Psychological therapies for people with borderline personality disorder

Ole Jakob Storebø<sup>a</sup>; Jutta M Stoffers-Winterling<sup>a</sup>; Birgit A Völlm; Mickey T Kongerslev; Jessica T Mattivi; Mie S Jørgensen; Erlend Faltinsen; Adnan Todorovac; Christian P Sales; Henriette E Callesen; Klaus Lieb<sup>a</sup>; Erik Simonsen<sup>a</sup>

doi:10.1002/14651858.CD012955.pub2

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Figure 1

Study flow diagram

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Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Figure 4

Trial Sequential Analysis on primary outcome: Psychotherapy ‐ borderline symptom severity at end of treatment

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Figure 5

Funnel plot of comparison 1: Psychotherapy versus TAU, outcome: 1.1 Primary outcome: BPD symptom severity.

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Figure 6

Trial Sequential Analysis on primary outcome: Psychotherapy ‐ self‐harm at end of treatment

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Figure 7

Funnel plot of comparison: 1 Psychotherapy versus TAU, outcome: 1.3 Primary outcome: self‐harm.

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Figure 8

Trial Sequential Analysis on primary outcome: Psychotherapy ‐ suicide‐related outcomes at end of treatment

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Figure 9

Funnel plot of comparison: 1 Psychotherapy compared with TAU, outcome: 1.5 Primary outcome: suicide‐related outcomes.

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Figure 10

Trial Sequential Analysis on primary outcome: Psychotherapy ‐ psychosocial functioning at end of treatment

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Figure 11

Funnel plot of comparison: 1 Psychotherapy compared with TAU, outcome: 1.7 Primary outcome: psychosocial functioning.

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Figure 12

Trial Sequential Analysis on secondary outcome: Psychotherapy ‐ depression at end of treatment

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Analysis 1.1

Comparison 1: Psychotherapy vs TAU, Outcome 1: Primary: BPD symptom severity (continuous)

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Analysis 1.2

Comparison 1: Psychotherapy vs TAU, Outcome 2: Primary: BPD symptom severity (dichotomous), at above 12 months follow‐up

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Analysis 1.3

Comparison 1: Psychotherapy vs TAU, Outcome 3: Primary: self‐harm (continuous)

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Analysis 1.4

Comparison 1: Psychotherapy vs TAU, Outcome 4: Primary: self‐harm (dichotomous)

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Analysis 1.5

Comparison 1: Psychotherapy vs TAU, Outcome 5: Primary: suicide‐related outcomes (continuous)

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Analysis 1.6

Comparison 1: Psychotherapy vs TAU, Outcome 6: Primary: suicide‐related outcomes (dichotomous)

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Analysis 1.7

Comparison 1: Psychotherapy vs TAU, Outcome 7: Primary: psychosocial functioning (continuous)

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Analysis 1.8

Comparison 1: Psychotherapy vs TAU, Outcome 8: Secondary: anger (continuous)

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Analysis 1.9

Comparison 1: Psychotherapy vs TAU, Outcome 9: Secondary: affective instability (continuous)

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Analysis 1.10

Comparison 1: Psychotherapy vs TAU, Outcome 10: Secondary: chronic feelings of emptiness (continuous)

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Analysis 1.11

Comparison 1: Psychotherapy vs TAU, Outcome 11: Secondary: impulsivity (continuous)

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Analysis 1.12

Comparison 1: Psychotherapy vs TAU, Outcome 12: Secondary: impulsivity (dichotomous), at end of treatment

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Analysis 1.13

Comparison 1: Psychotherapy vs TAU, Outcome 13: Secondary: interpersonal problems (continuous)

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Analysis 1.14

Comparison 1: Psychotherapy vs TAU, Outcome 14: Secondary: abandonment (continuous)

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Analysis 1.15

Comparison 1: Psychotherapy vs TAU, Outcome 15: Secondary: identity disturbance (continuous)

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Analysis 1.16

Comparison 1: Psychotherapy vs TAU, Outcome 16: Secondary: dissociation and psychotic‐like symptoms (continuous)

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Analysis 1.17

Comparison 1: Psychotherapy vs TAU, Outcome 17: Secondary: depression (continuous)

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Analysis 1.18

Comparison 1: Psychotherapy vs TAU, Outcome 18: Secondary: depression (dichotomous), at end of treatment

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Analysis 1.19

Comparison 1: Psychotherapy vs TAU, Outcome 19: Secondary: attrition (dichotomous)

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Analysis 1.20

Comparison 1: Psychotherapy vs TAU, Outcome 20: Secondary: non‐serious adverse effects (dichotomous), at end of treatment

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Analysis 1.21

Comparison 1: Psychotherapy vs TAU, Outcome 21: Secondary: serious adverse effects (dichotomous), at end of treatment

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Analysis 2.1

Comparison 2: Acceptance and commitment therapy (ACT) vs TAU, Outcome 1: Primary: BPD symptom severity (continuous), at end of treatment

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Analysis 2.2

Comparison 2: Acceptance and commitment therapy (ACT) vs TAU, Outcome 2: Secondary: affective instability (continuous), at end of treatment

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Analysis 2.3

Comparison 2: Acceptance and commitment therapy (ACT) vs TAU, Outcome 3: Secondary: depression (continuous), at end of treatment

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Analysis 2.4

Comparison 2: Acceptance and commitment therapy (ACT) vs TAU, Outcome 4: Secondary: attrition (dichotomous), at end of treatment

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Analysis 3.1

Comparison 3: Dialectical behavior therapy (DBT) vs TAU, Outcome 1: Primary: BPD symptom severity (continuous), at end of treatment

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Analysis 3.2

Comparison 3: Dialectical behavior therapy (DBT) vs TAU, Outcome 2: Primary, self‐harm (continuous)

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Analysis 3.3

Comparison 3: Dialectical behavior therapy (DBT) vs TAU, Outcome 3: Primary: suicide‐related outcomes (continuous), at end of treatment

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Analysis 3.4

Comparison 3: Dialectical behavior therapy (DBT) vs TAU, Outcome 4: Primary: suicide‐related outcomes, attempts (dichotomous), at end of treatment

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Analysis 3.5

Comparison 3: Dialectical behavior therapy (DBT) vs TAU, Outcome 5: Primary: psychosocial functioning (continuous), at end of treatment

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Analysis 3.6

Comparison 3: Dialectical behavior therapy (DBT) vs TAU, Outcome 6: Secondary: anger (continuous)

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Analysis 3.7

Comparison 3: Dialectical behavior therapy (DBT) vs TAU, Outcome 7: Secondary: affective instability (continuous), at end of treatment

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Analysis 3.8

Comparison 3: Dialectical behavior therapy (DBT) vs TAU, Outcome 8: Secondary: chronic feelings of emptiness (continuous), at end of treatment

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Analysis 3.9

Comparison 3: Dialectical behavior therapy (DBT) vs TAU, Outcome 9: Secondary: impulsivity (continuous)

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Analysis 3.10

Comparison 3: Dialectical behavior therapy (DBT) vs TAU, Outcome 10: Secondary: interpersonal problems (continuous), at end of treatment

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Analysis 3.11

Comparison 3: Dialectical behavior therapy (DBT) vs TAU, Outcome 11: Secondary: dissociation and psychotic‐like symptoms (continuous), at end of treatment

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Analysis 3.12

Comparison 3: Dialectical behavior therapy (DBT) vs TAU, Outcome 12: Secondary: depression (continuous)

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Analysis 3.13

Comparison 3: Dialectical behavior therapy (DBT) vs TAU, Outcome 13: Secondary: attrition (dichotomous)

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Analysis 3.14

Comparison 3: Dialectical behavior therapy (DBT) vs TAU, Outcome 14: Secondary: adverse effects (dichotomous), at end of treatment

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Analysis 3.15

Comparison 3: Dialectical behavior therapy (DBT) vs TAU, Outcome 15: Secondary: serious adverse effects (dichotomous), at end of treatment

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Analysis 4.1

Comparison 4: Mentalisation based therapy (MBT) vs TAU, Outcome 1: Primary: BPD symptom severity (continuous)

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Analysis 4.2

Comparison 4: Mentalisation based therapy (MBT) vs TAU, Outcome 2: Primary: self‐harm (continuous), at end of treatment

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Analysis 4.3

Comparison 4: Mentalisation based therapy (MBT) vs TAU, Outcome 3: Primary: self‐harm (dichotomous)

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Analysis 4.4

Comparison 4: Mentalisation based therapy (MBT) vs TAU, Outcome 4: Primary: suicide‐related outcomes (dichotomous)

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Analysis 4.5

Comparison 4: Mentalisation based therapy (MBT) vs TAU, Outcome 5: Primary: psychosocial functioning (continuous)

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Analysis 4.6

Comparison 4: Mentalisation based therapy (MBT) vs TAU, Outcome 6: Secondary: interpersonal problems (continuous)

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Analysis 4.7

Comparison 4: Mentalisation based therapy (MBT) vs TAU, Outcome 7: Secondary: depression (continuous)

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Analysis 4.8

Comparison 4: Mentalisation based therapy (MBT) vs TAU, Outcome 8: Secondary: depression (dichotomous), at end of treatment

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Analysis 4.9

Comparison 4: Mentalisation based therapy (MBT) vs TAU, Outcome 9: Secondary: attrition (dichotomous), at end of treatment

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Analysis 4.10

Comparison 4: Mentalisation based therapy (MBT) vs TAU, Outcome 10: Secondary: adverse effects (dichotomous), at end of treatment

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Analysis 4.11

Comparison 4: Mentalisation based therapy (MBT) vs TAU, Outcome 11: Mentalisation‐based treatment for eating disorders (MBT‐ED) versus specialist supportive clinical management (SSCM‐ED) (generic inverse variance)

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Analysis 5.1

Comparison 5: Cognitive behavioural therapy (CBT) and related treatments vs TAU, Outcome 1: Primary: BPD symptom severity (continuous)

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Analysis 5.2

Comparison 5: Cognitive behavioural therapy (CBT) and related treatments vs TAU, Outcome 2: Primary: BPD symptom severity (dichotomous), at above 12 months follow‐up

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Analysis 5.3

Comparison 5: Cognitive behavioural therapy (CBT) and related treatments vs TAU, Outcome 3: Primary: self‐harm (continuous)

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Analysis 5.4

Comparison 5: Cognitive behavioural therapy (CBT) and related treatments vs TAU, Outcome 4: Primary: self‐harm (dichotomous), at end of treatment

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Analysis 5.5

Comparison 5: Cognitive behavioural therapy (CBT) and related treatments vs TAU, Outcome 5: Primary: suicide‐related outcomes (continuous)

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Analysis 5.6

Comparison 5: Cognitive behavioural therapy (CBT) and related treatments vs TAU, Outcome 6: Primary: psychosocial functioning (continuous)

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Analysis 5.7

Comparison 5: Cognitive behavioural therapy (CBT) and related treatments vs TAU, Outcome 7: Secondary: interpersonal problems (continuous)

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Analysis 5.8

Comparison 5: Cognitive behavioural therapy (CBT) and related treatments vs TAU, Outcome 8: Secondary: dissociation and psychotic‐like symptoms (continuous)

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Analysis 5.9

Comparison 5: Cognitive behavioural therapy (CBT) and related treatments vs TAU, Outcome 9: Secondary: depression (continuous)

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Analysis 5.10

Comparison 5: Cognitive behavioural therapy (CBT) and related treatments vs TAU, Outcome 10: Secondary: attrition (dichotomous), at end of treatment

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Analysis 5.11

Comparison 5: Cognitive behavioural therapy (CBT) and related treatments vs TAU, Outcome 11: Secondary: adverse effects (dichotomous), at end of treatment

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Analysis 6.1

Comparison 6: Psychodynamic psychotherapy vs TAU, Outcome 1: Primary: BPD symptom severity (continuous)

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Analysis 6.2

Comparison 6: Psychodynamic psychotherapy vs TAU, Outcome 2: Primary: self‐harm (continuous)

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Analysis 6.3

Comparison 6: Psychodynamic psychotherapy vs TAU, Outcome 3: Primary: suicide‐related outcomes (continuous)

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Analysis 6.4

Comparison 6: Psychodynamic psychotherapy vs TAU, Outcome 4: Primary: psychosocial functioning (continuous)

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Analysis 6.5

Comparison 6: Psychodynamic psychotherapy vs TAU, Outcome 5: Secondary: anger (continuous)

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Analysis 6.6

Comparison 6: Psychodynamic psychotherapy vs TAU, Outcome 6: Secondary: affective instability (continuous)

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Analysis 6.7

Comparison 6: Psychodynamic psychotherapy vs TAU, Outcome 7: Secondary: chronic feelings of emptiness (continuous)

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Analysis 6.8

Comparison 6: Psychodynamic psychotherapy vs TAU, Outcome 8: Secondary: impulsivity (continuous)

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Analysis 6.9

Comparison 6: Psychodynamic psychotherapy vs TAU, Outcome 9: Secondary: interpersonal problems (continuous)

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Analysis 6.10

Comparison 6: Psychodynamic psychotherapy vs TAU, Outcome 10: Secondary: abandonment (continuous)

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Analysis 6.11

Comparison 6: Psychodynamic psychotherapy vs TAU, Outcome 11: Secondary: identity disturbance (continuous)

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Analysis 6.12

Comparison 6: Psychodynamic psychotherapy vs TAU, Outcome 12: Secondary: dissociation and psychotic‐like symptoms (continuous)

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Analysis 6.13

Comparison 6: Psychodynamic psychotherapy vs TAU, Outcome 13: Secondary: depression (continuous)

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Analysis 6.14

Comparison 6: Psychodynamic psychotherapy vs TAU, Outcome 14: Secondary: attrition (dichotomous), at end of treatment

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Analysis 7.1

Comparison 7: Schema‐focused therapy (SFT) vs TAU, Outcome 1: Primary: BPD symptom severity (continuous), at end of treatment

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Analysis 7.2

Comparison 7: Schema‐focused therapy (SFT) vs TAU, Outcome 2: Primary: psychosocial functioning (continuous), at end of treatment

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Analysis 7.3

Comparison 7: Schema‐focused therapy (SFT) vs TAU, Outcome 3: Secondary: affective instability (continuous), at end of treatment

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Analysis 7.4

Comparison 7: Schema‐focused therapy (SFT) vs TAU, Outcome 4: Secondary: impulsivity (continuous), at end of treatment

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Analysis 7.5

Comparison 7: Schema‐focused therapy (SFT) vs TAU, Outcome 5: Secondary: interpersonal problems (continuous), at end of treatment

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Analysis 7.6

Comparison 7: Schema‐focused therapy (SFT) vs TAU, Outcome 6: Secondary: dissociation and psychotic‐like symptoms (continuous), at end of treatment

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Analysis 7.7

Comparison 7: Schema‐focused therapy (SFT) vs TAU, Outcome 7: Secondary: attrition (dichotomous), at end of treatment

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Analysis 8.1

Comparison 8: Systems training for emotional predictability and problem solving (STEPPS) vs TAU, Outcome 1: Primary: BPD symptom severity (continuous), at end of treatment

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Analysis 8.2

Comparison 8: Systems training for emotional predictability and problem solving (STEPPS) vs TAU, Outcome 2: Primary: self‐harm (dichtomous), at end of treatment

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Analysis 8.3

Comparison 8: Systems training for emotional predictability and problem solving (STEPPS) vs TAU, Outcome 3: Primary: psychosocial functioning (continuous)

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Analysis 8.4

Comparison 8: Systems training for emotional predictability and problem solving (STEPPS) vs TAU, Outcome 4: Secondary: affective instability (continuous), at end of treatment

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Analysis 8.5

Comparison 8: Systems training for emotional predictability and problem solving (STEPPS) vs TAU, Outcome 5: Secondary: impulsivity (continuous), at end of treatment

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Analysis 8.6

Comparison 8: Systems training for emotional predictability and problem solving (STEPPS) vs TAU, Outcome 6: Secondary: impulsivity (dichotomous), at end of treatment

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Analysis 8.7

Comparison 8: Systems training for emotional predictability and problem solving (STEPPS) vs TAU, Outcome 7: Secondary: interpersonal problems (continuous), at end of treatment

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Analysis 8.8

Comparison 8: Systems training for emotional predictability and problem solving (STEPPS) vs TAU, Outcome 8: Secondary: dissociation and psychotic‐like symptoms (continuous), at end of treatment

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Analysis 8.9

Comparison 8: Systems training for emotional predictability and problem solving (STEPPS) vs TAU, Outcome 9: Secondary: depression (continuous), at end of treatment

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Analysis 8.10

Comparison 8: Systems training for emotional predictability and problem solving (STEPPS) vs TAU, Outcome 10: Secondary: attrition (dichotomous), at end of treatment

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Analysis 9.1

Comparison 9: Cognitive analytic therapy (CAT) vs TAU, Outcome 1: Primary: suicide‐related outcomes (continuous)

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Analysis 9.2

Comparison 9: Cognitive analytic therapy (CAT) vs TAU, Outcome 2: Primary: psychosocial functioning (continuous)

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Analysis 9.3

Comparison 9: Cognitive analytic therapy (CAT) vs TAU, Outcome 3: Secondary: anger (continuous)

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Analysis 9.4

Comparison 9: Cognitive analytic therapy (CAT) vs TAU, Outcome 4: Secondary: dissociation and psychotic‐like symptoms (continuous)

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Analysis 9.5

Comparison 9: Cognitive analytic therapy (CAT) vs TAU, Outcome 5: Secondary: depression (continuous)

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Analysis 9.6

Comparison 9: Cognitive analytic therapy (CAT) vs TAU, Outcome 6: Secondary: attrition (dichotomous), at end of treatment

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Analysis 10.1

Comparison 10: Motivation feedback (MF) vs TAU, Outcome 1: Primary: psychosocial functioning, at end of treatment

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Analysis 11.1

Comparison 11: Psychoeducation vs TAU, Outcome 1: Secondary: depression (continuous), at end of treatment

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Analysis 11.2

Comparison 11: Psychoeducation vs TAU, Outcome 2: Secondary: attrition (dichotomous), at end of treatment

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Analysis 12.1

Comparison 12: Transference‐focused psychotherapy (TFP) vs TAU, Outcome 1: Primary: BPD symptom severity (continuous), at end of treatment

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Analysis 12.2

Comparison 12: Transference‐focused psychotherapy (TFP) vs TAU, Outcome 2: Primary: self‐harm (dichotomous), at end of treatment

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Analysis 12.3

Comparison 12: Transference‐focused psychotherapy (TFP) vs TAU, Outcome 3: Primary: suicide‐related outcomes (dichotomous), at end of treatment

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Analysis 12.4

Comparison 12: Transference‐focused psychotherapy (TFP) vs TAU, Outcome 4: Primary: psychosocial functioning (continuous), at end of treatment

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Analysis 12.5

Comparison 12: Transference‐focused psychotherapy (TFP) vs TAU, Outcome 5: Secondary: depression (continuous), at end of treatment

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Analysis 12.6

Comparison 12: Transference‐focused psychotherapy (TFP) vs TAU, Outcome 6: Secondary: attrition (dichotomous), at end of treatment

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Analysis 13.1

Comparison 13: Once‐only interventions (individual setting) vs TAU, Outcome 1: Primary: self‐harm (continuous), at end of treatment

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Analysis 13.2

Comparison 13: Once‐only interventions (individual setting) vs TAU, Outcome 2: Primary: psychosocial functioning (continuous), at end of treatment

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Analysis 13.3

Comparison 13: Once‐only interventions (individual setting) vs TAU, Outcome 3: Secondary: depression (continuous), at end of treatment

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Analysis 13.4

Comparison 13: Once‐only interventions (individual setting) vs TAU, Outcome 4: Secondary: attrition (dichotomous), at end of treatment

