Efficacy of Treatment Modalities for Borderline Personality Disorder: A Systematic Review and Network Meta-analysis of DBT, TFP, and MBT

Abstract

Borderline Personality Disorder (BPD) is a severe and complex mental health condition associated with high rates of self-harm, interpersonal difficulties, and treatment challenges. This study aimed to evaluate the comparative efficacy of Dialectical Behavior Therapy (DBT), Transference-Focused Psychotherapy (TFP), and Mentalization-Based Treatment (MBT) using a network meta-analysis framework. This systematic review and network meta-analysis compared DBT, MBT, TFP, and other active comparators in adults with BPD across five continuous outcomes: BPD symptom severity, interpersonal problems, depressive symptoms, self-harm, and suicide attempts. Twenty randomized controlled trials (n = 1,706) published between 1980 and 2023 met eligibility criteria by reporting continuous data for at least one of these outcomes. A frequentist network meta- analysis was used to estimate pooled effect sizes (Cohen’s d) and to rank treatments. TFP showed a moderate effect on BPD symptom severity (d = 0.46). MBT yielded the strongest effects for interpersonal problems (d = -1.76), self-harm (d = -0.86), and suicide attempts (d = -0.74), all statistically significant. DBT offered a small but significant

reduction in self-harm, with negligible impact on suicide attempts. Overall, MBT ranked highest for reducing risk behaviors. Risk-of-bias assessments revealed methodological variability, with publication bias and imprecision reducing confidence in certain outcomes. Nonetheless, MBT appears particularly effective for risk behaviors and interpersonal functioning, while DBT and TFP demonstrate moderate benefits in select domains. This systematic review was registered with PROSPERO (CRD42022345795).