A Systematic Review of Dialectical Behaviour Therapy, Mentalisation-Based Treatment and Internal Family Systems Therapy for Borderline Personality Disorder with Comorbid Depression and/or Anxiety

Borderline Personality Disorder (BPD) is highly comorbid with depression and anxiety, creating additional difficulty in treating the conditions and poorer prognosis than BPD alone. Dialectical behaviour therapy (DBT) and Mentalisation-Based Treatment (MBT) are specialised psychotherapies for BPD that have demonstrated positive effects for reducing BPD symptoms and scores on depression and anxiety measures. Although developed for treating PTSD, Internal Family Systems (IFS) therapy is effective for addressing past trauma that is also common in BPD. This systematic review investigated the effectiveness of DBT, MBT and IFS for treating BPD with comorbid depression and/or anxiety (BPD+D/A). Using the PRISMA protocol, five academic databases were searched for relevant studies and relevant treatment outcomes. Findings were extracted from 12 included studies. This review found that DBT and MBT demonstrated significant reductions in BPD and depressive/anxious symptomatology, emotional and interpersonal difficulties, and impulsive behaviours. These therapeutic approaches also demonstrated reduced numbers of visits to emergency departments, reduced numbers of contacts with mental health services and reduced duration of contacts. No studies around IFS therapy outcomes for BPD+D/A were obtained. These findings are concordant with past research and have implications for increasing the use of DBT and MBT within BPD+D/A populations. Findings also demonstrate the effectiveness of brief DBT interventions that could be expanded as a more practical option for service users with BPD who experience frequent crisis periods and may struggle to commit to a traditional 12-month program.

边缘型人格障碍（Borderline Personality Disorder, BPD）与抑郁、焦虑存在高度共病性，相较于单纯BPD个体，此类共病患者的治疗难度更大、预后更差。辩证行为疗法（Dialectical Behaviour Therapy, DBT）与心智化基础治疗（Mentalisation-Based Treatment, MBT）是针对BPD的专科心理治疗方法，已有研究证实其可有效缓解BPD症状，并降低抑郁、焦虑量表的评分。尽管内部家庭系统疗法（Internal Family Systems, IFS）最初是为创伤后应激障碍（Post-Traumatic Stress Disorder, PTSD）的治疗而开发，但它同样可用于改善BPD患者常见的既往创伤问题。本系统综述针对共病抑郁和/或焦虑的BPD（BPD+D/A）患者，探究了DBT、MBT及IFS疗法的治疗有效性。研究遵循系统综述与Meta分析优先报告条目（PRISMA）规范，检索了5个学术数据库中的相关研究及治疗结局数据，最终纳入12项研究并提取其结果。本综述结果显示，DBT与MBT可显著改善BPD及抑郁/焦虑症状学、情绪与人际困扰，同时减少冲动行为；此外，两类治疗方法还可降低急诊科就诊次数、精神卫生服务接触频次及接触时长。本次检索未发现针对BPD+D/A患者的IFS疗法疗效相关研究。本研究结果与既往研究结论一致，对BPD+D/A人群中推广DBT与MBT的应用具有实践启示。同时，研究结果也证实了短程DBT干预的有效性，对于频繁遭遇危机、难以坚持传统12个月疗程的BPD患者而言，短程DBT可作为更具实用性的治疗选择。