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Analysis 14.1

Comparison 14: Eclectic treatments vs TAU, Outcome 1: Primary: BPD symptom severity (continuous), at end of treatment

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Analysis 14.2

Comparison 14: Eclectic treatments vs TAU, Outcome 2: Primary: self‐harm (continuous), at end of treatment

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Analysis 14.3

Comparison 14: Eclectic treatments vs TAU, Outcome 3: Primary: suicide‐related outcomes (continuous), at end of treatment

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Analysis 14.4

Comparison 14: Eclectic treatments vs TAU, Outcome 4: Primary: psychosocial functioning (continuous)

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Analysis 14.5

Comparison 14: Eclectic treatments vs TAU, Outcome 5: Secondary: anger (continuous), at end of treatment

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Analysis 14.6

Comparison 14: Eclectic treatments vs TAU, Outcome 6: Secondary: affective instability (continuous), at end of treatment

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Analysis 14.7

Comparison 14: Eclectic treatments vs TAU, Outcome 7: Secondary: chronic feelings of emptiness (continuous), at end of treatment

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Analysis 14.8

Comparison 14: Eclectic treatments vs TAU, Outcome 8: Secondary: impulsivity (continuous), at end of treatment

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Analysis 14.9

Comparison 14: Eclectic treatments vs TAU, Outcome 9: Secondary: interpersonal problems (continuous), at end of treatment

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Analysis 14.10

Comparison 14: Eclectic treatments vs TAU, Outcome 10: Secondary: abandonment (continuous), at end of treatment

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Analysis 14.11

Comparison 14: Eclectic treatments vs TAU, Outcome 11: Secondary: identity disturbance (continuous), at end of treatment

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Analysis 14.12

Comparison 14: Eclectic treatments vs TAU, Outcome 12: Secondary: depression (continuous), at end of treatment

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Analysis 14.13

Comparison 14: Eclectic treatments vs TAU, Outcome 13: Secondary: attrition (dichotomuous), at end of treatment

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Analysis 14.14

Comparison 14: Eclectic treatments vs TAU, Outcome 14: Secondary: adverse effects (dichotomous), at end of treatment

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Analysis 15.1

Comparison 15: Psychotherapy vs waiting list or no treatment, Outcome 1: Primary: BPD symptom severity (continuous), at end of treatment

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Analysis 15.2

Comparison 15: Psychotherapy vs waiting list or no treatment, Outcome 2: Primary: self‐harm (continuous), at end of treatment

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Analysis 15.3

Comparison 15: Psychotherapy vs waiting list or no treatment, Outcome 3: Primary: suicide‐related outcomes (continuous), at end of treatment

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Analysis 15.4

Comparison 15: Psychotherapy vs waiting list or no treatment, Outcome 4: Primary: psychosocial functioning (continuous)

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Analysis 15.5

Comparison 15: Psychotherapy vs waiting list or no treatment, Outcome 5: Secondary: anger (continuous), at end of treatment

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Analysis 15.6

Comparison 15: Psychotherapy vs waiting list or no treatment, Outcome 6: Secondary: affective instability (continuous)

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Analysis 15.7

Comparison 15: Psychotherapy vs waiting list or no treatment, Outcome 7: Secondary: chronic feelings of emptiness (continuous), at end of treatment

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Analysis 15.8

Comparison 15: Psychotherapy vs waiting list or no treatment, Outcome 8: Secondary: impulsivity (continuous)

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Analysis 15.9

Comparison 15: Psychotherapy vs waiting list or no treatment, Outcome 9: Secondary: interpersonal problems (continuous)

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Analysis 15.10

Comparison 15: Psychotherapy vs waiting list or no treatment, Outcome 10: Secondary: abandonment (continuous), at end of treatment

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Analysis 15.11

Comparison 15: Psychotherapy vs waiting list or no treatment, Outcome 11: Secondary: identity disturbance (continuous), at end of treatment

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Analysis 15.12

Comparison 15: Psychotherapy vs waiting list or no treatment, Outcome 12: Secondary: dissociation and psychotic‐like symptoms (continuous), at end of treatment

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Analysis 15.13

Comparison 15: Psychotherapy vs waiting list or no treatment, Outcome 13: Secondary: depression (continuous), at end of treatment

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Analysis 15.14

Comparison 15: Psychotherapy vs waiting list or no treatment, Outcome 14: Secondary: attrition (dichotomous), at end of treatment

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Analysis 16.1

Comparison 16: Dialectical behavior therapy (DBT) vs waiting list or no treatment, Outcome 1: Primary: BPD symptom severity (continuous), at end of treatment

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Analysis 16.2

Comparison 16: Dialectical behavior therapy (DBT) vs waiting list or no treatment, Outcome 2: Primary: self‐harm (continuous), at end of treatment

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Analysis 16.3

Comparison 16: Dialectical behavior therapy (DBT) vs waiting list or no treatment, Outcome 3: Primary: suicide‐related outcomes (continuous), at end of treatment

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Analysis 16.4

Comparison 16: Dialectical behavior therapy (DBT) vs waiting list or no treatment, Outcome 4: Primary: psychosocial functioning (continuous), at end of treatment

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Analysis 16.5

Comparison 16: Dialectical behavior therapy (DBT) vs waiting list or no treatment, Outcome 5: Secondary: anger (continuous), at end of treatment

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Analysis 16.6

Comparison 16: Dialectical behavior therapy (DBT) vs waiting list or no treatment, Outcome 6: Secondary: affective instability (continuous), at end of treatment

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Analysis 16.7

Comparison 16: Dialectical behavior therapy (DBT) vs waiting list or no treatment, Outcome 7: Secondary: impulsivity (continuous), at end of treatment

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Analysis 16.8

Comparison 16: Dialectical behavior therapy (DBT) vs waiting list or no treatment, Outcome 8: Secondary: dissociation and psychotic‐like symptoms (continuous), at end of treatment

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Analysis 16.9

Comparison 16: Dialectical behavior therapy (DBT) vs waiting list or no treatment, Outcome 9: Secondary: depression (continuous), at end of treatment

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Analysis 16.10

Comparison 16: Dialectical behavior therapy (DBT) vs waiting list or no treatment, Outcome 10: DBT‐couple therapy (CDBT) vs waiting list (generic inverse variance)

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Analysis 17.1

Comparison 17: Schema‐focused therapy (SFT) vs no treatment, Outcome 1: Primary: suicide‐related outcomes (continuous), at end of treatment

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Analysis 17.2

Comparison 17: Schema‐focused therapy (SFT) vs no treatment, Outcome 2: Secondary: depression (continuous), at end of treatment

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Analysis 18.1

Comparison 18: Interpersonal psychotherapy (IPT) vs waiting list, Outcome 1: Primary: BPD symptom severity (continuous), at end of treatment

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Analysis 18.2

Comparison 18: Interpersonal psychotherapy (IPT) vs waiting list, Outcome 2: Primary: self‐harm (continuous), at end of treatment

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Analysis 18.3

Comparison 18: Interpersonal psychotherapy (IPT) vs waiting list, Outcome 3: Primary: psychosocial functioning (continuous)

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Analysis 18.4

Comparison 18: Interpersonal psychotherapy (IPT) vs waiting list, Outcome 4: Secondary: anger (continuous), at end of treatment

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Analysis 18.5

Comparison 18: Interpersonal psychotherapy (IPT) vs waiting list, Outcome 5: Secondary: affective instability (continuous)

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Analysis 18.6

Comparison 18: Interpersonal psychotherapy (IPT) vs waiting list, Outcome 6: Secondary: chronic feelings of emptiness (continuous), at end of treatment

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Analysis 18.7

Comparison 18: Interpersonal psychotherapy (IPT) vs waiting list, Outcome 7: Secondary: impulsivity (continuous)

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Analysis 18.8

Comparison 18: Interpersonal psychotherapy (IPT) vs waiting list, Outcome 8: Secondary: interpersonal problems (continuous)

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Analysis 18.9

Comparison 18: Interpersonal psychotherapy (IPT) vs waiting list, Outcome 9: Secondary: abandonment (continuous), at end of treatment

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Analysis 18.10

Comparison 18: Interpersonal psychotherapy (IPT) vs waiting list, Outcome 10: Secondary: identity disturbance (continuous), at end of treatment

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Analysis 18.11

Comparison 18: Interpersonal psychotherapy (IPT) vs waiting list, Outcome 11: Secondary: dissociation and psychotic‐like symptoms (continuous), at end of treatment

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Analysis 18.12

Comparison 18: Interpersonal psychotherapy (IPT) vs waiting list, Outcome 12: Secondary outcome: depression (continuous), at end of treatment

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Analysis 18.13

Comparison 18: Interpersonal psychotherapy (IPT) vs waiting list, Outcome 13: Secondary outcome: attrition (dichotomous), at end of treatment

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Analysis 19.1

Comparison 19: Once‐only interventions (individual setting) vs waiting list, Outcome 1: Secondary: impulsivity (continuous), at end of treatment

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Analysis 19.2

Comparison 19: Once‐only interventions (individual setting) vs waiting list, Outcome 2: Secondary: interpersonal problems (continuous), at end of treatment

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Analysis 19.3

Comparison 19: Once‐only interventions (individual setting) vs waiting list, Outcome 3: Secondary: attrition (dichotomous), at end of treatment

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Analysis 20.1

Comparison 20: Eclectic treatments vs waiting list, Outcome 1: Primary outcome: psychosocial functioning (continuous), at end of treatment

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Analysis 20.2

Comparison 20: Eclectic treatments vs waiting list, Outcome 2: Secondary outcome: interpersonal problems (continuous), at end of treatment

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Analysis 21.1

Comparison 21: Dialectical behavior therapy (DBT) and related treatments vs active treatment, Outcome 1: Standard DBT (DBT) vs client‐centred therapy (CCT) (continuous)

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Analysis 21.2

Comparison 21: Dialectical behavior therapy (DBT) and related treatments vs active treatment, Outcome 2: DBT vs CCT, secondary: attrition (dichotomous), at end of treatment

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Analysis 21.3

Comparison 21: Dialectical behavior therapy (DBT) and related treatments vs active treatment, Outcome 3: Standard DBT (DBT) vs good psychiatric management (GPM) (continuous)

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Analysis 21.4

Comparison 21: Dialectical behavior therapy (DBT) and related treatments vs active treatment, Outcome 4: DBT vs GPM, secondary: attrition (dichotomous), at end of treatment

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Analysis 21.5

Comparison 21: Dialectical behavior therapy (DBT) and related treatments vs active treatment, Outcome 5: Standard DBT (DBT) vs individual DBT therapy + activities group (DBT‐I) (continuous)

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Analysis 21.6

Comparison 21: Dialectical behavior therapy (DBT) and related treatments vs active treatment, Outcome 6: DBT vs DBT‐I, secondary: attrition (dichotomous), at end of treatment

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Analysis 21.7

Comparison 21: Dialectical behavior therapy (DBT) and related treatments vs active treatment, Outcome 7: Standard DBT (DBT) vs skills training group + individual case management (DBT‐S) (continuous)

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Analysis 21.8

Comparison 21: Dialectical behavior therapy (DBT) and related treatments vs active treatment, Outcome 8: DBT vs DBT‐S, secondary: attrition (dichotomous), at 6‐12 months follow‐up

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Analysis 21.9

Comparison 21: Dialectical behavior therapy (DBT) and related treatments vs active treatment, Outcome 9: Standard DBT (DBT) vs step‐down DBT (DBT‐SD) (continuous)

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Analysis 21.10

Comparison 21: Dialectical behavior therapy (DBT) and related treatments vs active treatment, Outcome 10: DBT vs DBT‐SD, secondary: attrition (dichotomous), at end of treatment

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Analysis 21.11

Comparison 21: Dialectical behavior therapy (DBT) and related treatments vs active treatment, Outcome 11: Standard DBT (DBT) vs DBT Prolonged Exposure (PE) (continuous)

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Analysis 21.12

Comparison 21: Dialectical behavior therapy (DBT) and related treatments vs active treatment, Outcome 12: DBT vs DBT‐PE, secondary: attrition (dichotomous), at 0‐6 months follow‐up

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Analysis 21.13

Comparison 21: Dialectical behavior therapy (DBT) and related treatments vs active treatment, Outcome 13: DBT skills group + case management (DBT‐S) vs DBT individual therapy + activity group (DBT‐I) (continuous)

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Analysis 21.14

Comparison 21: Dialectical behavior therapy (DBT) and related treatments vs active treatment, Outcome 14: DBT‐S vs DBT‐I, secondary: attrition (dichotomous), at 6‐12 months follow‐up

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Analysis 21.15

Comparison 21: Dialectical behavior therapy (DBT) and related treatments vs active treatment, Outcome 15: DBT skills group (DBT‐S) vs cognitive therapy group (CT‐G) (continuous)

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Analysis 21.16

Comparison 21: Dialectical behavior therapy (DBT) and related treatments vs active treatment, Outcome 16: DBT‐S vs CT‐G, secondary: attrition (dichotomous), at end of treatment

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Analysis 21.17

Comparison 21: Dialectical behavior therapy (DBT) and related treatments vs active treatment, Outcome 17: DBT skills group (DBT‐S) vs schema‐focused therapy group (SFT‐G)

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Analysis 21.18

Comparison 21: Dialectical behavior therapy (DBT) and related treatments vs active treatment, Outcome 18: DBT mindfulness group (DBT‐M) vs DBT interpersonal effectiveness group (DBT‐IE) (continuous)

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Analysis 21.19

Comparison 21: Dialectical behavior therapy (DBT) and related treatments vs active treatment, Outcome 19: DBT‐M vs DBT‐IE, secondary: attrition (dichotomous), at end of treatment

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Analysis 21.20

Comparison 21: Dialectical behavior therapy (DBT) and related treatments vs active treatment, Outcome 20: DBT mindfulness group (DBT‐M) vs loving‐kindness and compassion meditation (LK/CM), primary: BPD symptom severity (continuous), at end of treatment

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Analysis 22.1

Comparison 22: Cognitive behavioural therapy (CBT) and related treatments vs active treatment, Outcome 1: CBT vs trauma‐ and anxiety‐related group psychoeducation (continuous)

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Analysis 22.2

Comparison 22: Cognitive behavioural therapy (CBT) and related treatments vs active treatment, Outcome 2: CBT vs trauma‐ and anxiety‐related group psychoeducation, secondary: attrition (dichotomous), at end of treatment

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Analysis 22.3

Comparison 22: Cognitive behavioural therapy (CBT) and related treatments vs active treatment, Outcome 3: CBT vs interpersonal psychotherapy (IPT) (continuous)

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Analysis 22.4

Comparison 22: Cognitive behavioural therapy (CBT) and related treatments vs active treatment, Outcome 4: CBT vs IPT, secondary: attrition (dichotomous), at end of treatment

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Analysis 22.5

Comparison 22: Cognitive behavioural therapy (CBT) and related treatments vs active treatment, Outcome 5: CBT vs Rogerian supportive therapy (continuous)

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Analysis 22.6

Comparison 22: Cognitive behavioural therapy (CBT) and related treatments vs active treatment, Outcome 6: CBT vs Rogerian supportive therapy, secondary: attrition (dichotomous), end of treatment

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Analysis 22.7

Comparison 22: Cognitive behavioural therapy (CBT) and related treatments vs active treatment, Outcome 7: MACT (Manual‐assisted Cognitive Therapy) vs MACT + therapeutic assessment (MACT + TA) (continuous)

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Analysis 22.8

Comparison 22: Cognitive behavioural therapy (CBT) and related treatments vs active treatment, Outcome 8: MACT vs MACT + TA, secondary: attrition (dichotomous), at end of treatment

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Analysis 22.9

Comparison 22: Cognitive behavioural therapy (CBT) and related treatments vs active treatment, Outcome 9: Meta‐Cognitive training for BPD (B‐MCT) vs progressive muscle relaxation training (PMR)

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Analysis 22.10

Comparison 22: Cognitive behavioural therapy (CBT) and related treatments vs active treatment, Outcome 10: B‐MCT vs progressive muscle relaxation (PMR) training + TAU (dichotomous). Secondary: attrition (dichotomous), at end of treatment

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Analysis 22.11

Comparison 22: Cognitive behavioural therapy (CBT) and related treatments vs active treatment, Outcome 11: MOTR (Motive‐Oriented Therapeutic Relationship) vs Good Psychiatric Management (GPM) (continuous)

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Analysis 22.12

Comparison 22: Cognitive behavioural therapy (CBT) and related treatments vs active treatment, Outcome 12: MOTR vs (GPM), secondary: attrition (dichotomous), at end of treatment

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Analysis 23.1

Comparison 23: Schema‐focused therapy (SFT) vs active treatment, Outcome 1: SFT vs TFP. Primary: BPD symptom severity (continuous), at end of treatment

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Analysis 23.2

Comparison 23: Schema‐focused therapy (SFT) vs active treatment, Outcome 2: SFT vs TFP. Secondary: attrition (dichotomous), at 0‐6 months follow‐up

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Analysis 23.3

Comparison 23: Schema‐focused therapy (SFT) vs active treatment, Outcome 3: SFT vs SFT + therapist availability (TA). Primary: BPD symptom severity (continuous), at end of treatment

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Analysis 23.4

Comparison 23: Schema‐focused therapy (SFT) vs active treatment, Outcome 4: SFT vs SFT + TA. Secondary: attrition (dichotomous), 0‐6 months follow‐up

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Analysis 24.1

Comparison 24: Systems training for emotional predictability and problem solving‐based psychoeducation (STEPPS‐PE) vs cognitive rehabilitation (CR), Outcome 1: STEPPS‐PE vs CR

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Analysis 24.2

Comparison 24: Systems training for emotional predictability and problem solving‐based psychoeducation (STEPPS‐PE) vs cognitive rehabilitation (CR), Outcome 2: STEPPS‐PE vs CR. Secondary: attrition (dichotomous), at end of treatment

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Analysis 25.1

Comparison 25: Eclectic treatments vs active treatment, Outcome 1: Combined inpatient and outpatient psychotherapy versus outpatient psychotherapy

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Analysis 25.2

Comparison 25: Eclectic treatments vs active treatment, Outcome 2: Combined inpatient and outpatient psychotherapy versus outpatient psychotherapy. Secondary: attrition (dichotomous), at end of treatment

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Analysis 25.3

Comparison 25: Eclectic treatments vs active treatment, Outcome 3: integrative BPD‐oriented adolescent family therapy (I‐BAFT) vs individual drug counselling (IDC)

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Analysis 26.1

Comparison 26: Subgroup analysis: therapeutic approaches, Outcome 1: BPD symptom severity

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Analysis 26.2

Comparison 26: Subgroup analysis: therapeutic approaches, Outcome 2: Psychosocial functioning

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Analysis 27.1

Comparison 27: Subgroup analysis: age, Outcome 1: BPD symptom severity

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Analysis 28.1

Comparison 28: Subgroup analysis: duration, Outcome 1: BPD symptom severity

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Analysis 28.2

Comparison 28: Subgroup analysis: duration, Outcome 2: Psychosocial functioning

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Analysis 29.1

Comparison 29: Subgroup analysis: mode of therapy, Outcome 1: BPD symptom severity

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Analysis 29.2

Comparison 29: Subgroup analysis: mode of therapy, Outcome 2: Psychosocial functioning

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Analysis 30.1

Comparison 30: Subgroup analysis: setting, Outcome 1: BPD symptom severity

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Analysis 30.2

Comparison 30: Subgroup analysis: setting, Outcome 2: Psychosocial functioning

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Analysis 31.1

Comparison 31: Subgroup analysis: types of raters, Outcome 1: BPD symptom severity

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Analysis 31.2

Comparison 31: Subgroup analysis: types of raters, Outcome 2: Psychosocial functioning

