeutic approaches also demonstrated reduced numbers of visits to emergency departments, reduced numbers of contacts with mental health services and reduced duration of contacts. No studies around IFS therapy outcomes for BPD+D/A were obtained. These findings are concordant with past research and have implications for increasing the use of DBT and MBT within BPD+D/A populations. Findings also demonstrate the effectiveness of brief DBT interventions that could be expanded as a more practical option for service users with BPD who experience frequent crisis periods and may struggle to commit to a traditional 12-month program.
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This systematic review was conducted according to the PRISMA protocol for systematic reviews (Moher, Liberati, Tetzlaff, Altman, & PRISMA Group., 2009) and using CADIMA, an online software tool for systematic reviews. This included searching five research databases for relevant studies which were PubMed, PsychINFO, MEDLINE with Full Text, Web of Science, and Academic Search Complete. Any duplicate studies were removed, and the remaining were screened according to the relevant inclusion/exclusion criteria. Studies deemed irrelevant after reviewing the titles and abstracts were excluded, followed by those deemed irrelevant after reviewing the full texts of the studies. Twelve studies were included in the review following this process. Relevant data was extracted from the twelve included studies and the quality of the reporting and methodology of the studies was assessed using the Downs and Black (1998) quality assessment tool.