Current state of the evidence on community treatments for people with complex emotional needs: a scoping review - BMC Psychiatry - BMC Psychiatry

Moran P, Romaniuk H, Coffey C, Chanen A, Degenhardt L, Borschmann R, Patton GC. The influence of personality disorder on the future mental health and social adjustment of young adults: a population-based, longitudinal cohort study. The Lancet Psychiatry. 2016;3(7):636–45.

PubMed  Article  Google Scholar 

Quirk SE, El-Gabalawy R, Brennan SL, Bolton JM, Sareen J, Berk M, Chanen AM, Pasco JA, Williams LJ. Personality disorders and physical comorbidities in adults from the United States: data from the National Epidemiologic Survey on Alcohol and Related Conditions. Soc Psychiatry Psychiatr Epidemiol. 2015;50(5):807–20.

PubMed  Article  Google Scholar 

Soeteman DI. Roijen LH-v, Verheul R, Busschbach JJ: The economic burden of personality disorders in mental health care. J Clin Psychiatry. 2008;69(2):259.

PubMed  Article  Google Scholar 

Hastrup L, Jennum P, Ibsen R, Kjellberg J, Simonsen E. Societal costs of Borderline Personality Disorders: a matched-controlled nationwide study of patients and spouses. Acta Psychiatr Scand. 2019;140(5):458–67.

CAS  PubMed  Article  Google Scholar 

Tyrer P, Mulder R, Crawford M, Newton-Howes G, Simonsen E, Ndetei D, Koldobsky N, Fossati A, Mbatia J, Barrett B. Personality disorder: a new global perspective. World Psychiatry. 2010;9(1):56.

PubMed  PubMed Central  Article  Google Scholar 

National Institute of Mental Health. Personality disorder: No longer a diagnosis of exclusion. London: Department of Health; 2003.

Google Scholar 

National Health and Medical Research Council. Clinical Practice Guideline for the Management of Borderline Personality Disorder. Melbourne: National Health and Medical Research Council; 2012.

Google Scholar 

Royal College of Psychiatrists. Personality Disorder in Scotland. 2018.

Google Scholar 

Northern Ireland Personality Disorder Strategy. Personality Disorder: A Diagnosis for Inclusion. 2010.

Google Scholar 

Sheridan Rains L, Echave A, Rees J, Scott HR, Lever Taylor B, Broeckelmann E, Steare T, Barnett P, Cooper C, Jeynes T. Service user experiences of community services for complex emotional needs: A qualitative thematic synthesis. PLoS ONE. 2021;16(4):e0248316.

CAS  PubMed  PubMed Central  Article  Google Scholar 

Lester R, Prescott L, McCormack M, Sampson M. North West Boroughs Healthcare NFT: Service users' experiences of receiving a diagnosis of borderline personality disorder: A systematic review. Personal Ment Health. 2020;14(3):263–83.

CAS  PubMed  Article  Google Scholar 

Ring D, Lawn S. Stigma perpetuation at the interface of mental health care: a review to compare patient and clinician perspectives of stigma and borderline personality disorder. J Ment Health. 2019:1–21. https://doi.org/10.1080/09638237.2019.158133.

RITB Position Statement On Borderline Personality Disorder [https://recoveryinthebin.org/2019/04/03/ritb-position-statement-on-borderline-personality-disorder/]

Trevillion K, Stuart R, Ocloo J, Broeckelmann E, Jeffreys S, Jeynes T, Allen D, Russell J, Billings J, Crawford MJ. Service user perspectives of community mental health services for people with complex emotional needs: A co-produced qualitative interview study. BMC Psychiatry. 2022;22(1):1–18.

Article  Google Scholar 

Royal College of Psychiatrists. Services for people diagnosable with personality disorder: Position statement. 2020.

Google Scholar 

National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. Safer Care for Patients with Personality Disorder. Manchester: University of Manchester; 2018.

Google Scholar 

Mental Health Council of Australia BaMI HRaEOC. Not for service: experiences of injustice and despair in mental health care in Australia. Canberra: Mental Health Council of Australia; 2005.