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Analysis 32.1

Comparison 32: Subgroup analysis: types of TAU, Outcome 1: BPD symptom severity

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Analysis 32.2

Comparison 32: Subgroup analysis: types of TAU, Outcome 2: Psychosocial functioning

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Analysis 33.1

Comparison 33: Subgroup analysis: type of comparison group, Outcome 1: BPD symptom severity

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Analysis 33.2

Comparison 33: Subgroup analysis: type of comparison group, Outcome 2: Psychosocial functioning

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Analysis 34.1

Comparison 34: Subgroup analysis: types of scales, Outcome 1: BPD symptom severity

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Analysis 34.2

Comparison 34: Subgroup analysis: types of scales, Outcome 2: Psychosocial functioning

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Analysis 35.1

Comparison 35: TSA sensitivity analyses: psychotherapy versus TAU, Outcome 1: Primary: BPD symptom severity, at end of treatment

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Analysis 35.2

Comparison 35: TSA sensitivity analyses: psychotherapy versus TAU, Outcome 2: Primary: self‐harm

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Analysis 35.3

Comparison 35: TSA sensitivity analyses: psychotherapy versus TAU, Outcome 3: Primary: suicide‐related outcomes

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Analysis 35.4

Comparison 35: TSA sensitivity analyses: psychotherapy versus TAU, Outcome 4: Primary: psychosocial functioning, at end of treatment

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Analysis 35.5

Comparison 35: TSA sensitivity analyses: psychotherapy versus TAU, Outcome 5: Secondary: depression

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Summary of findings 1. Psychotherapy versus treatment‐as‐usual

Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect(95% CI)	Number of participants (RCTs)	Quality of the evidence (GRADE)	Comments
Psychotherapy versus treatment‐as‐usual
Patient or population: borderline personality disorder Settings: inpatient and outpatient Intervention: psychotherapy Comparison: treatment‐as‐usual (TAU)
	Assumed risk	Corresponding risk
	TAU	Psychotherapy
BPD symptom severity Measured by: clinicians and self‐rated Timing of outcome assessment: end of treatment	‐	The mean score in the intervention groups was 0.52 SD lower (0.70 lower to 0.33 lower)	‐	1244 (22 RCTs)	⊕⊕⊕⊝ Moderate^a	The SMD of −0.52 corresponds to −3.6 on the Zanarini BPD scale. The MIREDIF on this scale is 3.0 points TSA adjusted Cl = −5.49 to −1.90 on the Zanarini BPD scale TSA RIS = 901
Self‐harm (frequency) Measured by: clinicians and self‐rated Timing of outcome assessment: end of treatment	‐	The mean score in the intervention groups was 0.32 SD lower (0.49 lower to 0.14 lower)	‐	616 (13 RCTs)	⊕⊕⊝⊝ Low^a,b	The SMD of −0. 32 corresponds to −0.82 on the DSHI. The MIREDIF on this scale is −1.25 points (½ SD) TSA adjusted CI = −0.59 to −0.08 on the DSHI TSA RIS = 97
Suicide‐related outcomes (suicidality) Measured by: clinicians and self‐rated Timing of outcome assessment: end of treatment	‐	The mean score in the intervention groups was 0.34 SD lower (0.57 lower to 0.11 lower)	‐	666 (13 RCTs)	⊕⊕⊝⊝ Low^a,b	The SMD of −0. 34 corresponds to −0.11 on the SASII. The MIREDIF on this scale is −0.17 points (½ SD) TSA adjusted CI = −0.18 to −0.04 on the SASII TSA RIS = 253
Psychosocial functioning Measured by: clinicians and self‐rated Timing of outcome assessment: end of treatment	‐	The mean score in the intervention groups was 0.45 SD lower (0.68 lower to 0.22 lower)	‐	1314 (22 RCTs)	⊕⊕⊝⊝ Low^a,c	The SMD of −0.45 corresponds to −2.8 on the GAF. The MIREDIF on this scale is −4.0 points TSA adjusted CI = −3.97 to −1.94 on the GAF TSA RIS = 947
Depression Measured by: clinicians and self‐rated Timing of outcome assessment: end of treatment	‐	The mean score in the intervention groups was 0.39 SD lower (0.61 lower to 0.17 lower)	‐	1568 (22 RCTs)	⊕⊝⊝⊝ Verylow^a,b,c	The SMD of ‐0.45 corresponds to −2.45 on the Hamilton Depression Scale. The MIREDIF on this scale is 3.0 points TSA adjusted CI = −3.34 to −1.72 on the Hamilton Depression Scale TSA RIS = 2274
Attrition Timing of outcome assessment: end of treatment	328 per 1000	328 per 1000 (95% CI 56 fewer to 66 higher)	RR 1.00 (95% CI 0.83 to 1.20)	2225 (32 RCTs)	⊕⊕⊝⊝ Low^a,b	‐
Adverse effects Timing of outcome assessment: end of treatment	74 per 1000	6 per 1000 (95% CI 41 fewer to 65 higher)	RR 0.92 (95% CI 0.45 to 1.88)	381 (2 RCTs)	⊕⊕⊝⊝ Low^a,b	‐
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; DSHI: Deliberate Self‐Harm Inventory; GAF: Global Assessment of Functioning scale; MIREDIF: Minimum relevant difference; RCTs: Randomised controlled trials; RIS: Required information size; RR: Risk Ratio; SASII: Suicide Attempt Self‐Injury Interview; SD: Standard deviation; SMD: Standardised mean difference; TAU: treatment‐as‐usual; TSA: Trial Sequential Analysis
GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate Very low quality: we are very uncertain about the estimate
^aWe downgraded the quality of this evidence by one level due to risk of bias (other bias). ^bWe downgraded the quality of this evidence by one level due to imprecision. ^cWe downgraded the quality of this evidence by one level due to high heterogeneity.

Summary of findings 1. Psychotherapy versus treatment‐as‐usual

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Summary of findings 2. Psychotherapy versus waiting list or no treatment

Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	Number of participants (RCTs)	Quality of the evidence (GRADE)	Comments
Psychotherapy versus waiting list or no treatment
Patient or population: borderline personality disorder Settings: inpatient and outpatient Intervention: psychotherapy Comparison: waiting list or no treatment
	Assumed risk	Corresponding risk
	Waiting list or no treatment	Psychotherapy
BPD symptom severity Measured by: clinicians and self‐rated Timing of outcome assessment: end of treatment	‐	The mean score in the intervention groups was 0.49 SD lower (0.93 lower to 0.05 lower)	‐	161 (3 RCTs)	⊕⊕⊝⊝ Low^a,b	An SMD of 0.49 represents a moderate effect.
Self‐harm Measured by: clinicians and self‐rated Timing of outcome assessment: end of treatment	‐	The mean score in the intervention groups was0.17 SD lower (0.52 lower to 0.18 higher)	‐	128 (2 RCTs)	⊕⊕⊝⊝ Low^a,b	An SMD of 0.17 represents a small effect.
Suicide‐related outcomes Measured by: self‐rated Timing of outcome assessment: end of treatment	‐	The mean score in the intervention groups was 5.62 SD lower (16.39 lower to 5.16 higher)	‐	108 (2 RCTs)	⊕⊝⊝⊝ Verylow^a,b,c	An SMD of 5.62 represents a large effect.
Psychosocial functioning Measured by: clinicians and self‐rated Timing of outcome assessment: end of treatment	‐	The mean score in the intervention groups was 0.56 SD lower (1.01 lower to 0.11 lower)	‐	219 (5 RCTs)	⊕⊕⊝⊝ Low^a,b	An SMD of 0.56 represents a moderate effect.
Depression Measured by: clinicians and self‐rated Timing of outcome assessment: end of treatment	‐	The mean score in the intervention groups was 1.28 SD lower (2.21 lower to 0.34 lower)	‐	239 (6 RCTs)	⊕⊕⊝⊝ Low^a,b	An effect size of 1.28 represents a large effect.
Attrition Timing of outcome assessment: end of treatment	81 per 1000	147 per 1000 (95% CI 118 fewer to 74 higher)	RR 0.55 (95% CI 0.20 to 1.50)	144 (3 RCTs)	⊕⊝⊝⊝ Verylow^a,b,c	‐
Adverse effects (not measured	See comments	See comments	‐	‐	‐	No studies were found that assessed this outcome
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RCTs: Randomised controlled trials; RR: Risk ratio; SMD: Standardized mean difference
GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate Very low quality: we are very uncertain about the estimate
^aWe downgraded the quality of this evidence by one level due to risk of bias. ^bWe downgraded the quality of this evidence by one level due to imprecision (there was a wide CI). ^cWe downgraded the quality of this evidence by one level due to inconsistency.

Summary of findings 2. Psychotherapy versus waiting list or no treatment

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Summary of findings 3. Dialectical behavioural therapy or mentalisation‐based therapy versus treatment‐as‐usual

Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	Number of participants (RCTs)	Quality of the evidence (GRADE)	Comments
Dialectical behavioural therapy or mentalisation‐based therapy versus treatment‐as‐usual
Patient or population: borderline personality disorder Settings: inpatient and outpatient Intervention: dialectical behavioural therapy (DBT) or mentalisation‐based therapy (MBT) Comparison: treatment‐as‐usual (TAU)
	Assumed risk	Corresponding risk
	TAU	DBT or MBT
*DBT*
BPD severity Measured by: clinicians Timing of outcome assessment: end of treatment	‐	The mean score in the intervention groups was 0.60 SD lower (1.05 lower to 0.14 lower)	‐	149 (3 RCTs)	⊕⊕⊝⊝ Low^a,b	An SMD of 0.60 represents a moderate effect.
Self‐harm Measured by: clinicians Timing of outcome assessment: end of treatment	‐	The mean score in the intervention groups was 0.28 SD lower (0.48 lower to 0.07 lower)	‐	376 (7 RCTs)	⊕⊕⊝⊝ Low^a,b	An SMD of 0.28 represents a small effect.
Psychosocial functioning Measured by: clinicians and self‐rated Timing of outcome assessment: end of treatment	‐	The mean score in the intervention groups was 0.36 SD lower (0.69 lower to 0.03 lower)	‐	225 (6 RCTs)	⊕⊕⊝⊝ Low^a,b,	An SMD of 0.36 represents a small effect.
MBT
Self‐harm Measured by: clinicians Timing of outcome assessment: end of treatment	631 per 1000	240 per 1000 (95% CI 334 fewer to 126 fewer)	RR 0.62 (95% CI 0.49 to 0.80)	252 (3 RCTs)	⊕⊕⊝⊝ Low^a,b	‐
Suicide‐related outcomes Measured by: clinicians Timing of outcome assessment: end of treatment	298 per 1000	268 per 1000 (95% CI 286 fewer to 209 fewer)	RR 0.10 (95% CI 0.04 to 0.30)	218 (3 RCTs)	⊕⊕⊝⊝ Low^a,b	‐
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; DBT: Dialectical behavioural therapy; MBT: Mentalisation‐based therapy; RCTs: Randomised controlled trials; RR: Risk ratio; SMD: Standardized mean difference; TAU: Treatment‐as‐usual
GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate Very low quality: we are very uncertain about the estimate
^aWe downgraded the quality of this evidence by one level due to risk of bias. ^bWe downgraded the quality of this evidence by one level due to imprecision (there was a wide CI).

Summary of findings 3. Dialectical behavioural therapy or mentalisation‐based therapy versus treatment‐as‐usual

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Table 1. Unused methods

Section	Protocol (Storebø 2018)	Review
Unit of analysis issues	Cross‐over trials We would have included cross‐over trials. We planned to include data up to the point of first cross‐over (first period only; Curtin 2002). We did not intend to use data from subsequent periods due to the likelihood of carry‐over effects from the preceding treatment(s). We planned not to combine repeated participant interventions in one meta‐analysis.	We did not include any cross‐over trial.
	Cluster‐randomised trials Had trials used cluster randomisation, we would have anticipated that investigators would have presented their results after appropriately controlling for clustering effects (robust standard errors or hierarchical linear models). If it had been unclear whether a cluster‐randomised trial had used appropriate controls for clustering, we would have contacted the investigators for further information. We would have requested and re‐analysed individual patient data using multilevel models that controlled for clustering, if appropriate controls had not been used. Following this, we would have analysed effect sizes and standard errors in RevMan 5 (Review Manager 2014), using the generic inverse method (Higgins 2011). If there had been insufficient information to control for clustering, we would have entered outcome data using individuals as the units of analysis, and then conducted a sensitivity analysis to assess the potential biasing effects of inadequately controlled cluster‐randomised trials (Donner 2002). If individual participant data had not been available, we would have looked for information on intra‐class correlation coefficients to adjust for the potential clustering effects.	We did not include any cluster‐randomised trial.
	Adjustment for multiplicity We planned to adjust the P values and CIs for multiplicity due to the many secondary outcome comparisons following the method described by Jakobsen 2014.	We only adjusted the primary outcomes and one secondary outcomes for multiplicity, i.e. those outcomes presented in the SoF table.
Dealing with missing data	Had dichotomous data not been presented on the basis of ITT data, we would have added the number of participants lost in each group to the participants with unfavourable results, acting on the assumption that most people with BPD do not get lost at random.	We were unable to perform this analysis due to insufficient information
Subgroup analysis and investigation of heterogeneity	We intended to conduct subgroup analyses to make hypotheses about the subgroups mentioned below. Sex (male versus female) Comorbidity (people with comorbidity versus people without comorbidity) Treatment intensity (once a week compared to more than once a week Concurrent‐drug interventions (trials with concurrent‐drug interventions compared to those without)	We did not conduct these preplanned analyses because of lack of data.
Sensitivity analysis	We intended to assess the impact of heterogeneity on the overall pooled effect estimate by removing studies ('outliers') that contributed to heterogeneity. We intended to remove outliers one by one and assess the impact on the overall outcome. Decisions made during the review process (our assessment of the level of clinical heterogeneity) Impact of bias (studies with low and high risk of bias) Type of data collection (for example, different ways to measure depression) Imputed data (comparing analyses with available outcome data with those using an ITT approach)	We were not able to perform these analyses, due to a lack of sufficient data.
TSA	We intended to calculate post hoc, low bias, risk diversity‐adjusted required information size TSA analyses for the primary outcomes.	We were not able to perform these analyses with low risk of bias trials.
BPD: borderline personality disorder; CI: confidence interval;ITT: intention to treat; TAU: treatment‐as‐usual

Table 1. Unused methods

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Table 2. Key demographic characteristics of the included studies

