AIR therapy: a pilot study of a clinician-assisted e-therapy for adolescents with borderline personality disorder

While the majority of personality disorder research focuses on adults, research shows that borderline personality disorder (BPD) often emerges in adolescence, highlighting the importance of early intervention for this population. Despite this, there are limited intervention programs tailored specifically for adolescents with BPD, and no research has explored the effectiveness of online therapist-assisted interventions for BPD in adolescents. As such, this pilot study aimed to address this gap in the literature by exploring the effectiveness of a therapist-assisted online intervention (AIR Therapy) with adolescents with BPD.

The intervention involved 6 online weekly learning modules in conjunction with a weekly telehealth consultation session with a clinician. Modules included: introduction to AIR therapy, mindfulness and managing distress, emotions, self and identity, our interpersonal skills, and self-care. Participants were 12 adolescents (83.3% female, M age = 15 years) and 12 clinicians (100% female, M age = 34.3 years) recruited naturalistically from publicly funded mental health services located in rural and remote locations. Adolescents were compared on BPD symptom severity, mental health symptoms and quality of life at baseline and follow-up. Measures and semi-structured interviews were also completed evaluating the effectiveness and acceptability of the intervention at follow-up.

Both adolescents and clinicians rated the intervention positively in terms of its effectiveness and acceptability. Paired-sample t-tests showed significant improvement in BPD symptoms, mental health and health satisfaction from intake to end of therapy. Adolescents' qualitative responses revealed themes of improving self-regulation and coping, ease of the online workbook, and the value of clinician interaction. Additionally, clinicians' responses highlighted themes of adding structure to therapy, the value of a brief intervention, enhancing self-insight and helping adolescents build skills that they can utilise in everyday life. Both adolescents and clinicians also highlighted suggested areas for improvement.

The structured online therapist-assisted intervention in the early treatment of BPD was acceptable and helpful for participants and their clinicians in this rural and remote real-world setting. This intervention may also be particularly suited for newer or trainee clinicians, providing structured tools for use with a challenging population.