Google Scholar 

Dale O, Sethi F, Stanton C, Evans S, Barnicot K, Sedgwick R, Goldsack S, Doran M, Shoolbred L, Samele C. Personality disorder services in England: findings from a national survey. BJPsych bulletin. 2017;41(5):247–53.

PubMed  PubMed Central  Article  Google Scholar 

Ng F, Townsend ML, Jewell M, Marceau EM, Grenyer BF. Priorities for service improvement in personality disorder in Australia: perspectives of consumers, carers and clinicians. Personal Ment Health. 2020;14(4):350–60.

PubMed  Article  Google Scholar 

Troup J, Lever Taylor B, Sheridan Rains L, Broeckelmann E, Russell J, Jeynes T, Cooper C, Steare T, Dedat Z, McNicholas S. Clinician perspectives on what constitutes good practice in community services for people with Complex Emotional Needs: A qualitative thematic meta-synthesis. PLoS ONE. 2022;17(5):e0267787.

CAS  PubMed  PubMed Central  Article  Google Scholar 

Fanaian M, Lewis KL, Grenyer BF. Improving services for people with personality disorders: Views of experienced clinicians. Int J Ment Health Nurs. 2013;22(5):465–71.

PubMed  Article  Google Scholar 

Flynn S, Raphael J, Graney J, Nyathi T, Williams A, Kapur N, Appleby L, Shaw J. The personality disorder patient pathway: Service user and clinical perspectives. Personal Ment Health. 2019;13(3):134–43.

CAS  PubMed  Article  Google Scholar 

Oud M, Arntz A, Hermens ML, Verhoef R, Kendall T. Specialized psychotherapies for adults with borderline personality disorder: a systematic review and meta-analysis. Aust N Z J Psychiatry. 2018;52(10):949–61.

PubMed  PubMed Central  Article  Google Scholar 

Barnicot K, Katsakou C, Bhatti N, Savill M, Fearns N, Priebe S. Factors predicting the outcome of psychotherapy for borderline personality disorder: A systematic review. Clin Psychol Rev. 2012;32(5):400–12.

PubMed  Article  Google Scholar 

Cristea IA, Gentili C, Cotet CD, Palomba D, Barbui C, Cuijpers P. Efficacy of psychotherapies for borderline personality disorder: a systematic review and meta-analysis. JAMA Psychiat. 2017;74(4):319–28.

Article  Google Scholar 

Storebø OJ, Stoffers-Winterling JM, Völlm BA, Kongerslev MT, Mattivi JT, Jørgensen MS, et al. Psychological therapies for people with borderline personality disorder. Cochrane Database Syst Rev. 2020;5:1–512.

Google Scholar 

Sharma M, Nazareth I, Petersen I. Observational studies of treatment effectiveness: worthwhile or worthless? Clin Epidemiol. 2019;11:35.

CAS  PubMed  Article  Google Scholar 

Munn Z, Peters MD, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol. 2018;18(1):1–7.

Article  Google Scholar 

Peters MD, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Scoping reviews. In: Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis. 2020.

Google Scholar 

Peters MD, Marnie C, Tricco AC, Pollock D, Munn Z, Alexander L, McInerney P, Godfrey CM, Khalil H. Updated methodological guidance for the conduct of scoping reviews. JBI Evidence Synthesis. 2020;18(10):2119–26.

PubMed  Article  Google Scholar 

Yuen NWZ, Barnett P, Rains LS, Johnson S, Billings J: Evaluation of international guidance for the community treatment of complex emotional needs: A systematic review. medRxiv. 2022.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE: The PRISMA,. statement: an updated guideline for reporting systematic reviews. BMJ. 2020;2021:372.

Google Scholar 

McMain SF, Guimond T, Barnhart R, Habinski L, Streiner DL. A randomized trial of brief dialectical behaviour therapy skills training in suicidal patients suffering from borderline disorder. Acta Psychiatr Scand. 2017;135(2):138–48.

PubMed  Article  Google Scholar 

Kramer U, Pascual-Leone A, Berthoud L, De Roten Y, Marquet P, Kolly S, Despland JN, Page D. Assertive anger mediates effects of dialectical behaviour-informed skills training for borderline personality disorder: A randomized controlled trial. Clin Psychol Psychother. 2016;23(3):189–202.

