F60.3
Conditions
Interventions
Group 1: Half of the patients (N=93) receive mechanism-based anti-aggression psychotherapy (MAAP). All elements of MAAP are taken from sophisticated evidence-based psychotherapy programs, such as DBT
Linehan, 1996) and MBT (Mentalization-Based Treatment
Bateman & Fonagy, 2009). We added specific attention training techniques to these multilayered evidence-based elements. The elements were combined to specifically target the hypothesized mechanisms of
Sponsors
Klinik für Allgemeine Psychiatrie
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Inclusion criteria
Inclusion criteria: - Outpatients with at least four diagnostic criteria of BPD fulfilled according to a structured interview, the International Personality Disorder Examination (IPDE based on DSM-5) - Exhibit overt aggression OAS-M(1-3) = 15 and irritability OAS-M(5-6) = 6 within two weeks prior to inclusion - live within 70km from a study centre - Sufficient German language skill to participate in a group setting
Exclusion criteria
Exclusion criteria: - Suicidality: due to the high prevalence of suicidality in patients with BPD, the possibility of initiating treatment is assessed using item 7 of the OAS-M, which captures suicidal tendencies; suicidality is assessed on an individual basis by a clinician if the score is =3 - Acute/previous schizophrenia - Acute bipolar I disorder - Acute moderate to severe substance use disorder - No ability/willingness to abstain from drug/alcohol use during therapy sessions (assessed by a clinician on an individual basis) - History of a serious medical condition that interferes with participation in regular sessions - Severe cognitive impairment as measured by mini-q (IQ<70) - Autism spectrum disorder (assessed by a clinician on an individual basis - taking into account the results of the AQ-10) - Other ongoing psychotherapy - Increase in current psychotropic medication or initiation of new psychotropic medication within two weeks prior to study assignment (6 weeks instead of 2 weeks for fluoxetine) - Ongoing criminal investigation, placement in a forensic hospital for at least 2 years, or incarceration
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Outward, overt aggression as measured by the first three items of the Overt Aggression Scale Modified (OAS-M(1-3)) at 32 weeks of follow-up | — |
Secondary
| Measure | Time frame |
|---|---|
| - Externally directed overt aggression in OAS-M(1-3) immediately after intervention (PT) and at follow-up 12, 20, and 28 weeks. - Attacks against self OAS-M (4), Irritability OAS-M(5-6) and suicidality OAS-M(7a/7b) immediately after the intervention (PT) and at follow-up at 12, 20, 28, and 32 weeks after the start of the intervention. - OAS-M response rate (i.e., reduction in OAS-M[1-3] of at least 50% compared with baseline) immediately after the intervention and at all follow-up measurement time points (12, 20, 28, and 32 weeks after the start of the intervention). - Anger and aggressive behavior measured with Ecological Momentary Assessment (EMA) over a 2-week period at 6 random time points beginning 2 weeks before the start of the intervention period and 2 weeks before the 32-week follow-up. - Symptom severity of BPD as measured by the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD) immediately after intervention (PT) and at 12 and 32 weeks of follow-up. - Quality of life (WHOQoL-Bref) at the time of PT and 20- and 32-week FUs - Anger (STAXI-II) immediately after the intervention (PT) and after 28 and 32 weeks of follow-up. - Everyday functioning (SOFAS) immediately after the intervention (PT) and after 12 and 32 weeks of follow-up. - Other exploratory outcome measures: Dimensional assessment of personality disorders (PDS-ICD-11 [PT, 20- and 32-week follow-up] ; PSD-5-BF+M [PT, 28- and 32-week follow Up]), anger ruminations (ARS [PT, 12- and 32-week follow Up]), symptom severity (BSCL-53 [PT, 12- and 32-week follow Up]), impulsivity (BIS-15 [PT, 20- and 32-week follow Up]), loneliness (UCLA-3 [PT, 20- and 32-week follow Up]), therapeutic relationship (GQ-D), emotional mentalizing ability (MEQ-16 [PT, 12- and 32-week follow Up]), negative effects of psychotherapy (NEQ [PT]), social network quality (SNQ [PT, 12- and 32-week follow Up]) | — |
Countries
Germany
Contacts
Public ContactChristine Sigrist
Klinik für Allgemeine Psychiatrie
Outcome results
None listed