Category	Study frequency	Study ID
*Sample size*
Sample size above 100 participants	5	Andreoli 2016; Antonsen 2017; Linehan 2006; McMain 2009; McMurran 2016
*Setting*
Studies with inpatient settings	5	Jahangard 2012; Leichsenring 2016; Mohamadizadeh 2017; Schilling 2018; Stanley 2017
Studies with both inpatient and outpatient settings	7	Antonsen 2017; Bateman 1999; Davidson 2014; Gleeson 2012; Kredlow 2017b; Laurenssen 2018; Smith 2012
*Gender*
Only females included	17	Carter 2010; Doering 2010; Farrell 2009; Gratz 2006; Gratz 2014; Harned 2014; Koons 2001a; Linehan 1991; Linehan 1994; Linehan 2006; Linehan 2015a; Mohamadizadeh 2017; Smith 2012; Van den Bosch 2005; Weinberg 2006; Zanarini 2008; Zanarini 2018
Only males included	2	Bianchini 2019; Kamalabadi 2012
*Diagnostic classification*
DSM‐III diagnosis	1	Linehan 1991
DSM‐III‐R diagnosis	4	Bateman 1999; Koons 2001a; Linehan 1994; Turner 2000
DSM‐IV diagnosis	6	Borschmann 2013; McMurran 2016; Mohamadizadeh 2017; Priebe 2012; Rossouw 2012b; Schilling 2018
DSM‐IV‐TR diagnosis	54	Andreoli 2016; Antonsen 2017; Bateman 2009; Bellino 2006; Bellino 2007; Bellino 2010; Blum 2008; Bos 2010; Carter 2010; Cottraux 2009; Davidson 2006; Davidson 2014; Doering 2010; Elices 2016; Feigenbaum 2012; Feliu-Soler 2017; Giesen-Bloo 2006; Gleeson 2012; Gratz 2006; Gratz 2014; Gregory 2008b; Haeyen 2018; Harned 2014; Jahangard 2012; Jochems 2015; Jørgensen 2013; Kamalabadi 2012; Kramer 2011; Kramer 2014; Kramer 2016: Kredlow 2017a; Kredlow 2017b; Laurenssen 2018; Leppänen 2016; Lin 2019; Linehan 2006; McMain 2009; McMain 2017; Morey 2010; Morton 2012; Nadort 2009; Pascual 2015; Philips 2018; Reneses 2013; Robinson 2016; Santisteban 2015; Schilling 2018; Sinnaeve 2018; Soler 2009; Smith 2012; Van den Bosch 2005; Weinberg 2006; Zanarini 2008; Zanarini 2018
ICD‐10 diagnosis	1	Leichsenring 2016
*Diagnostic assessment*
BPDSI‐IV (Arntz 2003)	1	Kamalabadi 2012
CI‐BPD (Zanarini 2003b)	1	Rossouw 2012b
DIB (Gunderson 1981) or DIB‐R (Zanarini 1989)	4	Cottraux 2009; Feliu-Soler 2017; Linehan 1991; Zanarini 2008
DIB‐R (Zanarini 1989) and the BSI (Conte 1980)	1	Farrell 2009
DIB‐R (Zanarini 1989) plus any other DSM‐oriented diagnostic interview SCID‐II (First 1997)	1	Bateman 1999
DIPD‐IV (Zanarini 1987)	3	Gratz 2006; Gratz 2014; Morey 2010
IPDE (Loranger 1995)	4	Andreoli 2016; Harned 2014; McMain 2017; McMurran 2016
IPDE‐self‐rating screening and questionnaire, with the preliminary findings confirmed in clinical interviews by a psychiatrist	1	Carter 2010
Millon Clinical Multiaxial Inventory, 3rd Edition (MCMI‐III)	1	Jahangard 2012
PDE (Loranger 1988)	1	Turner 2000
SCID‐II (First 1997)	46	Amianto 2011; Antonsen 2017; Bateman 1999; Bateman 2009; Bellino 2006; Bellino 2007; Bellino 2010; Borschmann 2013; Bos 2010; Davidson 2006; Davidson 2014; Doering 2010; Elices 2016; Feigenbaum 2012; Giesen-Bloo 2006; Gleeson 2012; Gregory 2008b; Haeyen 2018; Jørgensen 2013; Koons 2001a; Kramer 2011; Kramer 2014; Kramer 2016; Kredlow 2017a; Kredlow 2017b; Laurenssen 2018; Leichsenring 2016; Leppänen 2016; Lin 2019; Linehan 1994; Linehan 2006; Linehan 2015a; Koons 2001a; Morton 2012; Nadort 2009; Pascual 2015; Philips 2018; Priebe 2012; Reneses 2013; Robinson 2016; Schilling 2018; Soler 2009; Smith 2012; Van den Bosch 2005; Weinberg 2006; Zanarini 2018
SIDP‐IV (Pfohl 1997)	1	Blum 2008
*Exclusion criteria in included studies*
Participants with substance abuse or dependence excluded	43	Amianto 2011; Andreoli 2016; Antonsen 2017; Bateman 1999; Bateman 2009; Bellino 2006; Bellino 2007; Bellino 2010; Blum 2008; Carmona í Farrés 2019; Cottraux 2009; Davidson 2006; Doering 2010; Feigenbaum 2012; Giesen-Bloo 2006; Gratz 2006; Gratz 2014; Jørgensen 2013; Kamalabadi 2012; Koons 2001a; Kramer 2011; Kredlow 2017a; Laurenssen 2018; Leichsenring 2016; Leppänen 2016; Lin 2019; Linehan 1991; Linehan 1994; McMain 2009; Mohamadizadeh 2017; Morey 2010; Nadort 2009; Pascual 2015; Rossouw 2012b; Schilling 2018; Schuppert 2012; Sinnaeve 2018; Soler 2009; Stanley 2017; Smith 2012; Weinberg 2006; Zanarini 2008; Zanarini 2018
Alcohol or substance abuse and dependence included	4	Davidson 2014; Gregory 2008b; Robinson 2016; Santisteban 2015
Antisocial features or full antisocial personality disorders excluded	9	Antonsen 2017; Carter 2010; Cottraux 2009; Doering 2010; Giesen-Bloo 2006; Jørgensen 2013; Kamalabadi 2012; Koons 2001a; Nadort 2009
*Duration of interventions*
Less than six months	36	Andreoli 2016; Antonsen 2017; Blum 2008; Bohus 2013; Borschmann 2013; Bos 2010; Davidson 2014; Elices 2016; Feliu-Soler 2017; Gleeson 2012; Gratz 2006; Gratz 2014; Haeyen 2018; Jahangard 2012; Kamalabadi 2012; Kramer 2011; Kramer 2014; Kramer 2016; Kredlow 2017a; Kredlow 2017b; Leichsenring 2016; Lin 2019; McMain 2017; McMurran 2016; Mehlum 2014; Mohamadizadeh 2017; Morey 2010; Morton 2012; Pascual 2015; Reneses 2013; Schilling 2018; Schuppert 2012; Soler 2009; Weinberg 2006; Zanarini 2008; Zanarini 2018
Between six months and 12 months	32	Amianto 2011; Bellino 2006; Bellino 2007; Bellino 2010; Bianchini 2019; Carmona í Farrés 2019; Carter 2010; Cottraux 2009; Davidson 2006; Doering 2010; Farrell 2009; Feigenbaum 2012; Gregory 2008b; Harned 2014; Jochems 2015; Koons 2001a; Leppänen 2016; Linehan 1991; Linehan 1994; Linehan 2006; Linehan 2015a; McMain 2009; Priebe 2012; Robinson 2016; Rossouw 2012b; Salzer 2014; Santisteban 2015; Sinnaeve 2018; Stanley 2017; Smith 2012; Turner 2000; Van den Bosch 2005
Longer than 12 months	7	Bateman 1999; Bateman 2009; Giesen-Bloo 2006; Jørgensen 2013; Laurenssen 2018; Nadort 2009; Philips 2018
*Formats of interventions*
Individual treatment	33	Amianto 2011; Andreoli 2016; Borschmann 2013; Bellino 2006; Bellino 2007; Bellino 2010; Cottraux 2009; Davidson 2006; Davidson 2014; Doering 2010; Giesen-Bloo 2006; Gleeson 2012; Harned 2014; Jahangard 2012; Kramer 2011; Kramer 2014; Kredlow 2017a; Kredlow 2017b; Leichsenring 2016; McMain 2009; McMurran 2016; Mohamadizadeh 2017; Morey 2010; Nadort 2009; Philips 2018; Priebe 2012; Reneses 2013; Salzer 2014; Stanley 2017; Smith 2012; Weinberg 2006; Zanarini 2008; Zanarini 2018
Group treatment	22	Antonsen 2017; Blum 2008; Bohus 2013; Bos 2010; Elices 2016; Farrell 2009; Feliu-Soler 2017; Gratz 2006; Gratz 2014; Haeyen 2018; Jochems 2015; Kamalabadi 2012; Kramer 2016; Leppänen 2016; Lin 2019; Linehan 2015a; McMain 2017; Morton 2012; Pascual 2015; Santisteban 2015; Schilling 2018; Soler 2009
Combination of individual and group treatment	16	Bateman 1999; Bateman 2009; Bianchini 2019; Carter 2010; Feigenbaum 2012; Gregory 2008b; Jørgensen 2013; Koons 2001a; Linehan 1991; Linehan 1994; Linehan 2006; Laurenssen 2018; Robinson 2016; Rossouw 2012b; Turner 2000; Van den Bosch 2005
*Concomitant medication*
Allowed, if needed	59	Amianto 2011; Andreoli 2016; Antonsen 2017; Bateman 1999; Bateman 2009; Blum 2008; Bohus 2013; Borschmann 2013; Bos 2010; Carmona í Farrés 2019; Cottraux 2009; Davidson 2006; Doering 2010; Elices 2016; Farrell 2009; Feigenbaum 2012; Feliu‐Soler 2017; Giesen‐Bloo 2006; Gleeson 2012; Gratz 2006; Gratz 2014; Gregory 2008b; Harned 2014; Jochems 2015; Jørgensen 2013; Koons 2001a; Kramer 2011; Kramer 2014; Kramer 2016; Kredlow 2017a; Kredlow 2017b; Laurenssen 2018; Leichsenring 2016; Linehan 1991; Linehan 1994; Linehan 2006; Linehan 2015a; McMain 2009; McMain 2017; McMurran 2016; Mehlum 2014; Morey 2010; Morton 2012; Nadort 2009; Pascual 2015; Priebe 2012; Reneses 2013; Rossouw 2012b; Salzer 2014; Schilling 2018; Schuppert 2012; Sinnaeve 2018; Smith 2012; Soler 2009; Turner 2000; Van den Bosch 2005; Weinberg 2006; Zanarini 2008; Zanarini 2018
All participants of each group received the same kind of concomitant medication	4	Bellino 2006; Bellino 2007; Bellino 2010; Jahangard 2012
Partly (50% of each group concomitantly received a specified, concurrent medication, 50% placebo)	1	Stanley 2017
Not allowed	2	Lin 2019; Mohamadizadeh 2017
Not specified	9	Bianchini 2019; Carter 2010; Davidson 2014; Haeyen 2018; Kamalabadi 2012; Leppänen 2016; Philips 2018; Robinson 2016; Santisteban 2015
*Control interventions*
Obligatory	42	Amianto 2011; Andreoli 2016; Bateman 1999; Bateman 2009; Bellino 2006; Bellino 2010; Bianchini 2019; Borschmann 2013; Bos 2010; Carter 2010; Davidson 2014; Doering 2010; Farrell 2009; Feigenbaum 2012; Gleeson 2012; Gratz 2006; Gratz 2014; Jahangard 2012; Jochems 2015;Jørgensen 2013; Koons 2001a; Kramer 2016; Laurenssen 2018; Leichsenring 2016; Leppänen 2016; Linehan 2006; McMurran 2016; Mehlum 2014; Morton 2012; Mohamadizadeh 2017; Philips 2018; Priebe 2012; Reneses 2013; Robinson 2016; Rossouw 2012b; Schuppert 2012; Soler 2009; Stanley 2017; Smith 2012; Van den Bosch 2005; Weinberg 2006; Zanarini 2018
Optional	13	Blum 2008; Bohus 2013; Davidson 2006; Gregory 2008b; Haeyen 2018; Kamalabadi 2012; Kredlow 2017a; Linehan 1991; Linehan 1994; McMain 2017; Mohamadizadeh 2017; Salzer 2014; Zanarini 2008
*Funding*
Funded by grants from universities, authorities or research foundations	62	Amianto 2011; Antonsen 2017; Bateman 1999; Bateman 2009; Blum 2008; Bohus 2013; Borschmann 2013; Bos 2010; Carmona í Farrés 2019; Cottraux 2009; Davidson 2006; Davidson 2014; Doering 2010; Elices 2016; Farrell 2009; Feigenbaum 2012; Feliu‐Soler 2017; Giesen‐Bloo 2006; Gleeson 2012; Gratz 2006; Gratz 2014; Gregory 2008b; Haeyen 2018; Harned 2014; Jochems 2015; Jørgensen 2013; Kramer 2011; Kramer 2014; Kramer 2016; Kredlow 2017a; Kredlow 2017b; Laurenssen 2018; Leichsenring 2016; Lin 2019; Linehan 1991; Linehan 1994; Linehan 2006; Linehan 2015a; McMain 2009; McMain 2017; McMurran 2016; Mehlum 2014; Morey 2010; Nadort 2009; Pascual 2015; Philips 2018; Priebe 2012; Reneses 2013; Robinson 2016; Rossouw 2012b; Salzer 2014; Santisteban 2015; Schilling 2018; Schuppert 2012; Sinnaeve 2018; Smith 2012; Soler 2009; Stanley 2017; Van den Bosch 2005; Weinberg 2006; Zanarini 2008; Zanarini 2018
No funding received	4	Bellino 2006; Bellino 2007; Bellino 2010; Jahangard 2012
Unclear funding	9	Andreoli 2016; Bianchini 2019; Carter 2010; Kamalabadi 2012; Koons 2001a; Leppänen 2016; Mohamadizadeh 2017; Morton 2012; Turner 2000
BPDSI‐IV: Borderline Personality Disorder Severity Index; BSI: Borderline Syndrome Index; CI‐BPD: Childhood Interview for DSM‐IV Borderline Personality Disorder; DIB: Diagnostic Interview for Borderline Patients; DIB‐R: Diagnostic Interview for Borderline Patients ‐ revised version; DIPD‐IV: Diagnostic Interview for DSM‐IV Personality Disorders; DSM‐III: Diagnostic and Statistical Manual of Mental Disorders, Third Edition; DSM‐III‐R: Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised; DSM‐IV: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; DSM‐IV‐TR: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision; ICD‐10: International Classification of Diseases, Tenth Revision; IPDE: International Personality Disorder Examination; PDE: Personality Disorders Examination; SCID‐II: Structured Clinical Interview for DSM DSM‐IV Axis II Personality Disorders (SCID‐II); SIDP‐IV: Structured Interview for DSM‐IV Personality

Table 2. Key demographic characteristics of the included studies

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Comparison 1. Psychotherapy vs TAU

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1.1 Primary: BPD symptom severity (continuous) Show forest plot	23		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

1.1.1 End of treatment	22	1244	Std. Mean Difference (IV, Random, 95% CI)	‐0.52 [‐0.70, ‐0.33]
1.1.2 0‐6 months follow‐up	2	41	Std. Mean Difference (IV, Random, 95% CI)	‐0.59 [‐1.23, 0.05]
1.1.3 6‐12 months follow‐up	2	157	Std. Mean Difference (IV, Random, 95% CI)	‐0.04 [‐0.36, 0.27]
1.1.4 12 months and over follow‐up	2	97	Std. Mean Difference (IV, Random, 95% CI)	‐0.94 [‐2.58, 0.70]
1.2 Primary: BPD symptom severity (dichotomous), at above 12 months follow‐up Show forest plot	1		Risk Ratio (IV, Fixed, 95% CI)	Subtotals only

1.3 Primary: self‐harm (continuous) Show forest plot	13		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

1.3.1 End of treatment	13	616	Std. Mean Difference (IV, Random, 95% CI)	‐0.32 [‐0.49, ‐0.14]
1.3.2 0‐6 months follow‐up	1	28	Std. Mean Difference (IV, Random, 95% CI)	‐0.52 [‐1.28, 0.23]
1.3.3 6‐12 months follow‐up	3	174	Std. Mean Difference (IV, Random, 95% CI)	‐0.18 [‐0.48, 0.12]
1.4 Primary: self‐harm (dichotomous) Show forest plot	6		Risk Ratio (IV, Random, 95% CI)	Subtotals only

1.4.1 End of treatment	6	513	Risk Ratio (IV, Random, 95% CI)	0.85 [0.63, 1.14]
1.4.2 0‐6 months follow‐up	1	41	Risk Ratio (IV, Random, 95% CI)	0.14 [0.04, 0.56]
1.4.3 6‐12 months follow‐up	1	41	Risk Ratio (IV, Random, 95% CI)	0.27 [0.10, 0.68]
1.4.4 12 months and over follow‐up	1	41	Risk Ratio (IV, Random, 95% CI)	0.33 [0.15, 0.76]
1.5 Primary: suicide‐related outcomes (continuous) Show forest plot	13		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

1.5.1 End of treatment	13	666	Std. Mean Difference (IV, Random, 95% CI)	‐0.34 [‐0.57, ‐0.11]
1.5.2 0‐6 months follow‐up	2	36	Std. Mean Difference (IV, Random, 95% CI)	‐0.43 [‐1.10, 0.23]
1.5.3 6‐12 months follow‐up	2	109	Std. Mean Difference (IV, Random, 95% CI)	‐0.42 [‐0.80, ‐0.04]
1.5.4 Above 12 months follow‐up	1	76	Std. Mean Difference (IV, Random, 95% CI)	‐0.31 [‐0.77, 0.14]
1.6 Primary: suicide‐related outcomes (dichotomous) Show forest plot	5		Risk Ratio (IV, Random, 95% CI)	Subtotals only

1.6.1 End of treatment	5	396	Risk Ratio (IV, Random, 95% CI)	0.27 [0.11, 0.67]
1.6.2 0‐6 months follow‐up	1	41	Risk Ratio (IV, Random, 95% CI)	0.25 [0.06, 1.05]
1.6.3 Above 12 months follow‐up	1	41	Risk Ratio (IV, Random, 95% CI)	0.29 [0.11, 0.74]
1.7 Primary: psychosocial functioning (continuous) Show forest plot	23		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

1.7.1 End of treatment	22	1314	Std. Mean Difference (IV, Random, 95% CI)	‐0.45 [‐0.68, ‐0.22]
1.7.2 0‐6 months follow‐up	1	9	Std. Mean Difference (IV, Random, 95% CI)	‐1.23 [‐2.74, 0.29]
1.7.3 6‐12 months follow‐up	3	247	Std. Mean Difference (IV, Random, 95% CI)	‐0.09 [‐0.40, 0.23]
1.7.4 Above 12 months follow‐up	6	499	Std. Mean Difference (IV, Random, 95% CI)	‐0.27 [‐0.60, 0.05]
1.8 Secondary: anger (continuous) Show forest plot	8		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

1.8.1 End of treatment	8	323	Std. Mean Difference (IV, Random, 95% CI)	‐0.38 [‐0.64, ‐0.12]
1.8.2 0‐6 months follow‐up	1	8	Std. Mean Difference (IV, Random, 95% CI)	‐1.20 [‐2.82, 0.41]
1.8.3 6‐12 months follow‐up	2	111	Std. Mean Difference (IV, Random, 95% CI)	‐0.12 [‐0.50, 0.25]
1.8.4 Above 12 months follow‐up	1	80	Std. Mean Difference (IV, Random, 95% CI)	0.02 [‐0.42, 0.46]
1.9 Secondary: affective instability (continuous) Show forest plot	12		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

1.9.1 End of treatment	12	620	Std. Mean Difference (IV, Random, 95% CI)	‐0.68 [‐0.98, ‐0.39]
1.9.2 6‐12 months follow‐up	1	33	Std. Mean Difference (IV, Random, 95% CI)	‐0.52 [‐1.21, 0.18]
1.10 Secondary: chronic feelings of emptiness (continuous) Show forest plot	4		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

1.10.1 End of treatment	4	187	Std. Mean Difference (IV, Random, 95% CI)	‐0.39 [‐0.69, ‐0.10]
1.10.2 6‐12 months follow‐up	1	33	Std. Mean Difference (IV, Random, 95% CI)	‐0.58 [‐1.28, 0.11]
1.11 Secondary: impulsivity (continuous) Show forest plot	10		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

1.11.1 End of treatment	10	491	Std. Mean Difference (IV, Random, 95% CI)	‐0.54 [‐0.84, ‐0.25]
1.11.2 6‐12 months follow‐up	2	77	Std. Mean Difference (IV, Random, 95% CI)	0.32 [‐0.13, 0.77]
1.12 Secondary: impulsivity (dichotomous), at end of treatment Show forest plot	1		Risk Ratio (IV, Fixed, 95% CI)	Subtotals only

1.13 Secondary: interpersonal problems (continuous) Show forest plot	18		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

1.13.1 End of treatment	18	1159	Std. Mean Difference (IV, Random, 95% CI)	‐0.42 [‐0.68, ‐0.16]
1.13.2 0‐6 months follow‐up	1	53	Std. Mean Difference (IV, Random, 95% CI)	‐0.41 [‐1.01, 0.20]
1.13.3 6‐12 months follow‐up	2	132	Std. Mean Difference (IV, Random, 95% CI)	‐0.17 [‐0.65, 0.32]
1.13.4 Above 12 months follow‐up	3	172	Std. Mean Difference (IV, Random, 95% CI)	0.00 [‐0.54, 0.54]
1.14 Secondary: abandonment (continuous) Show forest plot	2		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

1.14.1 End of treatment	2	84	Std. Mean Difference (IV, Random, 95% CI)	‐0.22 [‐0.66, 0.21]
1.14.2 6‐12 months follow‐up	1	33	Std. Mean Difference (IV, Random, 95% CI)	‐0.39 [‐1.08, 0.30]
1.15 Secondary: identity disturbance (continuous) Show forest plot	4		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

1.15.1 End of treatment	4	250	Std. Mean Difference (IV, Random, 95% CI)	‐0.37 [‐0.84, 0.10]
1.15.2 6‐12 months follow‐up	1	33	Std. Mean Difference (IV, Random, 95% CI)	‐1.09 [‐1.83, ‐0.35]
1.16 Secondary: dissociation and psychotic‐like symptoms (continuous) Show forest plot	6		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

1.16.1 End of treatment	6	244	Std. Mean Difference (IV, Random, 95% CI)	‐0.47 [‐0.85, ‐0.10]
1.16.2 0‐6 months follow‐up	2	35	Std. Mean Difference (IV, Random, 95% CI)	‐0.97 [‐1.69, ‐0.26]
1.16.3 6‐12 months follow‐up	1	33	Std. Mean Difference (IV, Random, 95% CI)	‐0.59 [‐1.29, 0.11]
1.16.4 12 months and over follow‐up	1	24	Std. Mean Difference (IV, Random, 95% CI)	‐0.01 [‐0.81, 0.79]
1.17 Secondary: depression (continuous) Show forest plot	22		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

1.17.1 End of treatment	22	1568	Std. Mean Difference (IV, Random, 95% CI)	‐0.39 [‐0.61, ‐0.17]
1.17.2 0‐6 months follow‐up	4	125	Std. Mean Difference (IV, Random, 95% CI)	‐0.80 [‐1.26, ‐0.34]
1.17.3 6‐12 months follow‐up	3	260	Std. Mean Difference (IV, Random, 95% CI)	‐0.40 [‐0.95, 0.16]
1.17.4 12 months and over follow‐up	5	311	Std. Mean Difference (IV, Random, 95% CI)	‐0.40 [‐0.74, ‐0.06]
1.18 Secondary: depression (dichotomous), at end of treatment Show forest plot	1		Risk Ratio (IV, Fixed, 95% CI)	Subtotals only

1.19 Secondary: attrition (dichotomous) Show forest plot	33		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

1.19.1 End of treatment	32	2225	Risk Ratio (M‐H, Random, 95% CI)	1.00 [0.83, 1.20]
1.19.2 0‐6 months follow‐up	1	60	Risk Ratio (M‐H, Random, 95% CI)	0.58 [0.34, 1.00]
1.20 Secondary: non‐serious adverse effects (dichotomous), at end of treatment Show forest plot	2	381	Risk Ratio (M‐H, Random, 95% CI)	0.92 [0.45, 1.88]

1.21 Secondary: serious adverse effects (dichotomous), at end of treatment Show forest plot	4	571	Risk Ratio (IV, Fixed, 95% CI)	0.86 [0.14, 5.09]

Comparison 1. Psychotherapy vs TAU

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Comparison 2. Acceptance and commitment therapy (ACT) vs TAU

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2.1 Primary: BPD symptom severity (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

