Group Psychotherapy for Borderline Personality Disorder: A Meta-Analysis of Randomized-Controlled Trials

Treatment guidelines for borderline personality disorder (BPD) recommend psychotherapy as an important, if not essential, component of patient care. The current study is a meta-analysis of randomized controlled trials comparing group psychotherapy for BPD with treatment as usual (TAU). We included moderator analysis to examine how outcomes differ based on group and patient characteristics, risk of bias variables, and treatment elements of the TAU comparison condition (e.g.. whether psychotherapy was included). Twenty-four studies with 1,595 participants met eligibility criteria for interpretative analysis. Group psychotherapy had a large effect on reduction of BPD symptoms (g = 0.72, 95% confidence interval [0.41, 1.04], p < .001) and a moderate effect on suicidality/parasuicidality symptoms (g = 0.46, 95% confidence interval [0.22, 0.71], p < .001). Heterogeneity was high for both outcomes (I-2 = 76% and 70%, respectively), and the moderator analyses found an association between treatment structure and BPD symptoms and between theoretical orientation and suicidality/parasuicidality symptoms. There was also an association between group size and both BPD symptoms and suicidality/parasuicidality symptoms. There was a small to medium effect in favor of group treatments for secondary outcomes (i.e., anxiety, depression, and mental health). We concluded group treatments were associated with greater symptom reduction when compared with TAU and though some moderating variables were identified, additional heterogeneity needs to be explained. The discussion includes recommendations both for group psychotherapy practitioners and researchers.