Supplementary Online Content...4. Blum N, St John D, Pfohl B, et al. Systems Training for Emotional...

Supplementary Online Content

Cristea IA, Gentili C, Cotet CD, Palomba D, Barbui C, Cuijpers P. Efficacy of psychotherapies for borderline personality disorder: a systematic review and meta-analysis. JAMA Psychiatry. Published online March 1, 2017. doi:10.1001/jamapsychiatry.2016.4287

eMethods. Supplemental Methods eFigure 1. Flowchart of Selection and Inclusion Process, Following the PRISMA Statement eFigure 2. Risk of Bias Graph: Review Authors’ Judgments About Each Risk of Bias Item Presented as Percentages Across All Included Studies eFigure 3. Standardized Posttest Effect Sizes of Comparisons Between Investigated Psychotherapies and Control Conditions on Borderline Relevant Outcomes for a) Stand-alone Designs and b) Add-on Designs eFigure 4. Standardized Follow-up Effect Sizes of Comparisons Between Investigated Psychotherapies and Control Conditions on Borderline Relevant Outcomes for All Trials eFigure 5. Effects of Trial Risk of Bias (Number of Sources Rated as Low Risk) Posttest Borderline Relevant Outcomes: Meta-regression Analysis eFigure 6. Funnel Plots for Borderline Relevant Outcomes for a) Posttest (With Imputed Trials) and b) Follow-up (With Imputed Trials) eTable 1. Selected Characteristics of Included Studies eTable 2. Classification of Trial Characteristics as Used in the Subgroup and Meta-Regression Analysis This supplementary material has been provided by the authors to give readers additional information about their work.

© 2017 American Medical Association. All rights reserved.

Downloaded From: https://jamanetwork.com/ by a Non-Human Traffic (NHT) User on 05/08/2021

eMethods. Supplemental Methods Complete search string Pubmed: “borderline personality” Filter: Clinical trials Date: November 6th 2015; Hits: 230 Risk of bias (RoB) and data extraction Selective outcome reporting was not rated since inspection of the reports of the included trials revealed that only 6 out of 33 reported a trial registration number, 1 had a previously published protocol, and another referred to an unpublished one. Since trial registration is only the first step in looking at information for selective outcome reporting, we would have most likely been in the situation of rating most trials as unclear. The earliest of the six registered trials was conducted in 2008. We also computed Cohen’s Kappa inter-rater agreement for each of the four domains of the Cochrane Risk of Bias tool, prior to resolving disagreements. The Kappa inter-rater agreement coefficients were 0.88 for sequence generation, 0.95 for concealment of allocation, 0.90 for blinding for outcome assessors and 0.83 for dealing with incomplete data, showing high inter-rater agreement even prior to resolving disagreements. Handling of dichotomous data

Dichotomous data was handled staying as true to the intent-to-treat (ITT) principle as possible. For dichotomous symptom outcomes (e.g., number of patients with self-harm, suicide attempts or hospitalizations), we used the imputed or observed number of patients with the event, reported in the original article (e.g., how many participants attempted suicide or were hospitalized in each group). In calculating group rates for the event, we reported this number to the total number of participants randomized in that group. Specifically, in the cases where the authors of the original trial performed imputation themselves to account for missing data, we used their imputed data. However, in the cases where they just provided the observed count for an event (e.g., how many hospitalized or with suicide attempts), we made sure that this number was reported to the number of participants initially randomized in the group in question (and not the number of participants who stayed in treatment or whom the authors for various reasons decided to retain in their analysis).

Drop-outs are a particular case of dichotomous outcome, because in this case it was generally possible to reconstruct patient level data. Drop-outs were defined as any participant who did not finish treatment., regardless of the reasons. We perused the report of the trial for all the information available regarding drop-outs post-randomization (the PRISMA diagram, information in the text and tables) so as to “reconstruct” the exact number of drop-outs. Again, this number was reported to the total number of randomized participants in each group.



eReferences. List of studies included in the meta-analysis

1. Amianto F, Ferrero A, Pierò A, et al. Supervised team management, with or without structured psychotherapy, in heavy users of a mental health service with borderline personality disorder: a two-year follow-up preliminary randomized study. BMC Psychiatry. 2011;11:181. doi:10.1186/1471-244X-11-181.