2.2 Secondary: affective instability (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

2.3 Secondary: depression (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

2.4 Secondary: attrition (dichotomous), at end of treatment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

Comparison 2. Acceptance and commitment therapy (ACT) vs TAU

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Comparison 3. Dialectical behavior therapy (DBT) vs TAU

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
3.1 Primary: BPD symptom severity (continuous), at end of treatment Show forest plot	3	149	Std. Mean Difference (IV, Random, 95% CI)	‐0.60 [‐1.05, ‐0.14]

3.2 Primary, self‐harm (continuous) Show forest plot	7		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

3.2.1 End of treatment	7	376	Std. Mean Difference (IV, Random, 95% CI)	‐0.28 [‐0.48, ‐0.07]
3.2.2 6‐12 months follow‐up	2	141	Std. Mean Difference (IV, Random, 95% CI)	‐0.26 [‐0.59, 0.07]
3.3 Primary: suicide‐related outcomes (continuous), at end of treatment Show forest plot	5	231	Std. Mean Difference (IV, Random, 95% CI)	‐0.23 [‐0.68, 0.23]

3.4 Primary: suicide‐related outcomes, attempts (dichotomous), at end of treatment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

3.5 Primary: psychosocial functioning (continuous), at end of treatment Show forest plot	6	225	Std. Mean Difference (IV, Random, 95% CI)	‐0.36 [‐0.69, ‐0.03]

3.6 Secondary: anger (continuous) Show forest plot	5		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

3.6.1 End of treatment	5	230	Std. Mean Difference (IV, Random, 95% CI)	‐0.47 [‐0.86, ‐0.09]
3.6.2 6‐12 months follow‐up	1	78	Std. Mean Difference (IV, Random, 95% CI)	‐0.17 [‐0.62, 0.27]
3.6.3 Above 12 months follow‐up	1	80	Std. Mean Difference (IV, Random, 95% CI)	0.02 [‐0.42, 0.46]
3.7 Secondary: affective instability (continuous), at end of treatment Show forest plot	2	80	Std. Mean Difference (IV, Random, 95% CI)	‐0.57 [‐1.64, 0.51]

3.8 Secondary: chronic feelings of emptiness (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

3.9 Secondary: impulsivity (continuous) Show forest plot	3		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

3.9.1 End of treatment	3	128	Std. Mean Difference (IV, Random, 95% CI)	‐0.35 [‐0.71, ‐0.00]
3.9.2 6‐12 months follow‐up	1	44	Std. Mean Difference (IV, Random, 95% CI)	0.30 [‐0.30, 0.90]
3.10 Secondary: interpersonal problems (continuous), at end of treatment Show forest plot	3	148	Std. Mean Difference (IV, Random, 95% CI)	‐0.12 [‐0.45, 0.20]

3.11 Secondary: dissociation and psychotic‐like symptoms (continuous), at end of treatment Show forest plot	4	194	Std. Mean Difference (IV, Random, 95% CI)	‐0.45 [‐0.73, ‐0.16]

3.12 Secondary: depression (continuous) Show forest plot	5		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

3.12.1 End of treatment	5	219	Std. Mean Difference (IV, Random, 95% CI)	‐0.47 [‐0.98, 0.03]
3.12.2 6‐12 months follow‐up	1	81	Std. Mean Difference (IV, Random, 95% CI)	‐0.23 [‐0.67, 0.21]
3.13 Secondary: attrition (dichotomous) Show forest plot	11		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

3.13.1 End of treatment	10	591	Risk Ratio (M‐H, Random, 95% CI)	1.27 [0.70, 2.31]
3.13.2 0‐6 months follow‐up	1	60	Risk Ratio (M‐H, Random, 95% CI)	0.58 [0.34, 1.00]
3.14 Secondary: adverse effects (dichotomous), at end of treatment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

3.15 Secondary: serious adverse effects (dichotomous), at end of treatment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

Comparison 3. Dialectical behavior therapy (DBT) vs TAU

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Comparison 4. Mentalisation based therapy (MBT) vs TAU

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
4.1 Primary: BPD symptom severity (continuous) Show forest plot	6		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

4.1.1 End of treatment	5	267	Std. Mean Difference (IV, Random, 95% CI)	‐0.13 [‐0.38, 0.11]
4.1.2 0‐6 months follow‐up	1	15	Std. Mean Difference (IV, Random, 95% CI)	‐0.40 [‐1.49, 0.68]
4.1.3 Above 12 months follow‐up	2	97	Std. Mean Difference (IV, Random, 95% CI)	‐0.94 [‐2.58, 0.70]
4.2 Primary: self‐harm (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

4.3 Primary: self‐harm (dichotomous) Show forest plot	3		Risk Ratio (IV, Random, 95% CI)	Subtotals only

4.3.1 End of treatment	3	252	Risk Ratio (IV, Random, 95% CI)	0.62 [0.49, 0.80]
4.3.2 0‐6 months follow‐up	1	41	Risk Ratio (IV, Random, 95% CI)	0.14 [0.04, 0.56]
4.3.3 6‐12 months follow‐up	1	41	Risk Ratio (IV, Random, 95% CI)	0.27 [0.10, 0.68]
4.3.4 Above 12 months follow‐up	1	41	Risk Ratio (IV, Random, 95% CI)	0.33 [0.15, 0.76]
4.4 Primary: suicide‐related outcomes (dichotomous) Show forest plot	3		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

4.4.1 End of treatment	3	218	Risk Ratio (M‐H, Random, 95% CI)	0.10 [0.04, 0.30]
4.4.2 0‐6 months follow‐up	1	41	Risk Ratio (M‐H, Random, 95% CI)	0.25 [0.06, 1.05]
4.4.3 Above 12 months follow‐up	1	41	Risk Ratio (M‐H, Random, 95% CI)	0.29 [0.11, 0.74]
4.5 Primary: psychosocial functioning (continuous) Show forest plot	3		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

4.5.1 End of treatment	3	239	Std. Mean Difference (IV, Random, 95% CI)	‐0.54 [‐1.24, 0.16]
4.5.2 Above 12 months follow‐up	2	104	Std. Mean Difference (IV, Random, 95% CI)	‐0.41 [‐0.97, 0.15]
4.6 Secondary: interpersonal problems (continuous) Show forest plot	5		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

4.6.1 End of treatment	5	357	Std. Mean Difference (IV, Random, 95% CI)	‐0.68 [‐1.33, ‐0.02]
4.6.2 0‐6 months follow‐up	1	53	Std. Mean Difference (IV, Random, 95% CI)	‐0.41 [‐1.01, 0.20]
4.6.3 Above 12 months follow‐up	2	96	Std. Mean Difference (IV, Random, 95% CI)	‐0.28 [‐0.71, 0.14]
4.7 Secondary: depression (continuous) Show forest plot	4		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

4.7.1 End of treatment	4	333	Std. Mean Difference (IV, Random, 95% CI)	‐0.58 [‐1.22, 0.05]
4.7.2 0‐6 months follow‐up	2	91	Std. Mean Difference (IV, Random, 95% CI)	‐0.81 [‐1.69, 0.07]
4.7.3 6‐12 months follow‐up	1	37	Std. Mean Difference (IV, Random, 95% CI)	‐1.17 [‐1.88, ‐0.45]
4.7.4 Above 12 months follow‐up	2	90	Std. Mean Difference (IV, Random, 95% CI)	‐0.72 [‐1.55, 0.10]
4.8 Secondary: depression (dichotomous), at end of treatment Show forest plot	1		Risk Ratio (IV, Fixed, 95% CI)	Subtotals only

4.9 Secondary: attrition (dichotomous), at end of treatment Show forest plot	7	552	Risk Ratio (M‐H, Random, 95% CI)	0.99 [0.79, 1.25]

4.10 Secondary: adverse effects (dichotomous), at end of treatment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

4.11 Mentalisation‐based treatment for eating disorders (MBT‐ED) versus specialist supportive clinical management (SSCM‐ED) (generic inverse variance) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

4.11.1 Primary: psychosocial functioning (continuous), at end of treatment	1		Mean Difference (IV, Fixed, 95% CI)	‐0.07 [‐0.86, 0.72]
4.11.2 Primary: psychosocial functioning (dichotomous), at 0‐6 months follow‐up	1		Mean Difference (IV, Fixed, 95% CI)	‐0.44 [‐1.52, 0.64]
4.11.3 Secondary: interpersonal problems (continuous), at end of treatment	1		Mean Difference (IV, Fixed, 95% CI)	‐0.10 [‐0.89, 0.69]
4.11.4 Secondary: interpersonal problems (continuous), at 0‐6 months follow‐up	1		Mean Difference (IV, Fixed, 95% CI)	‐0.06 [‐1.15, 1.03]
4.11.5 Secondary: depression (continuous), at end of treatment	1		Mean Difference (IV, Fixed, 95% CI)	0.19 [‐0.60, 0.98]
4.11.6 Secondary: depression (continuous), at 0‐6 months follow‐up	1		Mean Difference (IV, Fixed, 95% CI)	0.51 [‐0.62, 1.64]

Comparison 4. Mentalisation based therapy (MBT) vs TAU

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Comparison 5. Cognitive behavioural therapy (CBT) and related treatments vs TAU

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
5.1 Primary: BPD symptom severity (continuous) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

5.1.1 End of treatment	1	26	Mean Difference (IV, Fixed, 95% CI)	‐3.08 [‐4.99, ‐1.17]
5.1.2 0‐6 months follow‐up	1	26	Mean Difference (IV, Fixed, 95% CI)	‐2.02 [‐4.23, 0.19]
5.2 Primary: BPD symptom severity (dichotomous), at above 12 months follow‐up Show forest plot	1	76	Risk Ratio (IV, Fixed, 95% CI)	0.91 [0.56, 1.48]

5.3 Primary: self‐harm (continuous) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

5.3.1 End of treatment	1	28	Mean Difference (IV, Fixed, 95% CI)	‐3.03 [‐5.68, ‐0.38]
5.3.2 0‐6 months follow‐up	1	28	Mean Difference (IV, Fixed, 95% CI)	‐4.71 [‐11.60, 2.18]
5.4 Primary: self‐harm (dichotomous), at end of treatment Show forest plot	1		Risk Ratio (IV, Fixed, 95% CI)	Subtotals only

5.5 Primary: suicide‐related outcomes (continuous) Show forest plot	2		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

5.5.1 End of treatment	2	104	Std. Mean Difference (IV, Random, 95% CI)	‐0.47 [‐1.02, 0.08]
5.5.2 0‐6 months follow‐up	1	28	Std. Mean Difference (IV, Random, 95% CI)	‐0.45 [‐1.20, 0.31]
5.5.3 6‐12 months follow‐up	1	76	Std. Mean Difference (IV, Random, 95% CI)	‐0.44 [‐0.89, 0.02]
5.5.4 Above 12 months follow‐up	1	76	Std. Mean Difference (IV, Random, 95% CI)	‐0.31 [‐0.77, 0.14]
5.6 Primary: psychosocial functioning (continuous) Show forest plot	2		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

5.6.1 End of treatment	1	99	Std. Mean Difference (IV, Random, 95% CI)	0.00 [‐0.39, 0.39]
5.6.2 6‐12 months follow‐up	1	90	Std. Mean Difference (IV, Random, 95% CI)	0.13 [‐0.28, 0.55]
5.6.3 Above 12 months follow‐up	2	209	Std. Mean Difference (IV, Random, 95% CI)	0.04 [‐0.36, 0.43]
5.7 Secondary: interpersonal problems (continuous) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

5.7.1 End of treatment	1	99	Mean Difference (IV, Fixed, 95% CI)	5.40 [‐3.70, 14.50]
5.7.2 6‐12 months follow‐up	1	99	Mean Difference (IV, Fixed, 95% CI)	0.30 [‐9.17, 9.77]
5.7.3 Above 12 months follow‐up	1	76	Mean Difference (IV, Fixed, 95% CI)	11.70 [0.72, 22.68]
5.8 Secondary: dissociation and psychotic‐like symptoms (continuous) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

5.8.1 End of treatment	1	26	Mean Difference (IV, Fixed, 95% CI)	‐2.30 [‐8.84, 4.24]
5.8.2 0‐6 months follow‐up	1	26	Mean Difference (IV, Fixed, 95% CI)	‐13.40 [‐24.49, ‐2.31]
5.9 Secondary: depression (continuous) Show forest plot	5		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

5.9.1 End of treatment	5	314	Std. Mean Difference (IV, Random, 95% CI)	‐0.21 [‐0.77, 0.35]
5.9.2 0‐6 months follow‐up	1	26	Std. Mean Difference (IV, Random, 95% CI)	‐0.96 [‐1.78, ‐0.14]
5.9.3 6‐12 months follow‐up	1	99	Std. Mean Difference (IV, Random, 95% CI)	‐0.29 [‐0.69, 0.11]
5.9.4 Above 12 months follow‐up	2	197	Std. Mean Difference (IV, Random, 95% CI)	‐0.15 [‐0.43, 0.13]
5.10 Secondary: attrition (dichotomous), at end of treatment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

5.11 Secondary: adverse effects (dichotomous), at end of treatment Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

5.11.1 Non‐serious adverse effects	1	306	Risk Ratio (M‐H, Random, 95% CI)	0.92 [0.45, 1.88]
5.11.2 Serious adverse effects	2	326	Risk Ratio (M‐H, Random, 95% CI)	2.65 [0.31, 22.93]

Comparison 5. Cognitive behavioural therapy (CBT) and related treatments vs TAU

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Comparison 6. Psychodynamic psychotherapy vs TAU

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
6.1 Primary: BPD symptom severity (continuous) Show forest plot	4		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

6.1.1 End of treatment	4	222	Std. Mean Difference (IV, Random, 95% CI)	‐0.29 [‐0.66, 0.09]
6.1.2 6‐12 months follow‐up	1	33	Std. Mean Difference (IV, Random, 95% CI)	‐0.31 [‐1.00, 0.38]
6.2 Primary: self‐harm (continuous) Show forest plot	1		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

6.2.1 End of treatment	1	33	Std. Mean Difference (IV, Random, 95% CI)	0.12 [‐0.56, 0.80]
6.2.2 6‐12 months follow‐up	1	33	Std. Mean Difference (IV, Random, 95% CI)	0.14 [‐0.55, 0.82]
6.3 Primary: suicide‐related outcomes (continuous) Show forest plot	3		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

6.3.1 End of treatment	3	101	Std. Mean Difference (IV, Random, 95% CI)	‐0.22 [‐0.62, 0.17]
6.3.2 6‐12 months follow‐up	1	33	Std. Mean Difference (IV, Random, 95% CI)	‐0.38 [‐1.07, 0.31]
6.4 Primary: psychosocial functioning (continuous) Show forest plot	4		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

6.4.1 End of treatment	4	140	Std. Mean Difference (IV, Random, 95% CI)	‐0.69 [‐1.98, 0.59]
6.4.2 6‐12 months follow‐up	1	33	Std. Mean Difference (IV, Random, 95% CI)	0.05 [‐0.64, 0.73]
6.4.3 Above 12 months follow‐up	1	16	Std. Mean Difference (IV, Random, 95% CI)	‐0.40 [‐1.39, 0.60]
6.5 Secondary: anger (continuous) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

6.5.1 End of treatment	1	33	Mean Difference (IV, Fixed, 95% CI)	0.00 [‐0.86, 0.86]
6.5.2 6‐12 months follow‐up	1	33	Mean Difference (IV, Fixed, 95% CI)	0.00 [‐0.89, 0.89]
6.6 Secondary: affective instability (continuous) Show forest plot	3		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

6.6.1 End of treatment	3	116	Std. Mean Difference (IV, Random, 95% CI)	‐0.50 [‐0.87, ‐0.13]
6.6.2 6‐12 months follow‐up	1	33	Std. Mean Difference (IV, Random, 95% CI)	‐0.52 [‐1.21, 0.18]
6.7 Secondary: chronic feelings of emptiness (continuous) Show forest plot	2		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

6.7.1 End of treatment	2	77	Std. Mean Difference (IV, Random, 95% CI)	‐0.49 [‐1.02, 0.04]
6.7.2 6‐12 months follow‐up	1	33	Std. Mean Difference (IV, Random, 95% CI)	‐0.58 [‐1.28, 0.11]
6.8 Secondary: impulsivity (continuous) Show forest plot	2		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

6.8.1 End of treatment	2	77	Std. Mean Difference (IV, Random, 95% CI)	‐0.39 [‐0.85, 0.07]
6.8.2 6‐12 months follow‐up	1	33	Std. Mean Difference (IV, Random, 95% CI)	0.35 [‐0.34, 1.04]
6.9 Secondary: interpersonal problems (continuous) Show forest plot	4		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

6.9.1 End of treatment	4	238	Std. Mean Difference (IV, Random, 95% CI)	‐0.21 [‐0.71, 0.29]
6.9.2 6‐12 months follow‐up	1	33	Std. Mean Difference (IV, Random, 95% CI)	‐0.51 [‐1.20, 0.19]
6.10 Secondary: abandonment (continuous) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

6.10.1 End of treatment	1	33	Mean Difference (IV, Fixed, 95% CI)	‐0.20 [‐0.95, 0.55]
6.10.2 6‐12 months follow‐up	1	33	Mean Difference (IV, Fixed, 95% CI)	‐0.40 [‐1.08, 0.28]
6.11 Secondary: identity disturbance (continuous) Show forest plot	3		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

6.11.1 End of treatment	3	199	Std. Mean Difference (IV, Random, 95% CI)	‐0.38 [‐1.02, 0.27]
6.11.2 6‐12 months follow‐up	1	33	Std. Mean Difference (IV, Random, 95% CI)	‐1.09 [‐1.83, ‐0.35]
6.12 Secondary: dissociation and psychotic‐like symptoms (continuous) Show forest plot	2		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

6.12.1 End of treatment	2	57	Std. Mean Difference (IV, Random, 95% CI)	‐0.18 [‐0.96, 0.60]
6.12.2 6‐12 months follow‐up	1	33	Std. Mean Difference (IV, Random, 95% CI)	‐0.59 [‐1.29, 0.11]
6.12.3 Above 12 months follow‐up	1	24	Std. Mean Difference (IV, Random, 95% CI)	‐0.01 [‐0.81, 0.79]
6.13 Secondary: depression (continuous) Show forest plot	3		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

6.13.1 End of treatment	3	190	Std. Mean Difference (IV, Random, 95% CI)	‐0.17 [‐0.81, 0.47]
6.13.2 Above 12 months follow‐up	1	24	Std. Mean Difference (IV, Random, 95% CI)	‐0.68 [‐1.51, 0.15]
6.14 Secondary: attrition (dichotomous), at end of treatment Show forest plot	3	210	Risk Ratio (M‐H, Random, 95% CI)	0.90 [0.56, 1.47]

Comparison 6. Psychodynamic psychotherapy vs TAU

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Comparison 7. Schema‐focused therapy (SFT) vs TAU

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
7.1 Primary: BPD symptom severity (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

7.2 Primary: psychosocial functioning (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

7.3 Secondary: affective instability (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

7.4 Secondary: impulsivity (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

7.5 Secondary: interpersonal problems (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

7.6 Secondary: dissociation and psychotic‐like symptoms (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

7.7 Secondary: attrition (dichotomous), at end of treatment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

Comparison 7. Schema‐focused therapy (SFT) vs TAU

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Comparison 8. Systems training for emotional predictability and problem solving (STEPPS) vs TAU

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
8.1 Primary: BPD symptom severity (continuous), at end of treatment Show forest plot	3		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

8.1.1 End of treatment	3	273	Std. Mean Difference (IV, Random, 95% CI)	‐0.39 [‐0.63, ‐0.15]
8.1.2 6‐12 months follow‐up	1	124	Std. Mean Difference (IV, Random, 95% CI)	0.03 [‐0.33, 0.38]
8.2 Primary: self‐harm (dichtomous), at end of treatment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