PubMed  Article  Google Scholar 

Feigenbaum JD, Fonagy P, Pilling S, Jones A, Wildgoose A, Bebbington PE. A real-world study of the effectiveness of DBT in the UK National Health Service. Br J Clin Psychol. 2012;51(2):121–41.

PubMed  Article  Google Scholar 

Priebe S, Bhatti N, Barnicot K, Bremner S, Gaglia A, Katsakou C, Molosankwe I, McCrone P, Zinkler M. Effectiveness and cost-effectiveness of dialectical behaviour therapy for self-harming patients with personality disorder: A pragmatic randomised controlled trial. Psychother Psychosom. 2012;81(6):356–65.

PubMed  Article  Google Scholar 

Carter GL, Willcox CH, Lewin TJ, Conrad AM, Bendit N. Hunter DBT project: randomized controlled trial of dialectical behaviour therapy in women with borderline personality disorder. Aust N Z J Psychiatry. 2010;44(2):162–73.

PubMed  Article  Google Scholar 

Soler J, Pascual JC, Tiana T, Cebrià A, Barrachina J, Campins MJ, Gich I, Alvarez E, Pérez V. Dialectical behaviour therapy skills training compared to standard group therapy in borderline personality disorder: A 3-month randomised controlled clinical trial. Behav Res Ther. 2009;47(5):353–8.

PubMed  Article  Google Scholar 

Van den Bosch LM, Koeter MW, Stijnen T, Verheul R, van den Brink W. Sustained efficacy of dialectical behaviour therapy for borderline personality disorder. Behav Res Ther. 2005;43(9):1231–41.

PubMed  Article  Google Scholar 

Verheul R, Van Den Bosch LM, Koeter MW, De Ridder MA, Stijnen T, Van Den Brink W. Dialectical behaviour therapy for women with borderline personality disorder: 12-month, randomised clinical trial in The Netherlands. Br J Psychiatry. 2003;182(2):135–40.

PubMed  Article  Google Scholar 

Linehan MM, Tutek DA, Heard HL, Armstrong HE. Interpersonal outcome of cognitive behavioral treatment for chronically suicidal borderline patients. Am J Psychiatry. 1994;151(12):1771–5.

CAS  PubMed  Article  Google Scholar 

Linehan MM, Armstrong HE, Suarez A, Allmon D, Heard HL. Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Arch Gen Psychiatry. 1991;48(12):1060–4.

CAS  PubMed  Article  Google Scholar 

Khabir L, Mohamadi N, Rahimi C, Dastgheib SA. The Effectiveness of Group Therapy based on Mentalization and Dialectical Behavior on Clinical Symptoms of Borderline Personality Disorder: A randomized controlled clinical trial. J Health Sci Surveillance System. 2018;6(2):80–8.

Google Scholar 

Koons CR, Robins CJ, Tweed JL, Lynch TR, Gonzalez AM, Morse JQ, Bishop GK, Butterfield MI, Bastian LA. Efficacy of dialectical behavior therapy in women veterans with borderline personality disorder. Behav Ther. 2001;32(2):371–90.

Article  Google Scholar 

Robinson S, Lang JE, Hernandez AM, Holz T, Cameron M, Brannon B. Outcomes of dialectical behavior therapy administered by an interdisciplinary team. Arch Psychiatr Nurs. 2018;32(4):512–6.

PubMed  Article  Google Scholar 

Flynn D, Kells M, Joyce M, Corcoran P, Gillespie C, Suarez C, Weihrauch M, Cotter P. Standard 12 month dialectical behaviour therapy for adults with borderline personality disorder in a public community mental health setting. Borderline Personal Disord Emot Dysregul. 2017;4(1):1–11.

Article  Google Scholar 

Rizvi SL, Hughes CD, Hittman AD, Vieira Oliveira P. Can trainees effectively deliver dialectical behavior therapy for individuals with borderline personality disorder? Outcomes from a training clinic. J Clin Psychol. 2017;73(12):1599–611.

