Do Patients with Borderline Personality Disorder Benefit from Group Treatment?

Meta-analyses allow researchers to summarize and compare the results of multiple studies investigating the same question. This meta-analysis examined 24 studies, each of which assessed whether patients with borderline personality disorder (BPD) who received group psychotherapy experienced a greater reduction of symptoms compared to patients who received treatment as usual (TAU) in their local community. The specific treatments offered through TAU varied between studies and could include case management visits or formal psychotherapy. The authors found patients who attended group psychotherapy did in fact experience greater benefit after completing treatment. To our knowledge, this is the first meta-analysis to address this question, and, for clinicians, this means they can recommend group format to treatment with greater confidence it will lead to a good outcome. These results may also help in efforts to demonstrate group’s effectiveness to third party payers or other disciplines.

The majority of studies included in the meta-analysis measured the effects of manualized, “skills” based groups, like DBT (utilized in 14 of the included 24 studies). Clinicians utilizing a psychodynamic approach to treatment may be interested in the two studies that tested this orientation (results supported its’ use for reducing suicidality/parasuicidality symptoms) or the one study that tested “interpersonal therapy.” Also of note, for most of the studies, group was not the sole form of treatment provided to patients. Patients commonly participated in individual therapy and medication management as well; it seems reasonable to presume patients will need additional forms of intervention to support their group experience, which aligns with the relational and functional difficulties characteristic of this disorder.

An important consideration for this study is that patients varied significantly in the amount of symptom reduction they experienced. This speaks to the complexity of group psychotherapy. Studies did not report on measures of process factors, like cohesion or working alliance, or measures of ruptures within the group, and therefore the authors were unable to test their impact on patient improvement. Clearly, clinical observation, in addition to research findings, is a necessary component of understanding treatment effectiveness with borderline pathology. Practitioners have to rely on additional information to guide their decisions about a patient’s fit for group, such as patient preference (e.g., Group Readiness Questionnaire), symptom reduction (e.g., Outcome Questionnaire), and process factors, like cohesion, (e.g., Group Questionnaire). 

McLaughlin, S., Barkowski, S., Burlingame, G., Strauss, B. & Rosendahl, J. Published online in March 2019. Efficacy of group psychotherapy for borderline personality disorder: A meta-analysis of randomized-controlled trials. Psychotherapy, 56(2), 260-273.

Is a Group Based Mindfulness Intervention Effective for Chronic Pain and Opioid Misuse?

Group-based psychosocial interventions have become increasingly common in the fight against opioid misuse, but how effective are these practices? In addition, what can we learn from the empirical literature to inform our own group work? A recent study in the Journal of Consulting and Clinical Psychology tested the effectiveness of a group-based mindfulness-oriented intervention (Mindfulness-Oriented Recovery Enhancement; MORE) for chronic pain patients receiving long-term opioid therapy and at risk for opioid misuse. Compared to a support group intervention, patients participating in MORE experienced reductions in pain severity and increases in positive psychological health, which represents positive emotions and meaning in life, at post-treatment and in opioid misuse risk at 3-month follow-up. Most interestingly, the authors found that in the MORE intervention, increases in positive psychological health contributed to reductions in patients’ pain severity and, ultimately, risk of opioid misuse.

But, how might these findings inform and enhance your group practice? First, whereas mindfulness practices have received increasing attention in the group therapy literature, this study provides evidence that such interventions are effective methods for treating chronic pain patients treated with long-term opioid therapy. Treatment of this patient group is a burgeoning problem facing many medical and mental health providers. Second, it suggests group therapists working with chronic pain patients may benefit from utilizing mindfulness and fostering patients’ positive emotions and meaning in life, such as reappraisal and savoring skills, in treatment.

Despite the positive findings of this study, we should also note that approximately 25% of patients dropped out of the MORE intervention. Unfortunately, the authors did not collect any group process data (e.g., group cohesion, group climate, etc.), and therefore it is difficult to ascertain why group members may have left treatment. Obviously, we must apply these findings with clinical wisdom to effectively utilize mindfulness approaches with group treatments; the complex dynamics that inevitably unfold in therapy groups must also be appreciated.

Garland, E. L., Hanley, A. W., Riquino, M. R., Reese, S. E., Baker, A. K., Salas, K., ... & Nakamura, Y. (2019). Mindfulness-oriented recovery enhancement reduces opioid misuse risk via analgesic and positive psychological mechanisms: A randomized controlled trial. Journal of Consulting and Clinical Psychology87(10), 927-940.