2. Bateman A, Fonagy P. Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial. Am J Psychiatry. 1999;156(10):1563-1569. doi:10.1176/ajp.156.10.1563.

3. Bateman A, Fonagy P. Randomized controlled trial of outpatient mentalization-based treatment versus structured clinical management for borderline personality disorder. Am J Psychiatry. 2009;166(12):1355-1364. doi:10.1176/appi.ajp.2009.09040539.

4. Blum N, St John D, Pfohl B, et al. Systems Training for Emotional Predictability and Problem Solving (STEPPS) for outpatients with borderline personality disorder: a randomized controlled trial and 1-year follow-up. Am J Psychiatry. 2008;165(4):468-478. doi:10.1176/appi.ajp.2007.07071079.

5. Bos EH, van Wel EB, Appelo MT, Verbraak MJPM. A randomized controlled trial of a Dutch version of systems training for emotional predictability and problem solving for borderline personality disorder. J Nerv Ment Dis. 2010;198(4):299-304. doi:10.1097/NMD.0b013e3181d619cf.

6. Carter GL, Willcox CH, Lewin TJ, Conrad AM, Bendit N. Hunter DBT project: randomized controlled trial of dialectical behaviour therapy in women with borderline personality disorder. Aust N Z J Psychiatry. 2010;44(2):162-173. doi:10.3109/00048670903393621.

7. Clarkin JF, Levy KN, Lenzenweger MF, Kernberg OF. Evaluating three treatments for borderline personality disorder: a multiwave study. Am J Psychiatry. 2007;164(6):922-928. doi:10.1176/ajp.2007.164.6.922.

8. Cottraux J, Note ID, Boutitie F, et al. Cognitive therapy versus Rogerian supportive therapy in borderline personality disorder. Two-year follow-up of a controlled pilot study. Psychother Psychosom. 2009;78(5):307-316. doi:10.1159/000229769.

9. Davidson K, Norrie J, Tyrer P, et al. The effectiveness of cognitive behavior therapy for borderline personality disorder: results from the borderline personality disorder study of cognitive therapy (BOSCOT) trial. J Pers Disord. 2006;20(5):450-465. doi:10.1521/pedi.2006.20.5.450.

10. Doering S, Hörz S, Rentrop M, et al. Transference-focused psychotherapy v. treatment by community psychotherapists for borderline personality disorder: randomised controlled trial. Br J Psychiatry. 2010;196(5):389-395. doi:10.1192/bjp.bp.109.070177.

11. Farrell JM, Shaw IA, Webber MA. A schema-focused approach to group psychotherapy for outpatients with borderline personality disorder: a randomized controlled trial. J Behav Ther Exp Psychiatry. 2009;40(2):317-328. doi:10.1016/j.jbtep.2009.01.002.

12. Gratz KL, Gunderson JG. Preliminary data on an acceptance-based emotion regulation group intervention for deliberate self-harm among women with



borderline personality disorder. Behav Ther. 2006;37(1):25-35. doi:10.1016/j.beth.2005.03.002.

13. Gratz KL, Tull MT, Levy R. Randomized controlled trial and uncontrolled 9-month follow-up of an adjunctive emotion regulation group therapy for deliberate self-harm among women with borderline personality disorder. Psychol Med. 2014;44(10):2099-2112. doi:10.1017/S0033291713002134.

14. Gregory RJ, Chlebowski S, Kang D, et al. A controlled trial of psychodynamic psychotherapy for co-occurring borderline personality disorder and alcohol use disorder. Psychotherapy (Chic). 2008;45(1):28-41. doi:10.1037/0033-3204.45.1.28.

15. Jørgensen CR, Freund C, Bøye R, Jordet H, Andersen D, Kjølbye M. Outcome of mentalization-based and supportive psychotherapy in patients with borderline personality disorder: a randomized trial. Acta Psychiatr Scand. 2013;127(4):305-317. doi:10.1111/j.1600-0447.2012.01923.x.