8.3 Primary: psychosocial functioning (continuous) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

8.3.1 End of treatment	1	124	Mean Difference (IV, Fixed, 95% CI)	‐7.00 [‐11.43, ‐2.57]
8.3.2 6‐12 months follow‐up	1	124	Mean Difference (IV, Fixed, 95% CI)	‐5.90 [‐12.49, 0.69]
8.4 Secondary: affective instability (continuous), at end of treatment Show forest plot	2	221	Std. Mean Difference (IV, Random, 95% CI)	‐0.25 [‐0.52, 0.02]

8.5 Secondary: impulsivity (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

8.6 Secondary: impulsivity (dichotomous), at end of treatment Show forest plot	1		Risk Ratio (IV, Fixed, 95% CI)	Subtotals only

8.7 Secondary: interpersonal problems (continuous), at end of treatment Show forest plot	2	177	Std. Mean Difference (IV, Random, 95% CI)	‐0.38 [‐0.67, ‐0.08]

8.8 Secondary: dissociation and psychotic‐like symptoms (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

8.9 Secondary: depression (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

8.9.1 End of treatment	1	124	Mean Difference (IV, Fixed, 95% CI)	‐3.80 [‐9.34, 1.74]
8.9.2 6‐12 months follow‐up	1	124	Mean Difference (IV, Fixed, 95% CI)	0.60 [‐8.42, 9.62]
8.10 Secondary: attrition (dichotomous), at end of treatment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

Comparison 8. Systems training for emotional predictability and problem solving (STEPPS) vs TAU

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Comparison 9. Cognitive analytic therapy (CAT) vs TAU

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
9.1 Primary: suicide‐related outcomes (continuous) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

9.1.1 End of treatment	1	9	Mean Difference (IV, Fixed, 95% CI)	‐1.40 [‐4.21, 1.41]
9.1.2 0‐6 months follow‐up	1	8	Mean Difference (IV, Fixed, 95% CI)	‐0.50 [‐2.05, 1.05]
9.2 Primary: psychosocial functioning (continuous) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

9.2.1 End of treatment	1	9	Mean Difference (IV, Fixed, 95% CI)	‐16.40 [‐31.20, ‐1.60]
9.2.2 0‐6 months follow‐up	1	9	Mean Difference (IV, Fixed, 95% CI)	‐15.80 [‐29.36, ‐2.24]
9.3 Secondary: anger (continuous) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

9.3.1 End of treatment	1	9	Mean Difference (IV, Fixed, 95% CI)	‐1.90 [‐7.97, 4.17]
9.3.2 0‐6 months follow‐up	1	8	Mean Difference (IV, Fixed, 95% CI)	‐4.50 [‐9.01, 0.01]
9.4 Secondary: dissociation and psychotic‐like symptoms (continuous) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

9.4.1 End of treatment	1	9	Mean Difference (IV, Fixed, 95% CI)	‐6.10 [‐15.01, 2.81]
9.4.2 0‐6 months follow‐up	1	9	Mean Difference (IV, Fixed, 95% CI)	‐11.70 [‐24.02, 0.62]
9.5 Secondary: depression (continuous) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

9.5.1 End of treatment	1	9	Mean Difference (IV, Fixed, 95% CI)	‐9.70 [‐20.10, 0.70]
9.5.2 0‐6 months follow‐up	1	8	Mean Difference (IV, Fixed, 95% CI)	‐3.70 [‐11.99, 4.59]
9.6 Secondary: attrition (dichotomous), at end of treatment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

Comparison 9. Cognitive analytic therapy (CAT) vs TAU

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Comparison 10. Motivation feedback (MF) vs TAU

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
10.1 Primary: psychosocial functioning, at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

Comparison 10. Motivation feedback (MF) vs TAU

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Comparison 11. Psychoeducation vs TAU

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
11.1 Secondary: depression (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

11.2 Secondary: attrition (dichotomous), at end of treatment Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

Comparison 11. Psychoeducation vs TAU

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Comparison 12. Transference‐focused psychotherapy (TFP) vs TAU

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
12.1 Primary: BPD symptom severity (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

12.2 Primary: self‐harm (dichotomous), at end of treatment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

12.3 Primary: suicide‐related outcomes (dichotomous), at end of treatment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

12.4 Primary: psychosocial functioning (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

12.5 Secondary: depression (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

12.6 Secondary: attrition (dichotomous), at end of treatment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

Comparison 12. Transference‐focused psychotherapy (TFP) vs TAU

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Comparison 13. Once‐only interventions (individual setting) vs TAU

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
13.1 Primary: self‐harm (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

13.2 Primary: psychosocial functioning (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

13.3 Secondary: depression (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

13.4 Secondary: attrition (dichotomous), at end of treatment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

Comparison 13. Once‐only interventions (individual setting) vs TAU

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Comparison 14. Eclectic treatments vs TAU

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
14.1 Primary: BPD symptom severity (continuous), at end of treatment Show forest plot	3	134	Std. Mean Difference (IV, Random, 95% CI)	‐0.90 [‐1.57, ‐0.23]

14.2 Primary: self‐harm (continuous), at end of treatment Show forest plot	2	83	Std. Mean Difference (IV, Random, 95% CI)	‐0.84 [‐1.29, ‐0.39]

14.3 Primary: suicide‐related outcomes (continuous), at end of treatment Show forest plot	2	221	Std. Mean Difference (IV, Random, 95% CI)	‐0.55 [‐1.29, 0.19]

14.4 Primary: psychosocial functioning (continuous) Show forest plot	2		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

14.4.1 End of treatment	2	231	Std. Mean Difference (IV, Random, 95% CI)	‐0.57 [‐1.10, ‐0.04]
14.4.2 Above 12 months follow‐up	1	170	Std. Mean Difference (IV, Random, 95% CI)	‐0.64 [‐1.04, ‐0.24]
14.5 Secondary: anger (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

14.6 Secondary: affective instability (continuous), at end of treatment Show forest plot	3	134	Std. Mean Difference (IV, Random, 95% CI)	‐0.95 [‐1.74, ‐0.15]

14.7 Secondary: chronic feelings of emptiness (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

14.8 Secondary: impulsivity (continuous), at end of treatment Show forest plot	3	134	Std. Mean Difference (IV, Random, 95% CI)	‐0.76 [‐1.30, ‐0.22]

14.9 Secondary: interpersonal problems (continuous), at end of treatment Show forest plot	2	112	Std. Mean Difference (IV, Random, 95% CI)	‐0.62 [‐1.09, ‐0.15]

14.10 Secondary: abandonment (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

14.11 Secondary: identity disturbance (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

14.12 Secondary: depression (continuous), at end of treatment Show forest plot	4	304	Std. Mean Difference (IV, Random, 95% CI)	‐0.82 [‐1.38, ‐0.26]

14.13 Secondary: attrition (dichotomuous), at end of treatment Show forest plot	4	326	Risk Ratio (M‐H, Random, 95% CI)	1.06 [0.85, 1.32]

14.14 Secondary: adverse effects (dichotomous), at end of treatment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

Comparison 14. Eclectic treatments vs TAU

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Comparison 15. Psychotherapy vs waiting list or no treatment

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
15.1 Primary: BPD symptom severity (continuous), at end of treatment Show forest plot	3	161	Std. Mean Difference (IV, Random, 95% CI)	‐0.49 [‐0.93, ‐0.05]

15.2 Primary: self‐harm (continuous), at end of treatment Show forest plot	2	128	Std. Mean Difference (IV, Random, 95% CI)	‐0.17 [‐0.52, 0.18]

15.3 Primary: suicide‐related outcomes (continuous), at end of treatment Show forest plot	2	108	Std. Mean Difference (IV, Random, 95% CI)	‐5.62 [‐16.39, 5.16]

15.4 Primary: psychosocial functioning (continuous) Show forest plot	5		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

15.4.1 End of treatment	5	219	Std. Mean Difference (IV, Random, 95% CI)	‐0.56 [‐1.01, ‐0.11]
15.4.2 0‐6 months follow‐up	1	30	Std. Mean Difference (IV, Random, 95% CI)	‐0.89 [‐1.65, ‐0.13]
15.4.3 6‐12 months follow‐up	1	30	Std. Mean Difference (IV, Random, 95% CI)	‐1.04 [‐1.81, ‐0.27]
15.4.4 Above 12 months follow‐up	1	28	Std. Mean Difference (IV, Random, 95% CI)	‐0.38 [‐1.14, 0.37]
15.5 Secondary: anger (continuous), at end of treatment Show forest plot	2	128	Std. Mean Difference (IV, Random, 95% CI)	‐0.58 [‐1.70, 0.55]

15.6 Secondary: affective instability (continuous) Show forest plot	2		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

15.6.1 End of treatment	2	128	Std. Mean Difference (IV, Random, 95% CI)	‐0.99 [‐1.36, ‐0.62]
15.6.2 0‐6 months follow‐up	1	30	Std. Mean Difference (IV, Random, 95% CI)	‐0.47 [‐1.20, 0.26]
15.6.3 6‐12 months follow‐up	1	30	Std. Mean Difference (IV, Random, 95% CI)	‐0.38 [‐1.10, 0.34]
15.6.4 Above 12 months follow‐up	1	30	Std. Mean Difference (IV, Random, 95% CI)	‐0.28 [‐1.01, 0.44]
15.7 Secondary: chronic feelings of emptiness (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

15.8 Secondary: impulsivity (continuous) Show forest plot	3		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

15.8.1 End of treatment	3	178	Std. Mean Difference (IV, Random, 95% CI)	‐0.52 [‐0.82, ‐0.22]
15.8.2 0‐6 months follow‐up	1	30	Std. Mean Difference (IV, Random, 95% CI)	‐0.90 [‐1.66, ‐0.14]
15.8.3 6‐12 months follow‐up	1	30	Std. Mean Difference (IV, Random, 95% CI)	‐0.79 [‐1.54, ‐0.04]
15.8.4 Above 12 months follow‐up	1	30	Std. Mean Difference (IV, Random, 95% CI)	‐0.75 [‐1.50, ‐0.01]
15.9 Secondary: interpersonal problems (continuous) Show forest plot	3		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

15.9.1 End of treatment	3	120	Std. Mean Difference (IV, Random, 95% CI)	‐0.85 [‐1.23, ‐0.47]
15.9.2 0‐6 months follow‐up	1	30	Std. Mean Difference (IV, Random, 95% CI)	‐1.40 [‐2.21, ‐0.59]
15.9.3 6‐12 months follow‐up	1	30	Std. Mean Difference (IV, Random, 95% CI)	‐0.90 [‐1.66, ‐0.14]
15.9.4 Above 12 months follow‐up	1	30	Std. Mean Difference (IV, Random, 95% CI)	‐0.86 [‐1.62, ‐0.11]
15.10 Secondary: abandonment (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

15.11 Secondary: identity disturbance (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

15.12 Secondary: dissociation and psychotic‐like symptoms (continuous), at end of treatment Show forest plot	2	77	Std. Mean Difference (IV, Random, 95% CI)	‐0.13 [‐0.65, 0.39]

15.13 Secondary: depression (continuous), at end of treatment Show forest plot	6	239	Std. Mean Difference (IV, Random, 95% CI)	‐1.28 [‐2.21, ‐0.34]

15.14 Secondary: attrition (dichotomous), at end of treatment Show forest plot	3	144	Risk Ratio (M‐H, Random, 95% CI)	0.55 [0.20, 1.50]

Comparison 15. Psychotherapy vs waiting list or no treatment

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Comparison 16. Dialectical behavior therapy (DBT) vs waiting list or no treatment

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
16.1 Primary: BPD symptom severity (continuous), at end of treatment Show forest plot	2	117	Std. Mean Difference (IV, Random, 95% CI)	‐0.71 [‐1.08, ‐0.33]

16.2 Primary: self‐harm (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

16.3 Primary: suicide‐related outcomes (continuous), at end of treatment Show forest plot	2	108	Std. Mean Difference (IV, Random, 95% CI)	‐5.62 [‐16.39, 5.16]

16.4 Primary: psychosocial functioning (continuous), at end of treatment Show forest plot	2	117	Std. Mean Difference (IV, Random, 95% CI)	‐0.73 [‐1.11, ‐0.36]

16.5 Secondary: anger (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

16.6 Secondary: affective instability (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

16.7 Secondary: impulsivity (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

16.8 Secondary: dissociation and psychotic‐like symptoms (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

16.9 Secondary: depression (continuous), at end of treatment Show forest plot	3	141	Std. Mean Difference (IV, Random, 95% CI)	‐3.20 [‐5.57, ‐0.83]

16.10 DBT‐couple therapy (CDBT) vs waiting list (generic inverse variance) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

16.10.1 Primary: BPD severity (continuous), at end of treatment	1		Mean Difference (IV, Fixed, 95% CI)	‐27.15 [‐31.59, ‐22.71]
16.10.2 Primary: suicide‐related outcomes (continuous), at end of treatment	1		Mean Difference (IV, Fixed, 95% CI)	‐0.94 [‐1.24, ‐0.64]
16.10.3 Primary: psychosocial functioning (continuous), at end of treatment	1		Mean Difference (IV, Fixed, 95% CI)	‐10.70 [‐12.31, ‐9.09]
16.10.4 Secondary: anger (continuous), at end of treatment	1		Mean Difference (IV, Fixed, 95% CI)	‐1.42 [‐1.72, ‐1.12]
16.10.5 Secondary: affective instability (continuous), at end of treatment	1		Mean Difference (IV, Fixed, 95% CI)	‐4.01 [‐5.44, ‐2.58]
16.10.6 Secondary: chronic feelings of emptiness (continuous), at end of treatment	1		Mean Difference (IV, Fixed, 95% CI)	‐3.54 [‐4.81, ‐2.27]
16.10.7 Secondary: impulsivity (continuous), at end of treatment	1		Mean Difference (IV, Fixed, 95% CI)	‐0.51 [‐0.72, ‐0.30]
16.10.8 Secondary: interpersonal problems (continuous), at end of treatment	1		Mean Difference (IV, Fixed, 95% CI)	‐1.98 [‐2.47, ‐1.49]
16.10.9 Secondary: abandonment (continuous), at end of treatment	1		Mean Difference (IV, Fixed, 95% CI)	‐0.86 [‐1.09, ‐0.63]
16.10.10 Secondary: identity disturbance (continuous), at end of treatment	1		Mean Difference (IV, Fixed, 95% CI)	‐2.44 [‐2.77, ‐2.11]
16.10.11 Secondary: dissociation or psychotic‐like symptoms (continuous), at end of treatment	1		Mean Difference (IV, Fixed, 95% CI)	‐1.92 [‐2.46, ‐1.38]
16.10.12 Secondary: depression (continuous), at end of treatment	1		Mean Difference (IV, Fixed, 95% CI)	‐10.43 [‐11.86, ‐9.00]

Comparison 16. Dialectical behavior therapy (DBT) vs waiting list or no treatment

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Comparison 17. Schema‐focused therapy (SFT) vs no treatment

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
17.1 Primary: suicide‐related outcomes (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

17.2 Secondary: depression (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

Comparison 17. Schema‐focused therapy (SFT) vs no treatment

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Comparison 18. Interpersonal psychotherapy (IPT) vs waiting list

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
18.1 Primary: BPD symptom severity (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

18.2 Primary: self‐harm (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

18.3 Primary: psychosocial functioning (continuous) Show forest plot	2		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

18.3.1 End of treatment	2	76	Std. Mean Difference (IV, Random, 95% CI)	‐0.03 [‐0.48, 0.42]
18.3.2 0‐6 months follow‐up	1	30	Std. Mean Difference (IV, Random, 95% CI)	‐0.89 [‐1.65, ‐0.13]
18.3.3 6‐12 months follow‐up	1	30	Std. Mean Difference (IV, Random, 95% CI)	‐1.04 [‐1.81, ‐0.27]
18.3.4 Above 12 months follow‐up	1	28	Std. Mean Difference (IV, Random, 95% CI)	‐0.38 [‐1.14, 0.37]
18.4 Secondary: anger (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

18.5 Secondary: affective instability (continuous) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

18.5.1 End of treatment	1	44	Mean Difference (IV, Fixed, 95% CI)	‐1.02 [‐1.66, ‐0.38]
18.5.2 0‐6 months follow‐up	1	30	Mean Difference (IV, Fixed, 95% CI)	‐0.46 [‐1.15, 0.23]
18.5.3 6‐12 months follow‐up	1	30	Mean Difference (IV, Fixed, 95% CI)	‐0.39 [‐1.12, 0.34]
18.5.4 Above 12 months follow‐up	1	30	Mean Difference (IV, Fixed, 95% CI)	‐0.34 [‐1.17, 0.49]
18.6 Secondary: chronic feelings of emptiness (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

18.7 Secondary: impulsivity (continuous) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

18.7.1 End of treatment	1	44	Mean Difference (IV, Fixed, 95% CI)	‐1.03 [‐1.69, ‐0.37]
18.7.2 0‐6 months follow‐up	1	30	Mean Difference (IV, Fixed, 95% CI)	‐1.10 [‐1.95, ‐0.25]
18.7.3 6‐12 months follow‐up	1	30	Mean Difference (IV, Fixed, 95% CI)	‐1.10 [‐2.06, ‐0.14]
18.7.4 Above 12 months follow‐up	1	30	Mean Difference (IV, Fixed, 95% CI)	‐1.09 [‐2.09, ‐0.09]
18.8 Secondary: interpersonal problems (continuous) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

18.8.1 End of treatment	1	44	Mean Difference (IV, Fixed, 95% CI)	‐1.14 [‐1.94, ‐0.34]
18.8.2 0‐6 months follow‐up	1	30	Mean Difference (IV, Fixed, 95% CI)	‐2.00 [‐2.98, ‐1.02]
18.8.3 6‐12 months follow‐up	1	30	Mean Difference (IV, Fixed, 95% CI)	‐1.56 [‐2.74, ‐0.38]
18.8.4 Above 12 months follow‐up	1	30	Mean Difference (IV, Fixed, 95% CI)	‐1.48 [‐2.63, ‐0.33]
18.9 Secondary: abandonment (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

18.10 Secondary: identity disturbance (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

18.11 Secondary: dissociation and psychotic‐like symptoms (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

18.12 Secondary outcome: depression (continuous), at end of treatment Show forest plot	3	98	Std. Mean Difference (IV, Random, 95% CI)	‐0.52 [‐1.11, 0.06]

18.13 Secondary outcome: attrition (dichotomous), at end of treatment Show forest plot	2	94	Risk Ratio (M‐H, Random, 95% CI)	0.55 [0.20, 1.50]

Comparison 18. Interpersonal psychotherapy (IPT) vs waiting list

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Comparison 19. Once‐only interventions (individual setting) vs waiting list

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
19.1 Secondary: impulsivity (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

19.2 Secondary: interpersonal problems (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

19.3 Secondary: attrition (dichotomous), at end of treatment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

Comparison 19. Once‐only interventions (individual setting) vs waiting list

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Comparison 20. Eclectic treatments vs waiting list

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
20.1 Primary outcome: psychosocial functioning (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

20.2 Secondary outcome: interpersonal problems (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

Comparison 20. Eclectic treatments vs waiting list

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Comparison 21. Dialectical behavior therapy (DBT) and related treatments vs active treatment

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
21.1 Standard DBT (DBT) vs client‐centred therapy (CCT) (continuous) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

