A pilot and feasibility study of Sage: A couple therapy for borderline personality disorder

Objective: Borderline personality disorder (BPD) is characterized by emotion dysregulation and relationship dysfunction. However, the majority of BPD treatments provide individually-focused treatment and do not target relationship functioning or include significant others. The current paper presents the primary and secondary outcomes from an uncontrolled trial of Sage, a manualized conjoint treatment for people with BPD and their intimate partners that targets BPD, relationship conflict, and partner mental health simultaneously. Method: Sixteen couples wherein one member has BPD and elevated suicidal ideation/chronic and frequent suicidal/self-injurious behavior were enrolled in the 12-session Sage protocol. Measures of BPD severity (including suicidal ideation, suicidal/self-injurious behaviors, and emotion dysregulation) and relationship outcomes were collected at pre-, mid-, and post-intervention, and three-month follow-up. Results: Self-reported BPD severity, suicidal ideation, and emotion dysregulation and interview-rated frequency of suicidal and self-injurious behaviors improved from baseline to follow-up. No changes were observed in relationship outcomes or informant-reported BPD severity and suicidal ideation. Conclusions: These findings suggest that Sage may aid in improving BPD pathology with moderate to large effect sizes. The lack of improvements in relationship outcomes may be due to the relatively high relationship functioning observed in couples at baseline, but more testing is needed.Trial registration: ClinicalTrials.gov identifier: NCT04737252..