PubMed  Article  Google Scholar 

Gregory RJ, Sachdeva S. Naturalistic outcomes of evidence-based therapies for borderline personality disorder at a medical university clinic. Am J Psychother. 2016;70(2):167–84.

PubMed  Article  Google Scholar 

Stiglmayr C, Stecher-Mohr J, Wagner T, Meiβner J, Spretz D, Steffens C, Roepke S, Fydrich T, Salbach-Andrae H, Schulze J. Effectiveness of dialectic behavioral therapy in routine outpatient care: The Berlin Borderline Study. Borderline Personal Disord Emot Dysregul. 2014;1(1):1–11.

Article  Google Scholar 

Koons CR, O'Rourke B, Carter B, Erhardt EB. Negotiating for improved reimbursement for dialectical behavior therapy: A successful project. Cogn Behav Pract. 2013;20(3):314–24.

Article  Google Scholar 

Gutteling BM, Montagne B, Nijs M, van den Bosch LW. Dialectical behavior therapy: Is outpatient group psychotherapy an effective alternative to individual psychotherapy? Preliminary conclusions. Comprehensive Psychiatry. 2012;53(8):1161–8.

PubMed  Article  Google Scholar 

Axelrod SR, Perepletchikova F, Holtzman K, Sinha R. Emotion regulation and substance use frequency in women with substance dependence and borderline personality disorder receiving dialectical behavior therapy. Am J Drug Alcohol Abuse. 2011;37(1):37–42.

PubMed  Article  Google Scholar 

Blennerhassett R, Bamford L, Whelan A, Jamieson S, O'Raghaillaigh JW. Dialectical behaviour therapy in an Irish community mental health setting. Irish J Psychol Med. 2009;26(2):59–63.

Article  Google Scholar 

Comtois KA, Elwood L, Holdcraft LC, Smith WR, Simpson TL. Effectiveness of dialectical behavior therapy in a community mental health center. Cogn Behav Pract. 2007;14(4):406–14.

Article  Google Scholar 

Harley RM, Baity MR, Blais MA, Jacobo MC. Use of dialectical behavior therapy skills training for borderline personality disorder in a naturalistic setting. Psychother Res. 2007;17(3):351–8.

Article  Google Scholar 

Zinkler M, Gaglia A, Arokiadass SR, Farhy E. Dialectical behaviour treatment: implementation and outcomes. Psychiatr Bull. 2007;31(7):249–52.

Article  Google Scholar 

Brassington J, Krawitz R. Australasian dialectical behaviour therapy pilot outcome study: effectiveness, utility and feasibility. Australas Psychiatry. 2006;14(3):313–8.

PubMed  Article  Google Scholar 

Ben-Porath DD, Peterson GA, Smee J. Treatment of individuals with borderline personality disorder using dialectical behavior therapy in a community mental health setting: Clinical application and a preliminary investigation. Cogn Behav Pract. 2004;11(4):424–34.

Article  Google Scholar 

Perseius K-I, Samuelsson M, Andersson E, Berndtsson T, Götmark H, Henriksson F, Kåver A, Nilsonne Å, Åsberg M. Does dialectical behavioural therapy reduce treatment costs for patients with borderline personality disorder. A pilot study. Vård I Norden. 2004;24(2):27–30.

Google Scholar 

Lopez A, Chessick CA. DBT graduate group pilot study: A model to generalize skills to create a "life worth living." Soc Work Ment Health. 2013;11(2):141–53.

Article  Google Scholar 

Comtois KA, Kerbrat AH, Atkins DC, Harned MS, Elwood L. Recovery from disability for individuals with borderline personality disorder: a feasibility trial of DBT-ACES. Psychiatr Serv. 2010;61(11):1106–11.

PubMed  Article  Google Scholar 

Stanley B, Brodsky B, Nelson JD, Dulit R. Brief dialectical behavior therapy (DBT-B) for suicidal behavior and non-suicidal self injury. Arch Suicide Res. 2007;11(4):337–41.