21.1.1 Primary: self‐harm (continuous), at end of treatment	1	24	Mean Difference (IV, Fixed, 95% CI)	‐2.75 [‐4.42, ‐1.08]
21.1.2 Primary: suicide‐related outcomes (continuous), at end of treatment	1	24	Mean Difference (IV, Fixed, 95% CI)	‐7.75 [‐14.66, ‐0.84]
21.1.3 Secondary: anger (continuous), at end of treatment	1	24	Mean Difference (IV, Fixed, 95% CI)	‐1.00 [‐1.98, ‐0.02]
21.1.4 Secondary: impulsivity (continuous), at end of treatment	1	24	Mean Difference (IV, Fixed, 95% CI)	‐1.50 [‐2.60, ‐0.40]
21.1.5 Secondary: dissociation and psychotic‐like symptoms (continuous), at end of treatment	1	24	Mean Difference (IV, Fixed, 95% CI)	‐7.16 [‐12.15, ‐2.17]
21.1.6 Secondary: depression (continuous), at end of treatment	1	24	Mean Difference (IV, Fixed, 95% CI)	‐9.16 [‐14.79, ‐3.53]
21.2 DBT vs CCT, secondary: attrition (dichotomous), at end of treatment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

21.3 Standard DBT (DBT) vs good psychiatric management (GPM) (continuous) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

21.3.1 Primary: BPD severity (continuous), at end of treatment	1	180	Mean Difference (IV, Fixed, 95% CI)	‐0.23 [‐1.97, 1.51]
21.3.2 Primary: self‐harm (continuous), at end of treatment	1	180	Mean Difference (IV, Fixed, 95% CI)	‐8.58 [‐19.38, 2.22]
21.3.3 Secondary: anger (continuous), at end of treatment	1	180	Mean Difference (IV, Fixed, 95% CI)	‐0.15 [‐1.65, 1.35]
21.3.4 Secondary: interpersonal problems (continuous), at end of treatment	1	180	Mean Difference (IV, Fixed, 95% CI)	‐1.34 [‐15.36, 12.68]
21.3.5 Secondary: depression (continuous), at end of treatment	1	180	Mean Difference (IV, Fixed, 95% CI)	‐2.65 [‐7.18, 1.88]
21.4 DBT vs GPM, secondary: attrition (dichotomous), at end of treatment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

21.5 Standard DBT (DBT) vs individual DBT therapy + activities group (DBT‐I) (continuous) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

21.5.1 Primary: self‐harm (continuous), at end of treatment	1	66	Mean Difference (IV, Fixed, 95% CI)	‐10.40 [‐22.99, 2.19]
21.5.2 Primary: self‐harm (continuous), at 6‐12 months follow‐up	1	66	Mean Difference (IV, Fixed, 95% CI)	‐8.10 [‐19.59, 3.39]
21.5.3 Primary: suicide‐related outcomes (continuous), at end of treatment	1	66	Mean Difference (IV, Fixed, 95% CI)	0.50 [‐1.37, 2.37]
21.5.4 Primary: suicide‐related outcomes (continuous), at 6‐12 months follow‐up	1	66	Mean Difference (IV, Fixed, 95% CI)	‐1.60 [‐2.79, ‐0.41]
21.5.5 Secondary: depression (continuous), at end of treatment	1	66	Mean Difference (IV, Fixed, 95% CI)	‐5.90 [‐9.74, ‐2.06]
21.5.6 Secondary: depression (continuous), at 6‐12 months follow‐up	1	66	Mean Difference (IV, Fixed, 95% CI)	1.30 [‐3.10, 5.70]
21.6 DBT vs DBT‐I, secondary: attrition (dichotomous), at end of treatment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

21.7 Standard DBT (DBT) vs skills training group + individual case management (DBT‐S) (continuous) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

21.7.1 Primary: self‐harm (continuous), at end of treatment	1	66	Mean Difference (IV, Fixed, 95% CI)	0.30 [‐8.42, 9.02]
21.7.2 Primary: self‐harm (continuous), at 6‐12 months follow‐up	1	66	Mean Difference (IV, Fixed, 95% CI)	‐1.50 [‐9.04, 6.04]
21.7.3 Primary: suicide‐related outcomes (continuous), at end of treatment	1	66	Mean Difference (IV, Fixed, 95% CI)	0.80 [‐1.06, 2.66]
21.7.4 Primary: suicide‐related outcomes (continuous), at 6‐12 months follow‐up	1	66	Mean Difference (IV, Fixed, 95% CI)	0.50 [‐0.02, 1.02]
21.7.5 Secondary: depression (continuous), at end of treatment	1	66	Mean Difference (IV, Fixed, 95% CI)	1.90 [‐1.60, 5.40]
21.7.6 Secondary: depression (continuous), at 6‐12 months follow‐up	1	66	Mean Difference (IV, Fixed, 95% CI)	3.30 [‐0.90, 7.50]
21.8 DBT vs DBT‐S, secondary: attrition (dichotomous), at 6‐12 months follow‐up Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

21.9 Standard DBT (DBT) vs step‐down DBT (DBT‐SD) (continuous) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

21.9.1 Primary: BPD symptom severity (continuous), at end of treatment	1	38	Mean Difference (IV, Fixed, 95% CI)	‐2.83 [‐11.21, 5.55]
21.9.2 Primary: self‐harm (continuous), at end of treatment	1	38	Mean Difference (IV, Fixed, 95% CI)	4.10 [‐4.07, 12.27]
21.9.3 Primary: suicide‐related outcomes (continuous), at end of treatment	1	38	Mean Difference (IV, Fixed, 95% CI)	0.30 [‐0.73, 1.33]
21.9.4 Secondary: anger (continuous), at end of treatment	1	41	Mean Difference (IV, Fixed, 95% CI)	‐0.53 [‐1.48, 0.43]
21.9.5 Secondary: affective instability (continuous), at end of treatment	1	41	Mean Difference (IV, Fixed, 95% CI)	‐0.71 [‐2.51, 1.09]
21.9.6 Secondary: chronic feeling of emptiness (continuous), at end of treatment	1	41	Mean Difference (IV, Fixed, 95% CI)	0.18 [‐1.68, 2.04]
21.9.7 Secondary: impulsivity (continuous), at end of treatment	1	41	Mean Difference (IV, Fixed, 95% CI)	0.24 [‐0.26, 0.75]
21.9.8 Secondary: interpersonal problems (continuous), at end of treatment	1	41	Mean Difference (IV, Fixed, 95% CI)	‐1.31 [‐2.05, ‐0.57]
21.9.9 Secondary: abandonment (continuous), at end of treatment	1	41	Mean Difference (IV, Fixed, 95% CI)	‐1.11 [‐2.14, ‐0.08]
21.9.10 Secondary: dissociation and psychotic‐like symptoms (continuous), at end of treatment	1	41	Mean Difference (IV, Fixed, 95% CI)	‐0.44 [‐1.56, 0.68]
21.10 DBT vs DBT‐SD, secondary: attrition (dichotomous), at end of treatment Show forest plot	1	84	Risk Ratio (M‐H, Fixed, 95% CI)	0.37 [0.17, 0.78]

21.11 Standard DBT (DBT) vs DBT Prolonged Exposure (PE) (continuous) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

21.11.1 Primary: self‐harm (continuous), end of treatment	1	18	Mean Difference (IV, Fixed, 95% CI)	0.10 [‐1.86, 2.06]
21.11.2 Primary: self‐harm (continuous), at 0‐6 months follow‐up	1	18	Mean Difference (IV, Fixed, 95% CI)	‐0.30 [‐1.09, 0.49]
21.11.3 Primary: suicide‐related outcomes (continuous), end of treatment	1	18	Mean Difference (IV, Fixed, 95% CI)	Not estimable
21.11.4 Primary: suicide‐related outcomes (continuous), at 0‐6 months follow‐up	1	18	Mean Difference (IV, Fixed, 95% CI)	Not estimable
21.11.5 Primary: psychosocial functioning (continuous), end of treatment	1	18	Mean Difference (IV, Fixed, 95% CI)	5.27 [‐2.06, 12.60]
21.11.6 Primary: psychosocial functioning (continuous), at 0‐6 months follow‐up	1	18	Mean Difference (IV, Fixed, 95% CI)	2.00 [‐6.27, 10.27]
21.11.7 Secondary: interpersonal problems (continuous), end of treatment	1	18	Mean Difference (IV, Fixed, 95% CI)	0.14 [‐0.42, 0.70]
21.11.8 Secondary: interpersonal problems (continuous), at 0‐6 months follow‐up	1	18	Mean Difference (IV, Fixed, 95% CI)	0.19 [‐0.48, 0.86]
21.11.9 Secondary: dissociation or psychotic‐like symptoms (continuous), end of treatment	1	18	Mean Difference (IV, Fixed, 95% CI)	4.60 [‐9.24, 18.44]
21.11.10 Secondary: dissociation or psychotic‐like symptoms (continuous), at 0‐6 months follow‐up	1	18	Mean Difference (IV, Fixed, 95% CI)	6.00 [‐9.46, 21.46]
21.11.11 Secondary: depression (continuous), end of treatment	1	18	Mean Difference (IV, Fixed, 95% CI)	3.70 [‐3.19, 10.59]
21.11.12 Secondary: depression (continuous), at 0‐6 months follow‐up	1	18	Mean Difference (IV, Fixed, 95% CI)	4.30 [‐1.08, 9.68]
21.12 DBT vs DBT‐PE, secondary: attrition (dichotomous), at 0‐6 months follow‐up Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

21.13 DBT skills group + case management (DBT‐S) vs DBT individual therapy + activity group (DBT‐I) (continuous) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

21.13.1 Primary: self‐harm (continuous), at end of treatment	1	66	Mean Difference (IV, Fixed, 95% CI)	‐10.70 [‐22.47, 1.07]
21.13.2 Primary: self‐harming behaviour (continuous), at 6‐12 months follow‐up	1	66	Mean Difference (IV, Fixed, 95% CI)	‐6.60 [‐19.72, 6.52]
21.13.3 Primary: suicide‐related outcomes (continuous), at end of treatment	1	66	Mean Difference (IV, Fixed, 95% CI)	‐0.30 [‐1.72, 1.12]
21.13.4 Primary: suicide‐related outcomes (continuous), at 6‐12 months follow‐up	1	66	Mean Difference (IV, Fixed, 95% CI)	‐2.10 [‐3.21, ‐0.99]
21.13.5 Secondary: depression (continuous), at end of treatment	1	66	Mean Difference (IV, Fixed, 95% CI)	‐7.80 [‐11.27, ‐4.33]
21.13.6 Secondary: depression (continuous), at 6‐12 months follow‐up	1	66	Mean Difference (IV, Fixed, 95% CI)	‐2.00 [‐6.44, 2.44]
21.14 DBT‐S vs DBT‐I, secondary: attrition (dichotomous), at 6‐12 months follow‐up Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

21.15 DBT skills group (DBT‐S) vs cognitive therapy group (CT‐G) (continuous) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

21.15.1 Primary: BPD symptom severity (continuous), at end of treatment	1	82	Mean Difference (IV, Fixed, 95% CI)	0.26 [‐0.13, 0.65]
21.15.2 Primary: BPD symptom severity (continuous), at 0‐6 months follow‐up	1	82	Mean Difference (IV, Fixed, 95% CI)	‐0.96 [‐1.15, ‐0.77]
21.15.3 Primary: suicide‐related outcomes (continuous), at end of treatment	1	82	Mean Difference (IV, Fixed, 95% CI)	0.46 [‐2.47, 3.39]
21.15.4 Primary: suicide‐related outcomes (continuous), at 0‐6 months follow‐up	1	82	Mean Difference (IV, Fixed, 95% CI)	‐2.69 [‐4.89, ‐0.49]
21.15.5 Secondary: depression (continuous), at end of treatment	1	82	Mean Difference (IV, Fixed, 95% CI)	‐2.12 [‐5.25, 1.01]
21.15.6 Secondary: depression (continuous), at 0‐6 months follow‐up	1	82	Mean Difference (IV, Fixed, 95% CI)	‐1.60 [‐5.07, 1.87]
21.16 DBT‐S vs CT‐G, secondary: attrition (dichotomous), at end of treatment Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

21.17 DBT skills group (DBT‐S) vs schema‐focused therapy group (SFT‐G) Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Subtotals only

21.17.1 Primary: suicide‐related outcomes (continuous), at end of treatment	1	24	Mean Difference (IV, Random, 95% CI)	0.92 [‐0.36, 2.20]
21.17.2 Secondary: depression (continuous), at end of treatment	1	24	Mean Difference (IV, Random, 95% CI)	4.33 [2.57, 6.09]
21.18 DBT mindfulness group (DBT‐M) vs DBT interpersonal effectiveness group (DBT‐IE) (continuous) Show forest plot	2		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

21.18.1 Primary: BPD symptom severity (continuous), at end of treatment	2	113	Std. Mean Difference (IV, Random, 95% CI)	‐0.45 [‐1.47, 0.58]
21.18.2 Secondary: impulsivity (continuous), at end of treatment	2	91	Std. Mean Difference (IV, Random, 95% CI)	‐0.36 [‐0.77, 0.06]
21.19 DBT‐M vs DBT‐IE, secondary: attrition (dichotomous), at end of treatment Show forest plot	2	134	Risk Ratio (M‐H, Random, 95% CI)	1.86 [1.07, 3.23]

21.20 DBT mindfulness group (DBT‐M) vs loving‐kindness and compassion meditation (LK/CM), primary: BPD symptom severity (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

Comparison 21. Dialectical behavior therapy (DBT) and related treatments vs active treatment

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Comparison 22. Cognitive behavioural therapy (CBT) and related treatments vs active treatment

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
22.1 CBT vs trauma‐ and anxiety‐related group psychoeducation (continuous) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

22.1.1 Primary: BPD symptom severity (continuous), at end of treatment	1	50	Mean Difference (IV, Fixed, 95% CI)	‐0.26 [‐1.46, 0.94]
22.1.2 Primary: BPD symptom severity (continuous), at 0‐6 months follow‐up	1	50	Mean Difference (IV, Fixed, 95% CI)	‐0.39 [‐1.60, 0.82]
22.1.3 Primary: BPD symptom severity (continuous), at 6‐12 months follow‐up	1	50	Mean Difference (IV, Fixed, 95% CI)	0.57 [‐0.48, 1.62]
22.1.4 Primary: psychosocial functioning (continuous), at end of treatment	1	50	Mean Difference (IV, Fixed, 95% CI)	‐0.64 [‐5.76, 4.48]
22.1.5 Primary: psychosocial functioning (continuous), at 0‐6 months follow‐up	1	50	Mean Difference (IV, Fixed, 95% CI)	‐1.23 [‐6.94, 4.48]
22.1.6 Primary: psychosocial functioning (continuous), at 6‐12 months follow‐up	1	50	Mean Difference (IV, Fixed, 95% CI)	0.61 [‐5.00, 6.22]
22.1.7 Secondary: depression (continuous), at end of treatment	1	50	Mean Difference (IV, Fixed, 95% CI)	0.76 [‐8.20, 9.72]
22.1.8 Secondary: depression (continuous), at 0‐6 months follow‐up	1	50	Mean Difference (IV, Fixed, 95% CI)	3.13 [‐4.05, 10.31]
22.1.9 Secondary: depression (continuous), at 6‐12 months follow‐up	1	50	Mean Difference (IV, Fixed, 95% CI)	0.77 [‐7.08, 8.62]
22.2 CBT vs trauma‐ and anxiety‐related group psychoeducation, secondary: attrition (dichotomous), at end of treatment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

22.3 CBT vs interpersonal psychotherapy (IPT) (continuous) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

22.3.1 Primary: psychosocial functioning (continuous), at end of treatment	1	26	Mean Difference (IV, Fixed, 95% CI)	‐5.30 [‐12.36, 1.76]
22.3.2 Secondary: depression (continuous), at end of treatment	1	26	Mean Difference (IV, Fixed, 95% CI)	‐0.40 [‐4.72, 3.92]
22.4 CBT vs IPT, secondary: attrition (dichotomous), at end of treatment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

22.5 CBT vs Rogerian supportive therapy (continuous) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

22.5.1 Primary: self‐harm (continuous), end of treatment	1	38	Mean Difference (IV, Fixed, 95% CI)	0.74 [‐0.03, 1.51]
22.5.2 Primary: self‐harm (continuous), at 6‐12 months follow‐up	1	21	Mean Difference (IV, Fixed, 95% CI)	‐0.63 [‐1.75, 0.49]
22.5.3 Primary: suicide‐related outcomes (continuous), at end of treatment	1	38	Mean Difference (IV, Fixed, 95% CI)	0.69 [‐2.60, 3.98]
22.5.4 Primary: suicide‐related outcomes (continuous), at 6‐12 months follow‐up	1	21	Mean Difference (IV, Fixed, 95% CI)	‐2.43 [‐6.14, 1.28]
22.5.5 Primary: psychosocial functioning (continuous), at end of treatment	1	38	Mean Difference (IV, Fixed, 95% CI)	‐0.43 [‐1.31, 0.45]
22.5.6 Primary: psychosocial functioning (continuous), at 6‐12 months follow‐up	1	21	Mean Difference (IV, Fixed, 95% CI)	‐0.98 [‐2.02, 0.06]
22.5.7 Secondary: impulsivity (continuous), at end of treatment	1	38	Mean Difference (IV, Fixed, 95% CI)	‐1.01 [‐3.85, 1.83]
22.5.8 Secondary: impulsivity (continuous), at 6‐12 months follow‐up	1	21	Mean Difference (IV, Fixed, 95% CI)	‐2.18 [‐5.91, 1.55]
22.5.9 Secondary: depression (continuous), at end of treatment	1	38	Mean Difference (IV, Fixed, 95% CI)	1.04 [‐5.59, 7.67]
22.5.10 Secondary: depression (continuous), at 6‐12 months follow‐up	1	21	Mean Difference (IV, Fixed, 95% CI)	‐5.15 [‐9.38, ‐0.92]
22.6 CBT vs Rogerian supportive therapy, secondary: attrition (dichotomous), end of treatment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

22.7 MACT (Manual‐assisted Cognitive Therapy) vs MACT + therapeutic assessment (MACT + TA) (continuous) Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Subtotals only

22.7.1 Primary: BPD symptom severity (continuous), at end of treatment	1	16	Mean Difference (IV, Random, 95% CI)	‐3.75 [‐14.17, 6.67]
22.7.2 Primary: self‐harm (continuous), at end of treatment	1	16	Mean Difference (IV, Random, 95% CI)	1.75 [‐18.71, 22.21]
22.7.3 Primary: suicide‐related outcomes (continuous), at end of treatment	1	16	Mean Difference (IV, Random, 95% CI)	‐0.63 [‐17.71, 16.45]
22.7.4 Secondary: affective instability (continuous), at end of treatment	1	16	Mean Difference (IV, Random, 95% CI)	‐5.25 [‐12.10, 1.60]
22.7.5 Secondary: interpersonal problems (continuous), at end of treatment	1	16	Mean Difference (IV, Random, 95% CI)	‐0.50 [‐11.24, 10.24]
22.7.6 Secondary: identity disturbance (continuous), at end of treatment	1	16	Mean Difference (IV, Random, 95% CI)	‐4.88 [‐14.98, 5.22]
22.8 MACT vs MACT + TA, secondary: attrition (dichotomous), at end of treatment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

22.9 Meta‐Cognitive training for BPD (B‐MCT) vs progressive muscle relaxation training (PMR) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

22.9.1 Primary: BPD symptom severity (continuous), at end of treatment	1	49	Mean Difference (IV, Fixed, 95% CI)	‐1.80 [‐4.97, 1.37]
22.9.2 Primary: BPD symptom severity (continuous), at 0‐6 months follow up	1	39	Mean Difference (IV, Fixed, 95% CI)	‐3.60 [‐7.16, ‐0.04]
22.9.3 Secondary: depression (continuous), at end of treatment	1	54	Mean Difference (IV, Fixed, 95% CI)	‐3.20 [‐9.91, 3.51]
22.9.4 Secondary: depression (continuous), at 0‐6 months follow‐up	1	47	Mean Difference (IV, Fixed, 95% CI)	8.50 [2.03, 14.97]
22.10 B‐MCT vs progressive muscle relaxation (PMR) training + TAU (dichotomous). Secondary: attrition (dichotomous), at end of treatment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

