Psychoeducation is a common feature of effective treatments for borderline personality disorder (BPD), as patients need to understand the illness and the problems for which their treatments are prescribed.
Lois W. Choi-Kain, MD, MEd, director of the Gunderson Personality Disorders Institute at McLean Hospital, Laura Germine, PhD, technical director of the McLean Institute for Technology in Psychiatry and director of the Laboratory for Brain and Cognitive Health Technology at McLean, and colleagues are conducting a pilot study to test the safety, feasibility, and preliminary efficacy of online psychoeducation videos along with self-report assessment and individualized feedback.
They outline the study protocol in PLoS One, explaining the intervention might prove to be suitable for primary care clinicians, generalist mental health clinicians, and emergency department professionals to prescribe as a first step before further treatment can be arranged.
Aims
The study has three objectives:
- Test the safety and feasibility of prescribing 10 online educational videos about BPD as a scalable intervention immediately after diagnostic disclosure
- Test the feasibility of online self-assessment and neuropsychological testing to assess BPD symptom severity, symptom change, underlying traits such as rejection sensitivity, and proposed mechanisms of change in treatment
- Assess the feasibility and incremental benefit of personalizing the intervention by providing simple feedback on the results of cognitive tests and self-reported symptoms
Design
The study design incorporates sequential randomization: BPD psychoeducational versus control videos (2:1 randomization), then randomization to feedback versus no feedback (1:1). There are thus three arms:
- BPD-related videos: feedback
- BPD-related videos: no feedback
- Control videos: no feedback
Participants
The goal is to enroll 100 participants diagnosed with BPD within the past three months, using advertisements posted online and in non-psychiatric medical settings as well as recruitment from inpatient psychiatric units. Key inclusion criteria are age ≥18, no prior evidence-based psychotherapy for BPD, and reliable access to a smartphone for the duration of the study.
Interventions
Two types of interventions are being employed: psychoeducational videos and feedback.
Psychoeducation
The 10 videos were filmed for this study. Each is four to 10 minutes long, covers a single topic, and features the same expert in BPD.
One video is delivered to participants in the BPD-related video group every business day for two weeks. Control videos are matched in length and frequency to the BPD-related videos but cover aspects of mental and physical health unrelated to BPD.
Feedback
To assess treatment effects and mechanisms, participants complete the following:
- 5 full-length cognitive tests at baseline, day 15, day 30, and day 60
- 1-minute versions of the Cognitive Performance Test and the Digit Symbol Matching Test daily for 30 days
- An ecological momentary assessment (EMA) containing questions about the participant’s immediate surroundings and functioning, as well as their emotional, interpersonal, and behavioral reactions to recent stressful or supportive social interactions, daily for 30 days
Participants assigned to the feedback condition receive an email between days 15 and 30 showing the results from their cognitive tests and their self-reported BPD symptoms.
Timeline
Enrollment for the study began in June 2022, interventions began in June 2023, and the estimated completion date is September 2024.
Data from the pilot will be used to support larger-scale research on psychoeducational video prescriptions as a scalable intervention to reduce BPD symptomatology.
Looking for mental health care for someone struggling with borderline personality disorder? Call us today at 617.855.3452 to refer a patient.