PubMed  Article  Google Scholar 

Flynn D, Kells M, Joyce M, Corcoran P, Hurley J, Gillespie C, Suarez C, Swales M, Arensman E. Multisite implementation and evaluation of 12-month standard Dialectical Behavior Therapy in a public community setting. J Pers Disord. 2020;34(3):377–93.

PubMed  Article  Google Scholar 

McMain SF, Guimond T, Streiner DL, Cardish RJ, Links PS. Dialectical behavior therapy compared with general psychiatric management for borderline personality disorder: Clinical outcomes and functioning over a 2-year follow-up. Am J Psychiatry. 2012;169(6):650–61.

PubMed  Article  Google Scholar 

Pasieczny N, Connor J. The effectiveness of dialectical behaviour therapy in routine public mental health settings: An Australian controlled trial. Behav Res Ther. 2011;49(1):4–10.

PubMed  Article  Google Scholar 

McMain SF, Links PS, Gnam WH, Guimond T, Cardish RJ, Korman L, Streiner DL. A randomized trial of dialectical behavior therapy versus general psychiatric management for borderline personality disorder. Am J Psychiatry. 2009;166(12):1365–74.

PubMed  Article  Google Scholar 

Clarkin JF, Levy KN, Lenzenweger MF, Kernberg OF. Evaluating three treatments for borderline personality disorder: A multiwave study. Am J Psychiatry. 2007;164(6):922–8.

PubMed  Article  Google Scholar 

Linehan MM, Comtois KA, Murray AM, Brown MZ, Gallop RJ, Heard HL, Korslund KE, Tutek DA, Reynolds SK, Lindenboim N. Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Arch Gen Psychiatry. 2006;63(7):757–66.

PubMed  Article  Google Scholar 

Linehan MM, Dimeff LA, Reynolds SK, Comtois KA, Welch SS, Heagerty P, Kivlahan DR. Dialectical behavior therapy versus comprehensive validation therapy plus 12-step for the treatment of opioid dependent women meeting criteria for borderline personality disorder. Drug Alcohol Depend. 2002;67(1):13–26.

PubMed  Article  Google Scholar 

Barnicot K, Crawford M. Dialectical behaviour therapy v. mentalisation-based therapy for borderline personality disorder. Psychol Med. 2019;49(12):2060–8.

PubMed  Article  Google Scholar 

Andión Ó, Ferrer M, Matali J, Gancedo B, Calvo N, Barral C, Valero S, Di Genova A, Diener MJ, Torrubia R. Effectiveness of combined individual and group dialectical behavior therapy compared to only individual dialectical behavior therapy: A preliminary study. Psychotherapy. 2012;49(2):241.

PubMed  Article  Google Scholar 

Carmona i Farrés C, Elices M, Soler J, Domínguez-Clavé E, Martín-Blanco A, Pomarol-Clotet E, Salvador R, Martinez-Horta S, Pascual JC. Effects of mindfulness training on the default mode network in borderline personality disorder. Clin Psychol Psychother. 2019;26(5):562–71.

PubMed  Article  Google Scholar 

Lin T-J, Ko H-C. Wu JY-W, Oei TP, Lane H-Y, Chen C-H: The effectiveness of dialectical behavior therapy skills training group vs. cognitive therapy group on reducing depression and suicide attempts for borderline personality disorder in Taiwan. Arch Suicide Res. 2019;23(1):82–99.

PubMed  Article  Google Scholar 

Elices M, Pascual JC, Portella MJ, Feliu-Soler A, Martín-Blanco A, Carmona C, Soler J. Impact of mindfulness training on borderline personality disorder: A randomized trial. Mindfulness. 2016;7(3):584–95.

Article  Google Scholar 

Linehan MM, Korslund KE, Harned MS, Gallop RJ, Lungu A, Neacsiu AD, McDavid J, Comtois KA, Murray-Gregory AM. Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: A randomized clinical trial and component analysis. JAMA Psychiat. 2015;72(5):475–82.

Article  CAS  Google Scholar 

Turner RM. Naturalistic evaluation of dialectical behavior therapy-oriented treatment for borderline personality disorder. Cogn Behav Pract. 2000;7(4):413–9.

