Telehealth for Borderline Personality Disorder Treatment Sees Success

Using telehealth to treat patients with borderline personality disorder (BPD) produced similar, positive outcomes as in-person treatment, according to a study from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project.

Past studies have shown telehealth’s success in treating mental health disorders such as depression, social anxiety disorder, and post-traumatic stress disorder, but there are limited studies that focus on using telehealth to treat borderline personality disorder, the Rhode Island researchers said.

BPD symptoms can include impulsivity, intense fluctuating emotions, unstable relationships, excessive anger, self-harm, and suicidal ideation. The risk of self-injury and suicidality for patients with BPD may speak to why telehealth treatment is so limited, the researchers said.

But clinicians and therapists had to adapt accordingly when the COVID-19 pandemic hit and called for limited in-person contact. The Rhode Island Hospital Adult partial hospital program transitioned to telehealth use for BPD treatment in response to the pandemic.

The study analyzed the outcomes of 64 patients who received BPD treatment virtually via Zoom between May 1 and December 15, 2020. The researchers compared the results to those of 117 patients who received in-person treatment at the partial hospital program between May 1 and December 15, 2019.

In comparing safety, effectiveness, and patient satisfaction levels, the researchers found that telehealth treatment was just as impactful as in-person treatment.

The telehealth patients attended individual therapy sessions, appointments with a psychiatrist, and three group therapy sessions on a daily basis. Although the number of sessions differed slightly for virtual and in-person sessions, the content and structure remained similar for both groups.

Both the in-person and telehealth patients received satisfaction surveys upon discharge from the program. Slightly less than half (48.4 percent) of the telehealth patients completed the survey compared to around 65 percent of the in-person group.

The majority of patients in the telehealth and in-person groups reported that they were very or extremely satisfied with their initial evaluations for BPD treatment (90 percent and 85.3 percent, respectively). More than 80 percent of patients in both groups also said that they were hopeful that they would get better.

What’s more, all the patients who received in-person treatment and 95.4 percent of telehealth patients said that they were very or extremely satisfied with their treatment following completion of the program. Most of the patients in both groups reported that they would recommend the treatment to a family member or friend, as well.

According to responses from a Remission from Depression Questionnaire that a handful of patients from both groups completed at admission and discharge, all the patients had significantly better outcomes at the end of the program regarding functioning, coping ability, positive mental health, and general wellbeing.

Around 80 percent of in-person patients and 76 percent of telehealth patients reported that they were a lot or very much better on the day of their discharge, researchers found.

Patients in the telehealth group missed fewer treatment days compared to the in-person group, perhaps highlighting the convenience of virtual sessions. Telehealth patients also received treatment for a longer period than the in-person group. The researchers noted this could be due to patients wanting more social interaction due to the increased isolation that the pandemic brought.

To qualify for the partial hospital program, patients must have had to be significantly functionally impaired, at-risk for self-harm, or have failed to progress in outpatient treatment. This means that the patients were more severely and chronically ill compared to patients treated as outpatients.

In order to ensure patient safety during the virtual appointments, the researchers leveraged risk management strategies. All team members received daily updated email and physical address information from patients in case of any safety concerns that required them to send emergency support to a patient. Patients also had to provide an emergency contact support person.

Additionally, a therapist monitored all group sessions and was available for patients to contact inside or outside of program hours for urgent needs or technical issues.

Contrary to the researchers’ prediction, the safety measures did not reduce patient satisfaction.

While the study’s initial goal was not to compare telehealth to in-person visits, as the transition to telehealth was inevitable due to COVID-19, the researchers ended up finding that treating BPD via telehealth was just as safe and effective as in-person treatment.

This is potentially good news for patients with BPD who preferred virtual treatment over in-person treatment for reasons such as limited transportation options or illnesses that made in-person attendance difficult.

“Thus, telehealth partial hospital treatment may establish some permanency either as a stand-alone program or perhaps incorporated into a combined in-person and virtual program,” the researchers concluded.