16. Kamalabadi MJ, Ahmadi SA, Etemadi O, Fatehizadeh M, Bahrami F, Firoozabadi A. A study of the effect of couple dialectical behavioral therapy on symptoms and quality of marital relationships and mental health of Iranian borderline personality couples: A controlled trial. SOURCE Interdisciplinary Journal of Contemporary Research in Business. 3(9):1480-1487.

17. Koons CR, Robins CJ, Lindsey Tweed J, et al. Efficacy of dialectical behavior therapy in women veterans with borderline personality disorder. Behavior Therapy. 2001;32(2):371-390. doi:10.1016/S0005-7894(01)80009-5.

18. Kramer U, Berger T, Kolly S, et al. Effects of motive-oriented therapeutic relationship in early-phase treatment of borderline personality disorder: a pilot study of a randomized trial. J Nerv Ment Dis. 2011;199(4):244-250. doi:10.1097/NMD.0b013e3182125d19.

19. Kramer U, Kolly S, Berthoud L, et al. Effects of motive-oriented therapeutic relationship in a ten-session general psychiatric treatment of borderline personality disorder: a randomized controlled trial. Psychother Psychosom. 2014;83(3):176-186. doi:10.1159/000358528.

20. Leppänen V, Hakko H, Sintonen H, Lindeman S. Comparing Effectiveness of Treatments for Borderline Personality Disorder in Communal Mental Health Care: The Oulu BPD Study. Community Ment Health J. 2016;52(2):216-227. doi:10.1007/s10597-015-9866-4.

21. Linehan MM, Dimeff LA, Reynolds SK, et al. Dialectical behavior therapy versus comprehensive validation therapy plus 12-step for the treatment of opioid dependent women meeting criteria for borderline personality disorder. Drug Alcohol Depend. 2002;67(1):13-26.

22. Linehan MM, Armstrong HE, Suarez A, Allmon D, Heard HL. Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Arch Gen Psychiatry. 1991;48(12):1060-1064.

23. Linehan MM, Comtois KA, Murray AM, et al. Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Arch Gen Psychiatry. 2006;63(7):757-766. doi:10.1001/archpsyc.63.7.757.



24. Linehan MM, Schmidt H, Dimeff LA, Craft JC, Kanter J, Comtois KA. Dialectical behavior therapy for patients with borderline personality disorder and drug-dependence. Am J Addict. 1999;8(4):279-292.

25. McMain SF, Links PS, Gnam WH, et al. A randomized trial of dialectical behavior therapy versus general psychiatric management for borderline personality disorder. Am J Psychiatry. 2009;166(12):1365-1374. doi:10.1176/appi.ajp.2009.09010039.

26. Munroe-Blum H, Marziali E. A Controlled Trial of Short-Term Group Treatment for Borderline Personality Disorder. Journal of Personality Disorders. 1995;9(3):190-198. doi:10.1521/pedi.1995.9.3.190.

27. Pascual JC, Palomares N, Ibáñez Á, et al. Efficacy of cognitive rehabilitation on psychosocial functioning in Borderline Personality Disorder: a randomized controlled trial. BMC Psychiatry. 2015;15:255. doi:10.1186/s12888-015-0640-5.

28. Priebe S, Bhatti N, Barnicot K, et al. Effectiveness and cost-effectiveness of dialectical behaviour therapy for self-harming patients with personality disorder: a pragmatic randomised controlled trial. Psychother Psychosom. 2012;81(6):356-365. doi:10.1159/000338897.

29. Reneses B, Galián M, Serrano R, et al. A new time limited psychotherapy for BPD: preliminary results of a randomized and controlled trial. Actas Esp Psiquiatr. 2013;41(3):139-148.

30. Soler J, Pascual JC, Tiana T, et al. Dialectical behaviour therapy skills training compared to standard group therapy in borderline personality disorder: a 3-month randomised controlled clinical trial. Behav Res Ther. 2009;47(5):353-358. doi:10.1016/j.brat.2009.01.013.

