Chair: Andrew Chanen
Co-chair: Carissa Wright
Aims: Borderline or severe personality disorder (BPD) usually emerges during adolescence and early adulthood. This developmental period represents a key opportunity for prevention and early intervention. Methods: This symposium will present pilot trial, longitudinal follow-up, cost-effectiveness and mechanisms-of-change findings stemming from four clinical trials conducted with young people (age range 12 to 25 years) with BPD features, implemented in Australia, Germany, Switzerland, and Denmark. Results: Participant recruitment is currently being completed in the first trial and a cost-effectiveness analysis is underway with the fourth trial. The second trial found that Adolescent Identity Treatment (AIT) was non inferior to Dialectical Behaviour Therapy for Adolescents (DBT-A), with both treatments potentially leading to change via different therapeutic pathways. Longitudinal follow-up of participants in the third trial revealed that BPD in adolescence represents a general maladjustment and early stage of psychopathological development that continue in the transition from adolescence into early adulthood. Conclusions: Early intervention has been demonstrated to be safe and effective in reducing psychopathology and improving functioning among young people with BPD in the shorter term. The evidence base regarding the factors that inform treatment selection (e.g. therapeutic pathways to change, cost-effectiveness, alternatives to therapy, etc.) and longer-term outcomes, continues to grow.
Findings from a pilot trial of relational peer work for young people with severe/borderline personality disorder attending primary care centres
Andrew M Chanen, Susan Cotton, Cathrine Mihalopoulos, Magenta Simmons, Jennifer K Betts, Louise McCutcheon, Katie Nicol, Eleanor Brown, Gina Chinnery, Shona Francey, Brendan Pawsey, Lidia Engel, Pru Howell-Jay, Mary Mansilla, Nathan Pham, Julie Ja, Ellie Ahounbar, Carissa Wright, Sarah Bostock
Aims: Effective early intervention for young people with BPD is not reliant upon specialist psychotherapy but does require youth-oriented care. This study aimed to evaluate the safety and acceptability of peer work for young people with BPD in primary care. Methods: The trial is currently being implemented at four headspace youth mental health centres in Melbourne, Australia. Young people aged 12-25 years with BPD features, who are not currently receiving a structured psychosocial treatment (e.g. psychotherapy), are invited to participate. Over 13 weeks, youth peer workers provide up to 10 sessions of peer work, informed by the relational care model. Peer workers are young people who have lived experience of mental illness, who are trained to use that experience to help others. Assessments are completed at baseline, Week 6 and Week 13 (primary end-point). Results: Five criteria have been set a priori to determine whether peer work is acceptable and safe (e.g. rate of consent, treatment completion, and treatment satisfaction). Change in quality of life will also be explored. To date, 14 young people have been enrolled and participant recruitment is scheduled to be completed by mid 2023. Conclusion: If peer work is shown to be safe and acceptable, a RCT will be warranted to investigate the clinical efficacy of peer work.
Adolescent Identity Treatment versus Dialectical Behavior Therapy in Adolescents – two approaches for early intervention in borderline personality disorder that are different but equally effective
Michael Kaess, Ronan Zimmerman, Stefan Lerch, Klaus Schmeck
Objectives: According to a Cochrane review, evidence for methods focused on treatment for adolescent BPD patients is very limited. Aims of the study were to demonstrate the non-inferiority of AIT compared to DBT-A, and that intensive early treatment of BPD leads to significant improvement of psychosocial and personality functioning in adolescents. Method: In a non-RCT employing a non-inferiority approach, we compared 37 patients treated with DBT-A with 23 patients treated with AIT (each comprising 25 weekly individual psychotherapy sessions and 5-8 family sessions). Assessments occurred at baseline, post-treatment, 1- and 2-year-follow-up. Primary outcome was psychosocial functioning at 1-year-follow-up. A variety of additional variables including assessments of therapeutic processes was conducted during the trial. Results: Both DBT-A and AIT significantly improved adolescents´ psychosocial functioning (AIT: d = 1.82; DBT-A: d = 1.73) and personality functioning. BPD-criteria and depression were significantly reduced by both treatments. Overall, AIT was found to be not inferior to DBT-A, and even more efficient in reducing BPD criteria. Treatment outcome was predicted by both expectancy and therapeutic alliance. Interestingly, the type of therapeutic alliance that was predictive of positive outcome was highly different between AIT and DBT-A. Conclusions: AIT is a promising approach and not inferior to DBT-A in respect to treatment efficiency. Both treatments may lead to improvements via different therapeutic pathways.
Borderline personality disorder in adolescence: a five-year follow-up study
Objectives: studies of the medium to long-term clinical and functional course for treatment-seeking adolescents with borderline personality disorder are lacking. Methods: The current study was a five-year follow-up study that aimed to outline the current psychopathological and functional state of participants from a randomized clinical trial that compared mentalization-based group treatment to treatment as usual. Personality and mental disorders were assessed using the gold standard semi-structured interviews the Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD) and Schedules for Clinical Assessment in Neuropsychiatry (SCAN) administered by trained clinical raters. Self-reported instruments assessed additional emotional and behavioral disorders and functioning. Results: Ninety-seven participants (87% of the original sample) aged 19-23 years participated. The majority of the participants (75%) continued to present with current psychopathology, of which the most prevalent were anxiety disorders (37%), depressive disorders (36%), borderline and avoidant personality disorders (24%), schizophrenia (16%), and eating disorders (13%). Around half of the sample was currently in psychological and psychopharmacological treatment, and functioning remained impaired with 36% of the sample not currently engaged in education, employment or training. Conclusions: BPD in adolescence represents a general maladjustment and early stage of psychopathological development that continue in the transition from adolescence into early adulthood.
An economic evaluation of three approaches to early intervention for young people with borderline personality disorder: a within-trial cost-utility analysis from the MOBY clinical trial
Yong Yi Lee, Ellen Lardner, Jennifer K. Betts, Henry Jackson, Sue M. Cotton, John Gleeson, Christopher G. Davey, Sharnel Perera, Victoria Rayner, Louise McCutcheon, Cathrine Mihalopoulos, Andrew M. Chanen
Aims: With limited funds available in national healthcare systems, it is important to know the cost-effectiveness of different interventions for BPD. Methods: A cost-utility analysis was nested withing the Monitoring Outcomes of BPD in Youth (MOBY) randomised controlled trial. Between 2011 and 2015, 139 young people (aged 15-25 years) with BPD were randomly assigned to one of three interventions that differed in complexity based on the service model (specialist or generalist) and the provision (or absence) of psychotherapy. The economic evaluation is currently underway. The evaluation will adopt an Australian healthcare sector perspective. Costs and outcome data were collected over 18 months. Costs will be denominated in 2015 Australian dollars (A$) and quality-adjusted life year (QALY) outcomes derived from the Assessment of Quality of Life-8 Dimensions questionnaire. Cost-effectiveness results will be expressed as an incremental cost-effectiveness ratio (ICER). Findings: Results will include a comparison of the costs, and cost-effectiveness, of each of the three MOBY treatment arms and will be informed by standard Australian willingness-to-pay thresholds (e.g. A$50,000 per QALY). Conclusions: Cost-effectiveness analyses ensure governments and society allocate scarce healthcare resources efficiently.