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Unread October 30th, 2006, 09:28 PM
James Pretzer James Pretzer is offline
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Default CBT with Borderline Personality Disorder

Once upon a time it was assumed that BPD couldn't be treated effectively with CBT. Many assumed that only psychodynamic treatment was appropriate for this problem.

Then Marsha Linehan developed Dialectical Behavior Therapy and conducted an actual outcome study that showed that it worked. This was a first, the psychodynamic folks hadn't actually gotten around to doing controlled outcome studies. For a number of years, people assumed that DBT was the way to treat BPD.

Now the floodgates are opening! The October, 2006 edition of the Journal of Personality Disorders includes four articles on CBT with BPD. Three of them are reports on the BOSCOT study testing Kate Davison's approach to treating BPD and the other is a test of her manualized CT for deliberate self-harm in BPD.

Also in the works, there's an open clinical trial of CT for BPD which I haven't seen in print yet but which produced interesting results and Arnhoud Arntz is conducting an outcome study on yet another approach to CBT with BPD which combines CT with Jeff Young's Schema Therapy. It looks like we'll have four different approaches to CBT with BPD.
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Unread October 31st, 2006, 08:21 AM
alexandra_k alexandra_k is offline
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Default Re: CBT with Borderline Personality Disorder

The floodgates have indeed opened!

Journal of Clinical Psychology 2006, Volume 62, Issue 4

Special Issue: Putative Mechanisms of Action in the Psychotherapy Treatment of Borderline Personality Disorder


Mechanisms of change in mentalization-based treatment of BPD (p 411-430)

Interpersonal psychotherapy for borderline personality disorder: Possible mechanisms of change (p 431-444)

Schema therapy for borderline personality disorder (p 445-458)

Mechanisms of change in dialectical behavior therapy: Theoretical and empirical observations (p 459-480)

The mechanisms of change in the treatment of borderline personality disorder with transference focused psychotherapy (p 481-501)

Hypothesized mechanisms of change in cognitive therapy for borderline personality disorder (p 503-516)

It is interesting to see what these therapies might have in common...
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Unread December 7th, 2006, 04:33 PM
James Pretzer James Pretzer is offline
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Default What I mean by CBT and references on CBT with Borderline Personality Disorder

> CBT has been shown to be effective for the treatment of BPD?
> Reference please...
> I know about schema therapy (cognitive therapy)
> I know about DBT (dialectical behaviour therapy)
> Are you using CBT to refer to the above two or is there something I'm missing?

Cognitive-behavioral therapy is a broad category that includes many related therapeutic approaches. Certainly DBT is a cognitive-behavioral therapy and Schema Therapy is generally seen as cognitive-behavioral (I'm not sure how Jeff Young sees it currently, I haven't talked with him in a while). Other CBT approaches that have at least some empirical support with BPD include Beck's Cognitive Therapy, Arntz's hybrid of Cognitive Therapy and Schema Therapy, and Davison's approach used in the BOSCOT study.

I don't have a full set of references handy but the references given in the first two posts in this thread are a good starting place.
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Unread March 5th, 2007, 10:39 PM
James Pretzer James Pretzer is offline
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Default Re: CBT with Borderline Personality Disorder

A Brief article in the APA Monitor summarizes a new article about Arntz's version of Schema Therapy. After three years of twice a week individual therapy 70% achieved clinically significant imp[rovement and at a one-year follow-up 52% no longer qualified for a diagnosis of BPD on the Borderline Personality Disorder Severity Index (compared with 29% of the participants who received transference-focused psychotherapy).

See: Archives of General Psychiatry, 63,649-658.
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Unread March 5th, 2007, 10:55 PM
James Pretzer James Pretzer is offline
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Default Re: CBT with Borderline Personality Disorder

BROWN G. K.; NEWMAN C. F. ; CHARLESWORTH S. E. ; CRITS-CHRISTOPH P. & BECK A. T. (2004). An open clinical trial of cognitive therapy for borderline personality disorder. Journal of Personality Disorders (Special feature on suicide and borderline personality disorder), 18, 257-271.

Abstract - Although borderline personality disorder (BPD) is a major public health concern, psychotherapeutic trials have been limited. The present uncontrolled clinical trial examines whether cognitive therapy for BPD is associated with significant improvement on measures of psychopathology. A total of 32 patients with BPD, who also reported suicide ideation or who engaged in self-injury behavior, received weekly cognitive therapy sessions over a 1-year period as described by Layden et al. (1993). The results revealed significant and clinically important decreases on measures of suicide ideation, hopelessness, depression, number of borderline symptoms and dysfunctional beliefs at termination and 18-month assessment interviews. Implications for further research with this difficult-to-treat patient population are discussed.

Note: Participants showed continued improvement following the end of treatment. At the beginning of treatment, all participants met full DSM criteria for BPD, at the termination of treatment 48% met full criteria for BPD, and six months after termination, only 16% met DSM criteria for BPD.

Does this mean that CT cures BPD? Not necessarily. Participants who no longer met DSM criteria weren't necessarily problem-free. However, they showed improvement on a wide range of outcome measures including suicidality and self-mutilation.

Last edited by James Pretzer; April 7th, 2007 at 08:56 PM. Reason: update
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