31. Turner RM. Naturalistic evaluation of dialectical behavior therapy-oriented treatment for borderline personality disorder. Cognitive and Behavioral Practice. 2000;7(4):413-419. doi:10.1016/S1077-7229(00)80052-8.

32. Verheul R, Van Den Bosch LMC, Koeter MWJ, De Ridder MAJ, Stijnen T, Van Den Brink W. Dialectical behaviour therapy for women with borderline personality disorder: 12-month, randomised clinical trial in The Netherlands. Br J Psychiatry. 2003;182:135-140.

33. Weinberg I, Gunderson JG, Hennen J, Cutter CJ. Manual assisted cognitive treatment for deliberate self-harm in borderline personality disorder patients. J Pers Disord. 2006;20(5):482-492. doi:10.1521/pedi.2006.20.5.482.



eFigure 1. Flowchart of Selection and Inclusion Process, Following the PRISMA Statement



eFigure 2. Risk of Bias Graph: Review Authors’ Judgments About Each Risk of Bias Item Presented as Percentages Across All Included Studies



eFigure 3. Standardized Posttest Effect Sizes of Comparisons Between Investigated Psychotherapies and Control Conditions on Borderline Relevant Outcomes for a) Stand-alone Designs and b) Add-on Designs



eFigure 4. Standardized Follow-up Effect Sizes of Comparisons Between Investigated Psychotherapies and Control Conditions on Borderline Relevant Outcomes for All Trials



eFigure 5. Effects of Trial Risk of Bias (Number of Sources Rated as Low Risk) Posttest Borderline Relevant Outcomes: Meta-regression Analysis



eFigure 6. Funnel Plots for Borderline Relevant Outcomes for a) Posttest (With Imputed Trials) and b) Follow-up (With Imputed Trials)



eTable 1. Selected Characteristics of Included Studies

Study Popula Recra % Fa

Txb Ctrb Nr txc

% md txd

% md ctrd

Th supe

Outcomef Tx (m)g

Nseg FU Typeg

FU (m)g

COh

Amianto, 2011

BPD (SCID) & heavy MHS use

MH outpat (>1 yr tr)

49 SB-APP+ STM

STM 18 100 100 Dev CGI; CGI-BPD; SCL-90-R; clin rec (SH, SU)

11 40 Supp Tx

6, 12

IT

Bateman, 1999

BPD (SCID) & DIB >7

Tx unit in gen psych serv

58 MBT-PH

SPT (outpat)

22 94 89 Dev SSHI; SCL-90-R; BDI; STAI-T; clin rec (SU)

18 312 Tx: Outpat GT Ctr: SPT

6, 12, 18

UK

Bateman, 2009

BPD (SCID) & suicide attempt/ life-threat SH last 6 ms

Spec PD serv

80 MBT (outpat)

SCM 71 78 68 Dev SSHI; SCL-90-R; BDI; clin rec (SH, SU)

18 92 - - UK

Blum, 2008 BPD (SCID)

Psych serv in- & outpat, MHC

83 STEPPS+TAU

TAU 93 65 56 Dev BESO; ZRSB; CGI; SCL-90-R

5 20 Nat 12 US

Bos, 2010 BPD (PDQ-4 & SCID)

Non-acad outpat MHC

82 STEPPS+ Indiv Tx

TAU (Indiv Tx)

45 60 62 Oth BPD-40; BPDSI-IV; SCL-90; CI (SU)

4 23 Tx: STEPPS Ctr: Nat

6 NL



Carter, 2010 BPD (CI) & >3 SH ep last 12 ms

GPs, psych, MHS

100 DBT TAU+WL

38 - - Oth PHI-2 6 - - - AU

Clarkin, 2007

BPD (IPDE)