22.11 MOTR (Motive‐Oriented Therapeutic Relationship) vs Good Psychiatric Management (GPM) (continuous) Show forest plot	2		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

22.11.1 Primary: BPD symptom severity (continuous), at end of treatment	1	74	Std. Mean Difference (IV, Random, 95% CI)	0.07 [‐0.39, 0.53]
22.11.2 Primary: psychosocial functioning (continuous), at end of treatment	2	99	Std. Mean Difference (IV, Random, 95% CI)	‐0.45 [‐0.85, ‐0.05]
22.11.3 Secondary: interpersonal problems (continuous), at end of treatment	2	99	Std. Mean Difference (IV, Random, 95% CI)	‐0.56 [‐0.97, ‐0.16]
22.12 MOTR vs (GPM), secondary: attrition (dichotomous), at end of treatment Show forest plot	2	110	Risk Ratio (M‐H, Random, 95% CI)	0.61 [0.26, 1.41]

Comparison 22. Cognitive behavioural therapy (CBT) and related treatments vs active treatment

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Comparison 23. Schema‐focused therapy (SFT) vs active treatment

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
23.1 SFT vs TFP. Primary: BPD symptom severity (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

23.2 SFT vs TFP. Secondary: attrition (dichotomous), at 0‐6 months follow‐up Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

23.3 SFT vs SFT + therapist availability (TA). Primary: BPD symptom severity (continuous), at end of treatment Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

23.4 SFT vs SFT + TA. Secondary: attrition (dichotomous), 0‐6 months follow‐up Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

Comparison 23. Schema‐focused therapy (SFT) vs active treatment

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Comparison 24. Systems training for emotional predictability and problem solving‐based psychoeducation (STEPPS‐PE) vs cognitive rehabilitation (CR)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
24.1 STEPPS‐PE vs CR Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

24.1.1 Primary: BPD symptom severity (continuous), at end of treatment	1	46	Mean Difference (IV, Fixed, 95% CI)	‐3.67 [‐6.52, ‐0.82]
24.1.2 Primary: BPD symptom severity (continuous), at 0‐6 months follow‐up	1	42	Mean Difference (IV, Fixed, 95% CI)	4.68 [1.42, 7.94]
24.1.3 Secondary: impulsivity (continuous), at end of treatment	1	46	Mean Difference (IV, Fixed, 95% CI)	1.99 [0.06, 3.92]
24.1.4 Secondary: impulsivity (continuous), at 0‐6 months follow‐up	1	42	Mean Difference (IV, Fixed, 95% CI)	9.92 [7.38, 12.46]
24.1.5 Secondary: depression (continuous), at end of treatment	1	48	Mean Difference (IV, Fixed, 95% CI)	‐2.58 [‐3.62, ‐1.54]
24.1.6 Secondary: depression (continuous), at 0‐6 months follow‐up	1	42	Mean Difference (IV, Fixed, 95% CI)	‐10.11 [‐11.35, ‐8.87]
24.2 STEPPS‐PE vs CR. Secondary: attrition (dichotomous), at end of treatment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

Comparison 24. Systems training for emotional predictability and problem solving‐based psychoeducation (STEPPS‐PE) vs cognitive rehabilitation (CR)

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Comparison 25. Eclectic treatments vs active treatment

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
25.1 Combined inpatient and outpatient psychotherapy versus outpatient psychotherapy Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

25.1.1 Primary: psychosocial functioning (continuous), at end of treatment	1	52	Mean Difference (IV, Fixed, 95% CI)	6.50 [‐0.06, 13.06]
25.1.2 Primary: psychosocial functioning (continuous), at above 12 months follow‐up	1	52	Mean Difference (IV, Fixed, 95% CI)	‐5.70 [‐13.33, 1.93]
25.1.3 Secondary: interpersonal problems (continuous), at end of treatment	1	52	Mean Difference (IV, Fixed, 95% CI)	0.05 [‐0.24, 0.34]
25.1.4 Secondary: interpersonal problems (continuous), at above 12 months follow‐up	1	52	Mean Difference (IV, Fixed, 95% CI)	‐0.42 [‐0.77, ‐0.07]
25.1.5 Secondary: identity disturbance (continuous), at end of treatment	1	52	Mean Difference (IV, Fixed, 95% CI)	‐0.25 [‐0.59, 0.09]
25.1.6 Secondary: identity disturbance (continuous), at above 12 months follow‐up	1	52	Mean Difference (IV, Fixed, 95% CI)	‐0.47 [‐0.78, ‐0.16]
25.1.7 Secondary: depression (continuous), at end of treatment	1	52	Mean Difference (IV, Fixed, 95% CI)	‐0.40 [‐6.25, 5.45]
25.1.8 Secondary: depression (continuous), at above 12 months follow‐up	1	52	Mean Difference (IV, Fixed, 95% CI)	‐4.70 [‐11.02, 1.62]
25.2 Combined inpatient and outpatient psychotherapy versus outpatient psychotherapy. Secondary: attrition (dichotomous), at end of treatment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

25.3 integrative BPD‐oriented adolescent family therapy (I‐BAFT) vs individual drug counselling (IDC) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

25.3.1 Primary: BPD symptom severity (dichotomous), at end of treatment	1	40	Risk Ratio (M‐H, Fixed, 95% CI)	0.91 [0.50, 1.64]
25.3.2 Secondary: attrition (dichotomous), at 6‐12 months follow‐up	1	40	Risk Ratio (M‐H, Fixed, 95% CI)	0.50 [0.18, 1.40]

Comparison 25. Eclectic treatments vs active treatment

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Comparison 26. Subgroup analysis: therapeutic approaches

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
26.1 BPD symptom severity Show forest plot	23		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

26.1.1 DBT	3	149	Std. Mean Difference (IV, Random, 95% CI)	‐0.60 [‐1.05, ‐0.14]
26.1.2 MBT	5	267	Std. Mean Difference (IV, Random, 95% CI)	‐0.13 [‐0.38, 0.11]
26.1.3 Psychodynamic psychotherapy	4	222	Std. Mean Difference (IV, Random, 95% CI)	‐0.29 [‐0.66, 0.09]
26.1.4 STEPPS	3	273	Std. Mean Difference (IV, Random, 95% CI)	‐0.39 [‐0.63, ‐0.15]
26.1.5 Eclectic treatments	3	134	Std. Mean Difference (IV, Random, 95% CI)	‐0.90 [‐1.57, ‐0.23]
26.1.6 ACT	1	41	Std. Mean Difference (IV, Random, 95% CI)	‐1.22 [‐1.89, ‐0.55]
26.1.7 CBT	1	26	Std. Mean Difference (IV, Random, 95% CI)	‐1.28 [‐2.14, ‐0.42]
26.1.8 SFT	1	28	Std. Mean Difference (IV, Random, 95% CI)	‐1.66 [‐2.54, ‐0.78]
26.1.9 CAT	1	9	Std. Mean Difference (IV, Random, 95% CI)	‐0.53 [‐1.88, 0.83]
26.1.10 Tranference‐focused psychotherapy	1	104	Std. Mean Difference (IV, Random, 95% CI)	‐0.55 [‐0.95, ‐0.16]
26.2 Psychosocial functioning Show forest plot	22		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

26.2.1 DBT	6	225	Std. Mean Difference (IV, Random, 95% CI)	‐0.36 [‐0.69, ‐0.03]
26.2.2 MBT	3	239	Std. Mean Difference (IV, Random, 95% CI)	‐0.54 [‐1.24, 0.16]
26.2.3 Psychodynamic psychotherapy	4	140	Std. Mean Difference (IV, Random, 95% CI)	‐0.69 [‐1.98, 0.59]
26.2.4 Eclectic treatments	2	231	Std. Mean Difference (IV, Random, 95% CI)	‐0.57 [‐1.10, ‐0.04]
26.2.5 CBT	1	99	Std. Mean Difference (IV, Random, 95% CI)	0.00 [‐0.39, 0.39]
26.2.6 SFT	1	28	Std. Mean Difference (IV, Random, 95% CI)	‐1.20 [‐2.03, ‐0.38]
26.2.7 STEPPS	1	124	Std. Mean Difference (IV, Random, 95% CI)	‐0.55 [‐0.91, ‐0.19]
26.2.8 CAT	1	9	Std. Mean Difference (IV, Random, 95% CI)	‐1.22 [‐2.73, 0.30]
26.2.9 Motivation feedback	1	43	Std. Mean Difference (IV, Random, 95% CI)	‐0.07 [‐0.69, 0.55]
26.2.10 Tranference‐focused psychotherapy	1	104	Std. Mean Difference (IV, Random, 95% CI)	‐0.34 [‐0.73, 0.05]
26.2.11 Once‐only intervention	1	72	Std. Mean Difference (IV, Random, 95% CI)	0.03 [‐0.43, 0.49]

Comparison 26. Subgroup analysis: therapeutic approaches

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Comparison 27. Subgroup analysis: age

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
27.1 BPD symptom severity Show forest plot	22		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

27.1.1 15 to 18 years old	2	156	Std. Mean Difference (IV, Random, 95% CI)	‐0.14 [‐0.46, 0.17]
27.1.2 Above 18 years old	20	1088	Std. Mean Difference (IV, Random, 95% CI)	‐0.57 [‐0.76, ‐0.37]

Comparison 27. Subgroup analysis: age

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Comparison 28. Subgroup analysis: duration

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
28.1 BPD symptom severity Show forest plot	22		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

28.1.1 Less than 6 months	8	525	Std. Mean Difference (IV, Random, 95% CI)	‐0.76 [‐1.10, ‐0.42]
28.1.2 6 to 12 months	11	606	Std. Mean Difference (IV, Random, 95% CI)	‐0.36 [‐0.60, ‐0.12]
28.1.3 Above 12 months	3	113	Std. Mean Difference (IV, Random, 95% CI)	‐0.37 [‐0.75, 0.01]
28.2 Psychosocial functioning Show forest plot	20		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

28.2.1 Less than 6 months	6	468	Std. Mean Difference (IV, Random, 95% CI)	‐0.31 [‐0.73, 0.11]
28.2.2 6 to 12 months	10	535	Std. Mean Difference (IV, Random, 95% CI)	‐0.25 [‐0.49, ‐0.01]
28.2.3 Over 12 months	4	263	Std. Mean Difference (IV, Random, 95% CI)	‐0.86 [‐1.62, ‐0.10]

Comparison 28. Subgroup analysis: duration

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Comparison 29. Subgroup analysis: mode of therapy

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
29.1 BPD symptom severity Show forest plot	22		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

29.1.1 Individual therapy	8	520	Std. Mean Difference (IV, Random, 95% CI)	‐0.39 [‐0.63, ‐0.16]
29.1.2 Group therapy	8	438	Std. Mean Difference (IV, Random, 95% CI)	‐0.89 [‐1.21, ‐0.57]
29.1.3 Mixed therapy	6	286	Std. Mean Difference (IV, Random, 95% CI)	‐0.15 [‐0.38, 0.09]
29.2 Psychosocial functioning Show forest plot	22		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

29.2.1 Individual therapy	8	570	Std. Mean Difference (IV, Random, 95% CI)	‐0.31 [‐0.75, 0.12]
29.2.2 Group therapy	7	366	Std. Mean Difference (IV, Random, 95% CI)	‐0.44 [‐0.65, ‐0.23]
29.2.3 Mixed therapy	7	378	Std. Mean Difference (IV, Random, 95% CI)	‐0.63 [‐1.14, ‐0.13]

Comparison 29. Subgroup analysis: mode of therapy

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Comparison 30. Subgroup analysis: setting

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
30.1 BPD symptom severity Show forest plot	22		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

30.1.1 Inpatient	2	217	Std. Mean Difference (IV, Random, 95% CI)	‐0.07 [‐0.34, 0.20]
30.1.2 Outpatient	20	1027	Std. Mean Difference (IV, Random, 95% CI)	‐0.58 [‐0.77, ‐0.39]
30.2 Psychosocial functioning Show forest plot	22		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

30.2.1 Inpatient	2	179	Std. Mean Difference (IV, Random, 95% CI)	‐0.85 [‐1.24, ‐0.46]
30.2.2 Outpatient	18	1057	Std. Mean Difference (IV, Random, 95% CI)	‐0.31 [‐0.54, ‐0.08]
30.2.3 Inpatient and outpatient	2	78	Std. Mean Difference (IV, Random, 95% CI)	‐1.34 [‐1.84, ‐0.84]

Comparison 30. Subgroup analysis: setting

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Comparison 31. Subgroup analysis: types of raters

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
31.1 BPD symptom severity Show forest plot	22		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

31.1.1 Self‐rated	8	408	Std. Mean Difference (IV, Random, 95% CI)	‐0.74 [‐1.19, ‐0.29]
31.1.2 Clinician‐rated	14	836	Std. Mean Difference (IV, Random, 95% CI)	‐0.42 [‐0.58, ‐0.25]
31.2 Psychosocial functioning Show forest plot	22		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

31.2.1 Self‐rated	12	728	Std. Mean Difference (IV, Random, 95% CI)	‐0.29 [‐0.60, 0.03]
31.2.2 Clinician‐rated	10	586	Std. Mean Difference (IV, Random, 95% CI)	‐0.66 [‐0.96, ‐0.37]

Comparison 31. Subgroup analysis: types of raters

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Comparison 32. Subgroup analysis: types of TAU

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
32.1 BPD symptom severity Show forest plot	22		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

32.1.1 Obligatory TAU	19	1071	Std. Mean Difference (IV, Random, 95% CI)	‐0.50 [‐0.70, ‐0.30]
32.1.2 Optional TAU	3	173	Std. Mean Difference (IV, Random, 95% CI)	‐0.63 [‐1.09, ‐0.17]
32.2 Psychosocial functioning Show forest plot	22		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

32.2.1 Obligatory TAU	17	1002	Std. Mean Difference (IV, Random, 95% CI)	‐0.32 [‐0.56, ‐0.09]
32.2.2 Optional TAU	5	312	Std. Mean Difference (IV, Random, 95% CI)	‐0.96 [‐1.62, ‐0.30]

Comparison 32. Subgroup analysis: types of TAU

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Comparison 33. Subgroup analysis: type of comparison group

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
33.1 BPD symptom severity Show forest plot	25		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

33.1.1 TAU	22	1244	Std. Mean Difference (IV, Random, 95% CI)	‐0.52 [‐0.70, ‐0.33]
33.1.2 Waiting list	3	161	Std. Mean Difference (IV, Random, 95% CI)	‐0.49 [‐0.93, ‐0.05]
33.2 Psychosocial functioning Show forest plot	27		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

33.2.1 TAU	22	1314	Std. Mean Difference (IV, Random, 95% CI)	‐0.45 [‐0.68, ‐0.22]
33.2.2 Waiting list	5	219	Std. Mean Difference (IV, Random, 95% CI)	‐0.56 [‐1.01, ‐0.11]

Comparison 33. Subgroup analysis: type of comparison group

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Comparison 34. Subgroup analysis: types of scales

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
34.1 BPD symptom severity Show forest plot	22		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

34.1.1 ZAN‐BPD	4	261	Std. Mean Difference (IV, Random, 95% CI)	‐0.45 [‐0.69, ‐0.20]
34.1.2 SCID	3	112	Std. Mean Difference (IV, Random, 95% CI)	‐0.58 [‐1.16, ‐0.00]
34.1.3 BEST	4	147	Std. Mean Difference (IV, Random, 95% CI)	‐1.10 [‐1.47, ‐0.72]
34.1.4 BPDSI	4	267	Std. Mean Difference (IV, Random, 95% CI)	‐0.21 [‐0.45, 0.04]
34.1.5 BPP‐40	1	52	Std. Mean Difference (IV, Random, 95% CI)	‐0.55 [‐1.11, 0.00]
34.1.6 CGI‐BPD	1	33	Std. Mean Difference (IV, Random, 95% CI)	0.00 [‐0.68, 0.68]
34.1.7 CCGI‐BPD	1	59	Std. Mean Difference (IV, Random, 95% CI)	‐1.01 [‐1.55, ‐0.47]
34.1.8 BPT	1	122	Std. Mean Difference (IV, Random, 95% CI)	‐0.07 [‐0.43, 0.28]
34.1.9 BPFS‐C	1	59	Std. Mean Difference (IV, Random, 95% CI)	‐0.01 [‐0.52, 0.50]
34.1.10 BSI	1	28	Std. Mean Difference (IV, Random, 95% CI)	‐1.66 [‐2.54, ‐0.78]
34.1.11 Mean number of DSM‐IV symptoms	1	104	Std. Mean Difference (IV, Random, 95% CI)	‐0.55 [‐0.95, ‐0.16]
34.2 Psychosocial functioning Show forest plot	22		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only

34.2.1 GAF	4	204	Std. Mean Difference (IV, Random, 95% CI)	‐0.73 [‐1.41, ‐0.05]
34.2.2 GAS	4	330	Std. Mean Difference (IV, Random, 95% CI)	‐0.71 [‐0.96, ‐0.46]
34.2.3 SAS	4	283	Std. Mean Difference (IV, Random, 95% CI)	‐0.23 [‐0.99, 0.53]
34.2.4 SPS	1	24	Std. Mean Difference (IV, Random, 95% CI)	‐2.17 [‐3.22, ‐1.13]
34.2.5 QQ45	1	41	Std. Mean Difference (IV, Random, 95% CI)	‐0.47 [‐1.09, 0.15]
34.2.6 WSAS	1	72	Std. Mean Difference (IV, Random, 95% CI)	0.03 [‐0.43, 0.49]
34.2.7 CORE‐OM	1	41	Std. Mean Difference (IV, Random, 95% CI)	0.29 [‐0.34, 0.92]
34.2.8 BDQ	1	48	Std. Mean Difference (IV, Random, 95% CI)	‐0.42 [‐1.00, 0.16]
34.2.9 SOFAS	1	9	Std. Mean Difference (IV, Random, 95% CI)	‐1.22 [‐2.73, 0.30]
34.2.10 SFQ	1	99	Std. Mean Difference (IV, Random, 95% CI)	0.00 [‐0.39, 0.39]
34.2.11 SDS	1	61	Std. Mean Difference (IV, Random, 95% CI)	‐0.28 [‐0.78, 0.23]
34.2.12 CGI	1	59	Std. Mean Difference (IV, Random, 95% CI)	‐0.29 [‐0.80, 0.22]
34.2.13 HoNOS	1	43	Std. Mean Difference (IV, Random, 95% CI)	‐0.07 [‐0.69, 0.55]

Comparison 34. Subgroup analysis: types of scales

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Comparison 35. TSA sensitivity analyses: psychotherapy versus TAU

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
35.1 Primary: BPD symptom severity, at end of treatment Show forest plot	22	1244	Std. Mean Difference (IV, Random, 95% CI)	‐0.47 [‐0.63, ‐0.31]

35.2 Primary: self‐harm Show forest plot	13	616	Mean Difference (IV, Random, 95% CI)	‐0.42 [‐0.69, ‐0.15]

35.3 Primary: suicide‐related outcomes Show forest plot	13	676	Std. Mean Difference (IV, Random, 95% CI)	‐0.30 [‐0.47, ‐0.14]

35.4 Primary: psychosocial functioning, at end of treatment Show forest plot	22	1314	Std. Mean Difference (IV, Random, 95% CI)	‐0.36 [‐0.55, ‐0.17]

35.5 Secondary: depression Show forest plot	22	1568	Std. Mean Difference (IV, Random, 95% CI)	‐0.34 [‐0.54, ‐0.14]

Comparison 35. TSA sensitivity analyses: psychotherapy versus TAU

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