Article  Google Scholar 

Feliu-Soler A, Pascual JC, Elices M, Martín-Blanco A, Carmona C, Cebolla A, Simón V, Soler J. Fostering self-compassion and loving-kindness in patients with borderline personality disorder: A randomized pilot study. Clin Psychol Psychother. 2017;24(1):278–86.

PubMed  Article  Google Scholar 

Kells M, Joyce M, Flynn D, Spillane A, Hayes A. Dialectical behaviour therapy skills reconsidered: applying skills training to emotionally dysregulated individuals who do not engage in suicidal and self-harming behaviours. Borderline Personal Disord Emot Dysregul. 2020;7(1):3.

PubMed  PubMed Central  Article  Google Scholar 

Lakeman R, Emeleus M, Davies S, Anderson S. A pragmatic evaluation of a high-fidelity dialectical behaviour therapy programme for youth with borderline personality disorder. Adv Mental Health. 2020;19(2):1–11.

Google Scholar 

Lyng J, Swales MA, Hastings RP, Millar T, Duffy DJ, Booth R. Standalone DBT group skills training versus standard (i.e. all modes) DBT for borderline personality disorder: A natural quasi-experiment in routine clinical practice. Comm Mental Health J. 2020;56(2):238–50.

Article  Google Scholar 

Aafjes-van Doorn K, Kamsteeg C, Portier K, Chitre G. A dialectical behavior therapy skills group in a psychoanalytic community service: A pilot study. J Cogn Psychother. 2020;34(1):21–46.

Article  Google Scholar 

Sandage SJ, Long B, Moen R, Jankowski PJ, Worthington EL Jr, Wade NG, Rye MS. Forgiveness in the treatment of borderline personality disorder: A quasi-experimental study. J Clin Psychol. 2015;71(7):625–40.

PubMed  Article  Google Scholar 

Williams SE, Hartstone MD, Denson LA. Dialectical behavioural therapy and borderline personality disorder: Effects on service utilisation and self-reported symptoms. Behav Chang. 2010;27(4):251.

Article  Google Scholar 

Yen S, Johnson J, Costello E, Simpson EB. A 5-day dialectical behavior therapy partial hospital program for women with borderline personality disorder: Predictors of outcome from a 3-month follow-up study. J Psychiatr Pract. 2009;15(3):173.

PubMed  PubMed Central  Article  Google Scholar 

Prendergast N, McCausland J. Dialectic behaviour therapy: A 12-month collaborative program in a local community setting. Behav Chang. 2007;24(1):25.

Article  Google Scholar 

Sambrook S, Abba N, Chadwick P. Evaluation of DBT emotional coping skills groups for people with parasuicidal behaviours. Behav Cogn Psychother. 2007;35(2):241.

Article  Google Scholar 

McQuillan A, Nicastro R, Guenot F, Girard M, Lissner C, Ferrero F. Intensive dialectical behavior therapy for outpatients with borderline personality disorder who are in crisis. Psychiatr Serv. 2005;56(2):193–7.

PubMed  Article  Google Scholar 

Conrad AM, Sankaranarayanan A, Lewin TJ, Dunbar A. Effectiveness of a 10-week group program based on Dialectical Behaviour Therapy skills among patients with personality and mood disorders: Findings from a pilot study. Australas Psychiatry. 2017;25(5):466–70.

PubMed  Article  Google Scholar 

Meaney-Tavares R, Hasking P. Coping and regulating emotions: A pilot study of a modified dialectical behavior therapy group delivered in a college counseling service. J Am Coll Health. 2013;61(5):303–9.

PubMed  Article  Google Scholar 

Pozzi E, Ridolfi ME, Manganaro D, Daniel DB, Berardi D. Multiple integrated treatment of borderline personality disorders. Psychoanal Psychother. 2008;22(3):218–34.

Article  Google Scholar 

Bohus M, Kleindienst N, Hahn C, Müller-Engelmann M, Ludäscher P, Steil R, Fydrich T, Kuehner C, Resick PA, Stiglmayr C. Dialectical Behavior Therapy for Posttrauma...