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Table 2 Data extraction of included studies on educational interventions for borderline personality disorder in healthcare

From: The impact of educational interventions on modifying health practitioners’ attitudes and practice in treating people with borderline personality disorder: an integrative review

Author, Year, Country MMAT v.18/JBI Quality Rating* Population Type Setting Aim/Purpose Study design/follow up Intervention/Mode of delivery Main Findings
Clarke et al. 2015 [43], UK **** Multi-disciplinary teams Inpatient setting The aim of this study was to assess whether training in neurobiological underpinnings of Borderline Personality Disorder (BPD) could improve knowledge and attitude change within staff members working in a low secure inpatient setting Within-subjects, quantitative questionnaire design / pre- and post- training and 2 month follow up The Science of BPD Attendance at the training session was associated with significant increases in theoretical knowledge, Perspective Taking and Locus of Origin scores. However, there were no changes observed in Empathic Concern scores. This research suggests that a relatively brief training session, that utilizes the neurobiological framework, can be effective in facilitating knowledge and attitudinal change for those working with BPD.
Commons Treloar et al. 2009 [44], Aus *** Registered health practitioners Aus / NZ health services To examine two theoretical frameworks (cognitive-behavioral and psychoanalytic), and compare changes in clinicians’ attitudes towards deliberate self-harm behaviors in BPD Exploratory Randomized Controlled Trial/ pre- and post-training and 6-months follow up Cognitive Behavioral Therapy, Psychotherapy (both 45 min); Seminar discussions (45 min) Compared with participants in the control group (N=22), participants in the cognitive-behavioral program (N=18) showed significant improvement in attitudes immediately after attending the program, as did participants in the psychoanalytic education program (N=25). The six-month follow-up revealed that only the psychoanalytic education group maintained significant changes in attitude. Results are discussed in terms of the use of relatively brief educational interventions in facilitating enduring attitude change toward working with this population.
Dickens et al. 2016 [35], UK JBI, Level 1.b/ Level 4* Mental health nurses   To collate the current evidence about interventions that have been devised to improve the responses of mental health nurses towards people with BPD Systematic Review Various interventions/duration of training Eight studies were included in this review, half of which were judged to be methodologically weak, and the remaining four studies judged to be of moderate quality. Only one study employed a control group. The largest effect sizes were found for changes related to cognitive attitudes including knowledge; smaller effect sizes were found in relation to changes in affective outcomes. Self-reported behavioral change in the form of increased use of components of Dialectical Behavior Therapy (DBT) following training in this treatment was associated with moderate effect sizes. Mental health nurses hold the poorest attitudes to people with BPD.
Dickens et al. 2019 [45], UK **** Mental Health staff Inpatient / community settings To evaluate/ explore mental health nurses’ responses to, and experience of, an educational intervention to improve attitudes towards people with a diagnosis of BPD Mixed methods/pre- and post- training surveys and 4-month follow up/Focus Groups Positive about Borderline including, Part 1: The Science of BPD (3-hr); and Part 2: Wot R U Like? Training (3-hr)/ Presentation, activities, discussion Quantitative evaluation revealed sustained changes consistent with expected attitudinal gains in relation to the perceived treatment characteristics of this group, the perception of their suicidal tendencies and negative attitudes. Qualitative findings revealed hostility towards the underpinning biosocial model and positive appreciation for the involvement of an expert by experience. Conclusions: Sustained benefits of an educational intervention for people working with people diagnosed with BPD in some but not all areas. The study provides evidence for incorporation of a biosocial model into staff training and the benefits of expert by experience co-production. Mental health nurses believe that more well-resourced services are the key to improving care.
Keuroghlian et al. 2006 [46], USA **** Mental Health clinicians including, psychiatrists, psychologists, counselors, nurses, and internists/primary care doctors Medical Centers/Hospitals Aims: (1) assess the effectiveness of Good Psychiatric Management workshops at improving clinicians’ attitudes to BPD and, (2) assess if changes in attitudes relate to the years of clinical experience Before and after design/ pre- and post-training follow-up Good Psychiatric Management Workshop (1-day)/ Didactic teaching; videos; case vignettes Participants reported decreased inclination to avoid patients with borderline, dislike of patients with borderline, belief that BPD prognosis is hopeless, and increased feeling of professional competence, belief that they can make a positive difference and that effective psychotherapies exist. Less clinical experience was related to an increased feeling of competence. Findings demonstrate Good Psychiatric Management potential for training clinicians to meet population-wide needs related to BPD.
Knaak et al. 2015 [47], Canada *** Health Practitioners including, social workers, psychiatrists, psychologists, counselors, nurses, students, director/managers Health services To identify whether a generalist or specialist approach is the better strategy for anti-stigma programming for disorders characterized by high levels of stigmatization; and to examine the extent an intervention led to change in perceptions towards people with BPD and mental illness. Pre-post design/ pre- and post-training follow-up BPD/ DBT Workshop (3-hr) Although effectiveness cannot be conclusively demonstrated with the current research design, results are encouraging that the intervention was successful at improving healthcare provider attitudes and behavioral intentions towards persons with BPD. The results further suggest that anti-stigma interventions effective at combating stigma against a specific disorder may also have positive generalizable effects towards a broader set of mental illnesses.
Masland et al. 2018 [48], USA **** Mental health clinicians, researchers, administrators Medical Centre including outpatient, inpatient, residential, private practice. To examine whether a 1-day training in Good Psychiatric Management can change clinician attitudes and beliefs and whether those changes persist over time Repeated Measures Design/ pre- and post-training s and 6-month follow up Good Psychiatric Management (1-day)/Lecture format; instructive case videos; case vignettes Staff attitudes did not change immediately after training, but 6 months later had changed significantly. Findings indicate that brief training can foster enduring improvements in clinician attitudes and beliefs about BPD.
Pigot et al. 2019 [49], Aus ***** Mental health clinicians, managers Public mental health services To understand the facilitators and barriers to real world implementation of a stepped care approach to treating personality disorders Qualitative study A Stepped Care approach/ post-training implementation at 18-mth follow-up Participants identified personal attitudes, knowledge and skills as important for successful implementation. Existing positive attitudes and beliefs about treating people with a personality disorder contributed to the emergence of clinical champions. Training facilitated positive attitudes by justifying the psychological approach. Management support was found to bi-directionally effect implementation. Findings suggests specific organizational and individual factors may increase timely and efficient implementation of interventions for people with BPD.
Warrender 2015 [50], UK ***** Nurses Acute mental health services To capture staff perceptions of the impact of health. Mentalization-based therapy skills (MBT-S) training on their practice when working with people BPD in acute mental health Qualitative/Focus groups MBT-S Training (2-day)/ Didactic teaching; role play; DVD clips MBT-S Training promoted empathy and humane responses to self-harm, impacted on participants ability to tolerate risk and changed some perceptions of BPD. Staff felt empowered and more confident to work with people with BPD. The positive implication for practice was the ease in which the approach was adopted and participants perception of MBT-S as an empowering skill set which also contributed to attitudinal change.
  1. Data extraction relevant to the review objectives and review question(s). *MMAT v.18 Quality rating: low = 1 to 2 stars; moderate = 3 stars; moderately high = 4 stars; high = 5 stars. *JBI Quality rating for level of evidence for effectiveness is level 1.b systematic review of RCTs and other study designs; and the level of meaningfulness is 4 - systematic reviews of expert opinion [51,52,53]