A randomised controlled trial of three forms of psychosocial early intervention for borderline personality disorder in youth.

Three interventions will be compared. Two of the interventions are two forms of the Helping Young People Early (HYPE) specialised early intervention for borderline personality disorder. The third intervention is youth mental health care. The three study arms will be: i) HYPE + individual Cognitive Analytic Therapy (HYPE+CAT); ii) HYPE + ‘Befriending’ (HYPE+Bef); iii) Youth mental health care + Befriending (YMH+Bef). HYPE+CAT is an integrated, multidisciplinary team-based early intervention service model for borderline personality disorder. It uses a shared psychosocial model of borderline personality disorder and a common language for communication with patients, families and carers, team members and the wider service system. HYPE+CAT includes: i) rigorous diagnosis of BPD and other personality pathology; ii) up to 16 x 50-minute individual Cognitive Analytic Therapy (CAT) sessions delivered over approximately 26 weeks; iii) assertive case management integrated with the delivery of psychotherapy; iv) developing a collaborative model of the individual patient’s difficulties that is shared with the patient, HYPE team, family and relevant others and is used for intra- and extra-service liaison; v) active engagement of families or carers, with psychoeducation and up to four sessions of family intervention; vi) general psychiatric care, with specific assessment and treatment of co-occurring psychiatric syndromes (‘comorbidity’), including the use of pharmacotherapy (where indicated), while minimising polypharmacy; vii) access to the shared elements of Orygen Youth Health – crisis team, inpatient care, activity group program; viii) with a clear model of brief and goal-directed crisis and inpatient care; ix) individual and group supervision of staff; and x) a quality assurance program. HYPE+Bef will comprise all of the elements of HYPE+CAT except that ‘individual Cognitive Analytic Therapy’ will be substituted with up to 16 x 50-minute individual sessions of ‘Befriending’ delivered over approximately 26 weeks. Befriending is a manualised intervention that consists of talking about neutral topics that interest the participant (e.g. music, sport, books). If the participant finds verbal interaction difficult, activities such as board games, walking, or playing sport, can be used with a view to using the activity as a tool to engage the participant in further neutral conversation during and after the activity. The therapist’s primary goals are to keep the participant engaged for the full duration of therapy and to keep the conversation or activity as close to a neutral ‘pleasant chat’ as possible.