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Logo of bmcpsycBioMed Centralsearchsubmit a manuscriptregisterthis articleBMC Psychiatry
 
BMC Psychiatry. 2011; 11: 181.
Published online Nov 21, 2011. doi:  10.1186/1471-244X-11-181
PMCID: PMC3260092
Supervised team management, with or without structured psychotherapy, in heavy users of a mental health service with borderline personality disorder: a two-year follow-up preliminary randomized study
Federico Amianto,#1 Andrea Ferrero,#2,3 Andrea Pierò,4 Elisabetta Cairo,2,3 Giuseppe Rocca,1 Barbara Simonelli,2,3 Simona Fassina,2,3 Giovanni Abbate-Daga,1 and Secondo Fassinocorresponding author1
1Neurosciences Department, Psychiatry Section, University of Torino, Via Cherasco 11, Turin, Italy
2Psychotherapy Unit, Mental Health Department, Health District TO-4, Via Don Paviolo 5, Settimo T.se, Turin, Italy
3SAIGA Institute of Research, Via Principe Amedeo 16, Turin, Italy
4Centre Hospitalier Alpes-Isère, Grenoble, 38000, France
corresponding authorCorresponding author.
#Contributed equally.
Federico Amianto: federico.amianto/at/unito.it; Andrea Ferrero: andfer52/at/hotmail.com; Andrea Pierò: andrea.piero/at/unito.it; Elisabetta Cairo: cairoelisabetta/at/hotmail.it; Giuseppe Rocca: bepperocca/at/gmail.com; Barbara Simonelli: barbara.simonelli/at/tiscalinet.it; Simona Fassina: simonafassina/at/hotmail.it; Giovanni Abbate-Daga: giovanni.abbatedaga/at/unito.it; Secondo Fassino: secondo.fassino/at/unito.it
Received May 10, 2011; Accepted November 21, 2011.
Abstract
Background
Individuals affected by severe Borderline Personality Disorder (BPD) are often heavy users of Mental Health Services (MHS). Short-term treatments currently used in BPD therapy are useful to target disruptive behaviors but they are less effective in reducing heavy MHS use. Therefore, alternative short-term treatments, less complex than long-term psychodynamic psychotherapies but specifically oriented to BPD core problems, need to be developed to reduce MHS overuse. This study aimed to evaluate the efficacy of adding Sequential Brief Adlerian Psychodynamic Psychotherapy (SB-APP) to Supervised Team Management (STM) in BPD treatment compared to STM alone in a naturalistic group of heavy MHS users with BPD. Effectiveness was evaluated 6 times along a two-year follow-up.
Methods
Thirty-five outpatients who met inclusion criteria were randomly assigned to two treatment groups (STM = 17; SB-APP = 18) and then compared. Clinical Global Impression (CGI) and CGI-modified (CGI-M) for BPD, Global Assessment of Functioning (GAF), State-Trait Anger Expression Inventory (STAXI), and Symptom Checklist-90 Revised (SCL-90-R) were administered at T1, T3, T6, T12, T18 and T24. At T12 the Working Alliance Inventory-Short Form (WAI-S) was also completed. At the one-year follow-up, SB-APP group did not receive any additional individual psychological support. MHS team was specifically trained in BPD treatment and had regular supervisions.
Results
All patients improved on CGI, GAF, and STAXI scores after 6 and 12 months, independently of treatment received. SB-APP group showed better outcome on impulsivity, suicide attempts, chronic feelings of emptiness, and disturbed relationships. We found a good stabilization at the one year follow-up, even after the interruption of brief psychotherapy in the SB-APP group.
Conclusions
Although STM for BPD applied to heavy MHS users was effective in reducing symptoms and improving their global functioning, adding a time-limited and focused psychotherapy was found to achieve a better outcome. In particular, focusing treatment on patients' personality with a specific psychotherapeutic approach (i.e. SB-APP) seemed to be more effective than STM alone.
Trial Registration
ClinicalTrials.gov: NCT1356069
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