MHC, PP, self-ref

92 DBT; TFP

ST 61 70; 52

65 Dev ND ES calc

12 52; 96

- - US

Cottraux, 2009

BPD (MINI) & DIB-R>8

Outpat acad hosp

77 CT RST 33 73 81 Dev SHBCL; CGI; HAMD; BDI; BAI

12 36 Nat 12 FR

Davidson, 2006

BPD (SCID) & inpat psych or AE serv/SH ep last 12 ms

Comm MHC, clin psy & liason psych serv

84 CBT+ TAU

TAU 54 - - Dev ADSHI; BSI; BDI-II; STAI-T; clin rec (SU)

12 16 Nat 6, 12

UK

Doering, 2010

BPD (SCID)

Outpat acad unit

100 TFP ECP 52 62 48 Dev train

SCID; CISSB; BSI; BDI; STAI-T; CRTHI

12 48.5 - - DE

Farrell, 2009 BPD (DIBP-R & BSI) & tx ~6 ms

Psy, th, MHC, acad outpat clin

100 SFT+ TAU

TAU 16 100 100 Dev BDSI; DIB-R; SCL-90

8 30 Nat 6 US

Gratz, 2006 BPD (SCID), DIB-R>8 & 1 SH

BPD hosp unit, PP, self-ref

100 ERG+ TAU

TAU+WL

14 - - - BEST; DSHI; DASS-D; DASS-A

3 14 - - US



ep last 6 ms

Gratz, 2014 BPD/subth BPD (SCID, DIPD-IV) & 1 SH ep last 6 ms

Comm ad, clinician- & self-ref

100 ERG+ TAU

TAU+WL

31 - - Dev BESOT; ZRSB; DSHI; SHI; BDI-II; DASS-D; DASS-A

3 14 Tx: Nat Ctr: ERG

9 US

Gregory, 2008

BPD (SCID) & alcohol abuse, depend

AE, MHC, rehab, inpat psych unit

80 DDP TAU 15 67 60 Dev BESOT; LPC; BDI; THI

12 48 - - US

Jorgensen, 2013

BPD (SCID)

Psych units, PP, outpat clin

96 MBT ST 74 70 68 Dev train

SCID; GAF-S; SCL-90-R; BDI; BAI; STAI-T

24 152 - - DK

Kalamabadi, 2012

BPD (BPDSI-IV) mar

Psych 0 DBT-C WL 15 - - - ND ES calc

3 14 - - IR

Koons, 2001 BPD (SCID) veteran

VA med cent

100 DBT TAU 14 - - Oth SCID; BSSI; PHI; BHS; BDI; HAMD; HAMA; THI

6 50.9 - - US

Kramer, 2011

BPD (SCID)

Outpat 76 MOTR+TAU

TAU 11 82 86 Oth OQ 2.5 10 - - CH



Kramer, 2014

BPD (SCID)

Acad outpat psych clin

69 MOTR+GPM

GPM 42 58 61 Oth BSL-23; OQ

3 8.77 - - CH

Leppänen, 2016

BPD (SCID) & severe sympt

MH units

86 SFT+ DBT

TAU 24 - - Oth BPDSI-IV;

12 80 - - FIN

Linehan, 1991

BPD (DSM-III), DIB>7, 2 SH ep last 5 yrs (1 last 8 wk)

Clin ref 100 DBT TAU 24 - - Dev PHI; THI 12 104 Nat (11 pat DBT)

6, 12

US

Linehan, 1999

BPD (SCID, IPDE) & SUD (SCID)

Clin ref 100 DBT TAU 12 8 13 Dev ND ES calc

12 43.1 Nat 4 US

Linehan, 2002

BPD (SCID, IPDE) & heroin addict

MHC, addict clin, HIV NPs

100 DBT CVT+ 12-Step

12 - - Dev ND ES calc

12 59.8 Nat 4 US

Linehan, 2006

BPD (SCID, IPDE), 2 suicide/SH ep last 5 yrs (1 last 8 wk)

- 100 DBT CTBE 60 87 90 - SASII; SBQ; HAMD; THI

12 80.5 Nat 12 US



Monroe-Blum, 1995

BPD (DIB >7)

Inpat & outpat psych unit

81 IGP TAU 59 - - Dev ND ES calc

8.5 30 Nat 12, 24

CA

McMain, 2009

BPD (SCID), 2 suicide/SH ep last 5 yrs (1 last m)

