John R Keefe1, Thomas T Kim2, Robert J DeRubeis2, David L Streiner3,4, Paul S Links3, Shelley F McMain4,5. 1. Department of Psychiatry, Weill Medical College of Cornell University, New York, NY, USA. 2. Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA. 3. Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada. 4. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. 5. Borderline Personality Disorder Clinic, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
Abstract
BACKGROUND: No evidence-based therapy for borderline personality disorder (BPD) exhibits a clear superiority. However, BPD is highly heterogeneous, and different patients may specifically benefit from the interventions of a particular treatment. METHODS: From a randomized trial comparing a year of dialectical behavior therapy (DBT) to general psychiatric management (GPM) for BPD, long-term (2-year-post) outcome data and patient baseline variables (n = 156) were used to examine individual and combined patient-level moderators of differential treatment response. A two-step bootstrapped and partially cross-validated moderator identification process was employed for 20 baseline variables. For identified moderators, 10-fold bootstrapped cross-validated models estimated response to each therapy, and long-term outcomes were compared for patients randomized to their model-predicted optimal v. non-optimal treatment. RESULTS: Significant moderators surviving the two-step process included psychiatric symptom severity, BPD impulsivity symptoms (both GPM > DBT), dependent personality traits, childhood emotional abuse, and social adjustment (all DBT > GPM). Patients randomized to their model-predicted optimal treatment had significantly better long-term outcomes (d = 0.36, p = 0.028), especially if the model had a relatively stronger (top 60%) prediction for that patient (d = 0.61, p = 0.004). Among patients with a stronger prediction, this advantage held even when applying a conservative statistical check (d = 0.46, p = 0.043). CONCLUSIONS: Patient characteristics influence the degree to which they respond to two treatments for BPD. Combining information from multiple moderators may help inform providers and patients as to which treatment is the most likely to lead to long-term symptom relief. Further research on personalized medicine in BPD is needed.
BACKGROUND: No evidence-based therapy for borderline personality disorder (BPD) exhibits a clear superiority. However, BPD is highly heterogeneous, and different patients may specifically benefit from the interventions of a particular treatment. METHODS: From a randomized trial comparing a year of dialectical behavior therapy (DBT) to general psychiatric management (GPM) for BPD, long-term (2-year-post) outcome data and patient baseline variables (n = 156) were used to examine individual and combined patient-level moderators of differential treatment response. A two-step bootstrapped and partially cross-validated moderator identification process was employed for 20 baseline variables. For identified moderators, 10-fold bootstrapped cross-validated models estimated response to each therapy, and long-term outcomes were compared for patients randomized to their model-predicted optimal v. non-optimal treatment. RESULTS: Significant moderators surviving the two-step process included psychiatric symptom severity, BPD impulsivity symptoms (both GPM > DBT), dependent personality traits, childhood emotional abuse, and social adjustment (all DBT > GPM). Patients randomized to their model-predicted optimal treatment had significantly better long-term outcomes (d = 0.36, p = 0.028), especially if the model had a relatively stronger (top 60%) prediction for that patient (d = 0.61, p = 0.004). Among patients with a stronger prediction, this advantage held even when applying a conservative statistical check (d = 0.46, p = 0.043). CONCLUSIONS: Patient characteristics influence the degree to which they respond to two treatments for BPD. Combining information from multiple moderators may help inform providers and patients as to which treatment is the most likely to lead to long-term symptom relief. Further research on personalized medicine in BPD is needed.
Authors: Carlijn J M Wibbelink; Arnoud Arntz; Raoul P P P Grasman; Roland Sinnaeve; Michiel Boog; Odile M C Bremer; Eliane C P Dek; Sevinç Göral Alkan; Chrissy James; Annemieke M Koppeschaar; Linda Kramer; Maria Ploegmakers; Arita Schaling; Faye I Smits; Jan H Kamphuis Journal: BMC Psychiatry Date: 2022-02-05 Impact factor: 3.630
Authors: Ole Jakob Storebø; Johanne Pereira Ribeiro; Mickey T Kongerslev; Jutta Stoffers-Winterling; Mie Sedoc Jørgensen; Klaus Lieb; Anthony Bateman; Richard Kirubakaran; Nicolas Dérian; Eirini Karyotaki; Pim Cuijpers; Erik Simonsen Journal: BMJ Open Date: 2021-06-21 Impact factor: 2.692