We examined the effectiveness of psychotherapies for adult Borderline Personality Disorder (BPD) in a multilevel meta-analysis, including all trial types (PROSPERO ID: CRD42020111351). We tested several predictors, including trial- and outcome type (continuous or dichotomous), setting, BPD symptom domain and mean age. We included 87 studies (N = 5881) from searches between 2013 and 2019 in four databases. We controlled for differing treatment lengths and a logarithmic relationship between treatment duration and effectiveness. Sensitivity analyses were conducted by excluding outliers and by prioritizing total scale scores when both subscale and total scores were reported. Schema Therapy, Mentalization-Based Treatment and reduced Dialectical Behavior Therapy were associated with higher effect sizes than average, and treatment-as-usual with lower effect sizes. General severity and affective instability showed the strongest improvement, dissociation, anger, impulsivity and suicidality/self-injury the least. Treatment effectiveness decreased as the age of participants increased. Dichotomous outcomes were associated to larger effects, and analyses based on last observation carried forward to smaller effects. Compared to the average, the highest reductions were found for certain specialized psychotherapies. All BPD domains improved, though not equally. These findings have a high generalizability. However, causal conclusions cannot be drawn, although the design type did not influence the results.

Background: Dropout from psychotherapy for borderline personality disorder (BPD) is a notorious problem. We investigated whether treatment, treatment format, treatment setting, substance use exclusion criteria, proportion males, mean age, country, and other variables influenced dropout.Methods: From Pubmed, Embase, Cochrane, Psycinfo and other sources, 111 studies (159 treatment arms, N = 9100) of psychotherapy for non-forensic adult patients with BPD were included. Dropout per quarter during one year of treatment was analyzed on participant level with multilevel survival analysis, to deal with multiple predictors, nonconstant dropout chance over time, and censored data. Multiple imputation was used to estimate quarter of drop-out if unreported. Sensitivity analyses were done by excluding DBT-arms with deviating push-out rules.Results: Dropout was highest in the first quarter of treatment. Schema therapy had the lowest dropout overall, and mentalization-based treatment in the first two quarters. Community treatment by experts had the highest dropout. Moreover, individual therapy had lowest dropout, group therapy highest, with combined formats in-between. Other variables such as age or substance-use exclusion criteria were not associated with dropout.Conclusion: The findings do not support claims that all treatments are equal, and indicate that efforts to reduce dropout should focus on early stages of treatment and on group treatment.

Significance: It is not well understood why and how memories of similar events sometimes strengthen each other, but at other times compete, causing either facilitation or impairment of memory recollection. Reasoning that the environment (spatial context) in which events occur is a critical component of memory function, we show that similar memories strengthen each other’s retrievability when the events occurred in the same context, whereas memories impair each other’s recall when experiences took place across different contexts. Interestingly, these patterns may change or even reverse if contextual cues are present during recall. Our results thus suggest that episodic memory alterations are adjustable rather than permanent, and provide strategies to optimize memory retention and reduce interference in educational and legal settings.

Emotional memory can persist strikingly long, but it is believed that not all its elements are protected against the fading effects of time. So far, studies of emotional episodic memory have mostly investigated retention up to 24h postencoding and revealed that central emotional features (items) are usually strengthened, while contextual binding of the event is reduced. However, even though it is known for neutral memories that central versus contextual elements evolve differently with longer passage of time, the time-dependent evolution of emotional memories remains unclear. Hypothetically, compared to neutral memories, emotional item memory becomes increasingly stronger, accompanied by accelerated decay of-already fragile-links with their original encoding contexts, resulting in progressive reductions in contextual dependency. Here, we tested these predictions in a large-scale study. Participants encoded emotional and neutral episodes, and were assessed 30 minutes (N = 40), 1 day (N = 40), 1 week (N = 39), or 2 weeks (N = 39) later on item memory, contextual dependency, and subjective quality of memory. The results show that, with the passage of time, emotional memories were indeed characterized by increasingly stronger item memory and weaker contextual dependency. Interestingly, analyses of the subjective quality of memories revealed that stronger memory for emotional items with time was expressed in familiarity, whereas increasingly smaller contextual dependency for emotional episodes was reflected in recollection. Together, these findings uncover the time-dependent transformation of emotional episodic memories, thereby shedding light on the ways healthy and maladaptive human memories may develop. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Background: The identification of moderators of exposure-based cognitive behavioral therapy (EXCBT) outcomes has the potential to (1) guide the judicious application of the limited resource that is EXCBT and (2) identify additional treatment targets for ameliorating the deleterious effects of an identified moderator, thereby enhancing clinical response. Experimental and clinical studies have yielded intriguing findings for the moderating influence of positive affect on EXCBT outcomes. Mixed findings for state positive affect (at the time of extinction or exposure trials) as a predictor of EXCBT outcomes stand in contrast to evidence that baseline levels of trait positive affect may be a more effective predictor. As such, questions remain about the best way to assess positive affect as a potential treatment moderator. Objective: This study was designed to investigate (1) the relative value of state and trait positive affect for predicting the outcome of a single-session virtual reality exposure intervention for public speaking anxiety in adults attending college and (2) the role of 3 related constructs—optimism, hopefulness, and mental health self-efficacy—that may explain the predictive significance of trait positive affect. Methods: State affect will be manipulated at an experimental level using affect induction procedures; trait positive affect will be measured at baseline. Three dependent measures—a primary outcome of public speaking anxiety and secondary outcomes of social phobia and self-reported valence—will be examined. This study relies on a team science approach and is being conducted across 12 collaborating sites through the Exposure Therapy Consortium, allowing for replication of all findings across diverse study sites worldwide. Results: Data collection for this study began in October 2024 and ended in August 2025. We expect to complete data analysis and submit results for publication in approximately November 2025. Conclusions: This study will help clarify the relationship among positive affect (state and trait), exposure learning, and 3 related constructs (optimism, hopefulness, and mental health self-efficacy). These findings will illuminate strategies for future treatment improvement and enhanced efficacy.

Contextual overgeneralization of emotional memory is a core aspect of anxiety disorders. Identifying methods to enhance contextual dependency of emotional memory is therefore of significant clinical interest. Animal research points to a promising approach: reexposure to the context in which fear is acquired reduces generalization to other contexts. However, the exact conditions for this effect are unknown, complicating translation to effective interventions. Most notably, exposure to a context that resembles—but is not identical to—the learning context may diminish contextual dependency of memory by integration of additional contextual cues. Here, we therefore assessed in a large-scale study (N = 180) whether context reexposure enhances contextual dependency of emotional episodic memory whereas exposure to a similar context impairs it. We also tested whether relatively strong memory retrieval during context (re)exposure amplifies these effects. We replicated prior research showing that correct recognition depends on context and contextual dependency is lower for emotional than neutral memories. However, exposure to the encoding context or a similar context did not affect contextual dependency of memory, and retrieval strength did not interact with such effects. Thorough insight into factors underlying the effects of context (re)exposure on contextual dependency seems key to eventually attain a memory recontextualization intervention.