- 92 DBT GPM 90 - - Dev train

ZRSB; SASII; SCL-90-R; BDI; THI

12 58 Nat 6, 12, 18, 24

CA

Pascual, 2015

BPD (SCID, DIB-R)

Hosp outpat

74 CR PE 36 75 68 - BSL-23; MADRS; HAMA

4 32 Nat 6 ES

Priebe, 2012 PD (SCID) (all but 1 BPD) & > 5 days SH

DBT serv ref

88 DBT TAU 40 - - - ZRSB; CI (SH); BPRS; BSI; CSRI

12 42.2 - - UK

Reneses, 2013

BPD (SCID)

Hosp outpat

70 PFPR+TAU

TAU 25 100 100 - ZRSB; CGI; SCL-90; MADRS; STAI-S

5 20 - - ES

Soler, 2009 BPD (SCID, DIB-R)

Outpat & AE serv

83 DBT-ST SGT 30 83 80 - CGI-BPD; BPRS; SCL-90-R; HAMD; HAMA

3 13 - - ES

Turner, 2000 BPD (SCID, DIB)

AE serv, outpat MHC

79 DBT CCT 12 67 92 - BSSI; SH Likert BPRS; HAMD;

12 49-84

- - US



BDI; BAI; clin rec (SH, suicide, SU)

Verheul, 2003

BPD (SCID, PDQ)

Addictpsych & MH clin, PP

100 DBT TAU 31 - - Dev train

BPDSI-IV; LPC; THI

12 52 Nat 6 NL

Weinberg, 2006

BPD (DSM-IV, DIB-R) & 1 SH ep last m

Comm ad, hosp clin serv, PD study

100 MACT+TAU

TAU 15 47 60 Dev PHI; SBQ

2 6 Nat 6 US

Note. a Popul, population; Recr, recruitment; Acad, academic; Ad, advertisement; Addict, addiction; AE, accident and emergency; BPD, borderline personality disorder; BSI, Borderline Syndrome Index; CI, clinical interview; Clin, clinic/clinical; Comm, community; Depend, dependence; DIB/DIB-R, Diagnostic Interview for Borderline Personality Disorders (R-Revised); DIBP-R, Diagnostic Interview for Borderline Patients Revised; DIPD-IV, Diagnostic Interview for DSM-IV Personality Disorders DSM-IV, Diagnostic and Statistical Manual IV; Ep, episode; F, female; Gen, general; GP, general practitioner; Hosp, hospital; Inpat, inpatient; Interv, interview; IPDE, International Personality Disorder Examination; Mar, married; MHC, mental health center; MHS, mental health service; Min, minimum; MINI, Mini International Neuropsychiatric Interview; M, month; NP, no profit; Outpat, outpatient; PD, personality disorder; PDQ-4, Personality Diagnostic Questionnaire, DSM-IV; PP, private practice; Psych, psychiatry; Psy, psychologist; Ref, referral; SCID, Structured Clinical Interview for DSM; Serv, service; SH, self-harm; Spec, specialist; Subth, subthreshold; SUD, Substance Use Disorder; Sympt, symptomatology; Ther, therapist; Threat, threatening; Tr, treatment; Tx, psychotherapy; VA, Veteran Affairs; Wk, week; Yr, year. b CBT, Cognitive Behavior Therapy; CCT, Client Centered Therapy; CR, Cognitive Rehabilitation; CT, Cognitive Therapy; CTBE, Community Treatment by Experts; Ctr, control; CVT, Comprehensive Validation Therapy; DBT, Dialectical Behaviour Therapy (ST – Skills Training; C-couples); DDP, Dynamic Deconstructive Psychotherapy; ECP, Expert Community Psychotherapists; ERG, Emotional Regulation Group Intervention; GPM, General Psychiatric Management; IGP, Interpersonal Group Psychotherapy; Indiv, individual; MACT, Manual Assisted Cognitive Treatment; MBT, Mentalization-based treatment (PH – partial hospitalization);



MOTR, Motive-oriented therapeutic relationship; Outpat, outpatient; PE, Psychoeducation; PFPR, Psychotherapy Focused on Psychic Representation; PMR, Progressive muscle relaxation; RST, Rogersian Supportive Therapy; SB-APP, Sequential Brief Adlerian Psychodynamic Psychotherapy; SCM, Structured Clinical Management; SFT, Schema Focused Therapy; SGT, Standard Group Treatment; SPT, Standard Psychiatric Care; ST, Supportive Therapy (group); STEPPS, Systems Training for Emotional Predictability and Problem Solving; STM, Supervised Team Management; TAU, treatment as usual; TFP, Transference Focused Psychotherapy; Tx, psychotherapy; WL, Waiting list. c Nr, Number randomized; d % md, Proportion of patients taking medication at baseline (if no overall group estimation was give, the estimation used was for the drug class taken by the largest proportion of participants); Tx, psychotherapy; Ctr, control e Th sup, therapist supervision; Dev, developer; Dev train, therapist trained by developer; Oth, other; fADSHI, Acts of Deliberate Self-Harm Inventory; BAI, Beck Anxiety Inventory; BDI, Beck Depression Inventory; BDI-II, Beck Depression Inventory – II; BDSI, Borderline Syndrome Index; BESOT, Borderline Evaluation Scale Over Time; BEST, Borderline Evaluation of Severity over time; BHS, Beck Hopelessness Scale; BPD-40, Borderline Personality Disorder checklist-40; BPDSI-IV, Borderline Personality Disorder Severity Index; BPRS, Brief Psychiatric Rating Scale; BSI, Brief Symtom Inventory (GSI-Global Severity Index; PST- Positive Symptom Total; PSDI-Positive Symptom Distress Index); BSL-23, Borderline Symtom List; BSSI, Beck Scale for Suicide Ideation; CGI/CGI-BPD, Clinical Global Impression (BPD – Modified for Borderline Personality Disorder); CISSB, Cornell Interview for Suicidal and Self-Harming Behavior – Self Report; Clin rec, clinical record; CRTHI, Cornell Revised Treatment History Inventory; CSRI, Client Service Receipt Inventory; DASS, Depression Anxiety Stress Scales; DIB-R, Diagnostic Interview for Borderline Personality Disorders-Revised; DIPD-IV, Diagnostic Interview for DSM-IV Personality Disorders; DSHI, Deliberate Self-Harm Inventory; GAF-S, Global Assessment of Functioning (symptoms); HAMA – Hamilton Rating Scale for Anxiety; HAMD – Hamilton Rating Scale for Depression; LPC, Lifetime Parasuicide Count; MADRS – Montgomery-Asberg Depression Rating Scale; ND ES calc, no data for effect size calculation; OQ, Outcome Questionnaire; PHI, Parasuicide History Interview; PHI-2, Parasuicide History Interview–3 month period; SASII, Suicide Attempt Self-Injury Interview; SBQ, Suicidal Behaviors Questionnaire; SCID – Structured Clinical Interview for DSM; SCL-90-R, Symptom Checklist-90 Revised; SH, Self-harming; SHBCL, Self-harm behaviors checklist; SHI, Self-harm inventory; SSHI, Suicide and Self-Harm Inventory; STAI-S, State Trait Anxiety Inventory – State; STAI-T, State Trait Anxiety Inventory – Trait; SU, service use; THI, Treatment History Interview; ZRSB, Zanarini Rating Scale for Borderline. g Ctr, control; DBT, Dialectical Behaviour Therapy; ERG, Emotional Regulation Group Intervention; FU, follow-up; M, months; Nat, naturalistic; Nse, number of sessions; Outpat GT, Outpatient Groupt Treatment; Pat, patients; SPT, Standard Psychiatric Care; Supp, supportive; STEPPS, Systems Training for Emotional Predictability and Problem Solving; Tx, psychotherapy.



h AU, Australia; CA, Canada; CH, Switzerland; CO, Country of provenance; DE, Germany; DK, Denmark; ES, Spain; FIN, Finland; FR, France; IR, Iran; IT, Italy; NL, Netherlands; UK, United Kingdom; US, United States of America.



eTable 2. Classification of Trial Characteristics as Used in the Subgroup and Meta-Regression Analysis Study Design Therapy

typea Ctrl groupa

Ctrl manuala

Study team treating ctrl groupa

Treatment devel trial authora

Therapy superva

RoBa Treatment duration for treatment group (h)

Treatment duration for ctrl group (h)

Difference in treatment duration (h)b

Amianto, 2011

Add-on PDT TAU N Y Y Devel 2 40 40 0

Bateman, 1999

Stand-alone

PDT TAU N N Y Devel 0 470 120 350

Bateman, 2009

Stand-alone

PDT Ad hoc Y Y Y Devel 4 92 84 8

Blum, 2008

Add-on CBT TAU N N Y Devel 2 40 0 40

Bos, 2010 Add-on CBT TAU N N N Other 0 23 9 14 Carter, 2010

Stand-alone

DBT TAU N N N - 3 - - -

Cottraux, 2009

Stand-alone

CBT ST Y Y Y Devel 3 36 36 0

Davidson, 2006

Add-on CBT TAU N N Y Devel 3 16 0 16

Doering, 2010

Stand-alone

PDT TAU N N N Other 3 40.42 18.6 21.82

Farrell, 2009

Add-on Otherc TAU N N Y Other 1 - - 45

Gratz, 2006

Add-on Otherc TAU N N Y - 1 50.4 41.3 9.1

Gratz, 2014

Add-on Otherc TAU N N Y Devel 2 37.8 35 2.78

Gregory, 2008

Stand-alone

PDT TAU N N Y Devel 2 42.84 73.3 -30.46

Jorgensen, Stand- PDT ST Y Y N Other 1 174 72 102



2013 alone Koons, 2001

Stand-alone

DBT TAU N N N Other 1 66.95 34.4 32.55

Kramer, 2011

Add-on Otherc Ad hoc Y Y Y Other 4 10 10 0

Kramer, 2014

Add-on Otherc Ad hoc Y Y Y Devel 3 8.77 8.86 -0.09

Leppänen, 2016

Stand-alone

Otherc TAU N N N Other 2 100 - -

Linehan, 1991

Stand-alone

DBT TAU N N Y Devel 1 182 - -

Linehan, 2006

Stand-alone

DBT Ad hoc N Y Y - 2 137.5 33 104.5

McMain, 2009

Stand-alone

DBT Ad hoc Y Y N Other 4 84 31 53

Pascual, 2015

Stand-alone

Other Ad hoc Y Y Y - 3 64 32 32

Priebe, 2012

Stand-alone

DBT TAU N N N - 3 42.2 12.1 30.1

Reneses, 2013

Add-on PDT TAU N N Y - 1 - - 15

Soler, 2009

Stand-alone

DBT Ad hoc - Y N - 2 26 26 0

Turner, 2000

Stand-alone

DBT ST Y Y N - 1 - - -

Verheul, 2003

Stand-alone

DBT TAU N N N Other 1 182 26 156

Weinberg, 2006

Add-on CBT TAU N N N Devel 1 - - 6

Note. a CBT, Cognitive Behavior Therapy; ctrl, control; DBT, Dialectical Behaviour Therapy; devel, developer; PDT, Psychodynamic Therapy; RoB, rating of Bias; TAU, treatment as usual; ST, supportive therapy; superv, supervisor.



b Represents the difference of treatment duration between the therapy and the control group, measured in hours – a positive score indicates treatment duration was longer for the treatment group. c Therapies classified as other included (in this order): Schema Focused Therapy (SFT), Emotion Regulation Group Intervention, Motive-oriented therapeutic relationship, SFT+DBT



Supplementary Online Content...4. Blum N, St John D, Pfohl B, et al. Systems Training for Emotional...

Documents

Transcript of Supplementary Online Content...4. Blum N, St John D, Pfohl B, et al. Systems Training for Emotional...