Group Experience Therapy for outpatients with Borderline Personality Disorder features: preliminary results on its effectiveness in a randomized trial

Raffaele Visintini, Emanuela Roder, Nicolò Gaj, Cesare Maffei


Objective: Group Experience Therapy (GET; Visintini et al., 2019) is a structured treatment for patients with Borderline Personality Disorder (BPD) features. The study aimed at evaluating GET effectiveness in a longitudinal, single-blind, two-arm parallel design, comparing GET with Dialectical Behavior Therapy (DBT; Linehan, 1993, 2014). The individual variability was expected to be consistent.

Methods: The sample was comprised of 95 outpatients, assigned to groups with the minimisation procedure and assessed every three months. Treatments were delivered by 28 therapists at the San Raffaele Scientific Institute, Milan, Italy. Hierarchical Linear Models with random effects were used; supplementary analyses were repeated for the completers’ subsample (N = 53).

Results: Suicidality, self-harm, emotional and behavioral dysregulation decreased in both groups after one year. Strategies to regulate intense emotions and mindfulness skills improved better in GET for the completers. Unconditional growth models indicated that subjects differed in the elevation and in the rate of change.

Discussion: GET and DBT reached comparable outcomes on target variables over one year. Group setting or the intensity of treatment could be hypothesized as GET-specific therapeutic mechanisms.


Borderline Personality Disorder; Psychotherapy; Treatment effectiveness evaluation; Dialectical Behavior Therapy; Group psychotherapy; Multivariate analysis.

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Altman, D. G., Schulz, K. F., Moher, D., Egger, M., Davidoff, F., Elbourne, D., Gøtzsche, P. C., & Lang, T. (2001). The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Annals of Internal Medicine, 134(8), 663-694. Doi: 10.7326/0003-4819-134-8-200104170-00012

American Psychiatric Association (2001). Practice guideline for the treatment of patients with Borderline Personality Disorder. American Journal of Psychiatry, 158(10)(suppl),1-52.

American Psychiatric Association (2013). Diagnostic and Statistical Manual of mental disorders, Fifth Edition (DSM-5). Arlington, VA: American Psychiatric Publishing.

Andión, Ó., Ferrer, M., Matali, J., Gancedo, B., Calvo, N., Barral, C., Valero, S., Di Genova, A., Diener, M. J., Torrubia, R., & Casas, M. (2012). Effectiveness of combined individual and group Dialectical Behavior Therapy compared to only individual Dialectical Behavior Therapy: A preliminary study. Psychotherapy, 49(2), 241-250. Doi: 10.1037/a0027401

Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13(1), 27-45. Doi: 10.1177/1073191105283504

Barnicot, K., Gonzalez, R., McCabe, R., & Priebe, S. (2016). Skills use and common treatment processes in Dialectical Behaviour Therapy for Borderline Personality Disorder. Journal of Behavior Therapy and Experimental Psychiatry, 52, 147-156. Doi: 10.1016/j.jbtep.2016.04.006

Barnicot, K., Katsakou, C., Bhatti, N., Savill, M., Fearns, N., & Priebe, S. (2012). Factors predicting the outcome of psychotherapy for Borderline Personality Disorder: a systematic review. Clinical Psychology Review, 32(5), 400-412. Doi: 10.1016/j.cpr.2012.04.004

Barrett, L. F., Gross, J., Christensen, T. C., & Benvenuto, M. (2001). Knowing what you’re feeling and knowing what to do about it: Mapping the relation between emotion differentiation and emotion regulation. Cognition & Emotion, 15(6), 713-724. Doi: 10.1080/02699930143000239

Beck, A. T., Davis, D. D., & Freeman, A. (Eds., 2015). Cognitive therapy of Personality Disorders. New York, NY: Guilford Press.

Bender, D. S., Dolan, R. T., Skodol, A. E., Sanislow, C. A., Dyck, I. R., McGlashan, T. H., Shea, T. H., Zanarini, M. T., Oldham, M. C., & Gunderson, J. G. (2001). Treatment utilization by patients with Personality Disorders. American Journal of Psychiatry, 158(2), 295-302. Doi: 10.1176/appi.ajp.158.2.295

Berenson, K. R., Gregory, W. E., Glaser, E., Romirowsky, A., Rafaeli, E., Yang, X., & Downey, G. (2016). Impulsivity, rejection sensitivity, and reactions to stressors in Borderline Personality Disorder. Cognitive Therapy and Research, 40(4), 510-521. Doi: 10.1007/s10608-015-9752-y

Boutron, I., Altman, D. G., Moher, D., Schulz, K. F., & Ravaud, P. (2017). CONSORT statement for randomized trials of nonpharmacologic treatments: a 2017 update and a CONSORT extension for nonpharmacologic trial abstracts. Annals of Internal Medicine, 167(1), 40-47. Doi: 10.7326/M17-0046

Carretta, I., Visintini, R., Gaj, N., Roder., E., Ramazzi, R., Lorentino, C., & Maffei, C. (2015, September). A randomized controlled study of two structured treatment programs for subjects with borderline personality features in a day-hospital setting: efficacy over one year. In C. Maffei (Chair), Emotional dysregulation in Borderline Personality Disorder: complex structured treatment programs in different clinical settings. Symposium conducted at the 17th National Congress of the Italian Psychological Association, Clinical and Dynamic Psychology Section, Milazzo (ME), IT. Abstract published on Mediterranean Journal of Clinical Psychology, 1(3/2), Suppl. 1a., 32-33.

Cavicchioli, M., Rugi, C., & Maffei, C. (2015). Inability to withstand present-moment experiences in Borderline Personality Disorder: a meta-analytic review. Clinical Neuropsychiatry, 12(4), 101-110.

Correale, A., & Nicoletti, V. (2001). Il gruppo in psichiatria [The group in psychiatry]. Rome, IT: Borla.

Cristea, I. A., Gentili, C., Cotet, C. D., Palomba, D., Barbui, C., & Cuijpers, P. (2017). Efficacy of psychotherapies for Borderline Personality Disorder: a systematic review and meta-analysis. JAMA Psychiatry, 74(4), 319-328. Doi: 10.1001/jamapsychiatry.2016.4287

Dixon-Gordon, K. L., Chapman, A. L., Weiss, N. H., & Rosenthal, M. Z. (2014). A preliminary examination of the role of emotion differentiation in the relationship between borderline personality and urges for maladaptive behaviors. Journal of Psychopathology and Behavioral Assessment, 36(4), 616-625. Doi: 10.1007/s10862-014-9423-4

Dryden, W., & Still, A. (2006). Historical aspects of mindfulness and self-acceptance in psychotherapy. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 24(1), 3-28. Doi: 10.1007/s10942-006-0026-1

Dubovsky, A. N., & Kiefer, M. M. (2014). Borderline Personality Disorder in the primary care setting. Medical Clinics, 98(5), 1049-1064. Doi: 10.1016/j.mcna.2014.06.005

Elices, M., Pascual, J. C., Portella, M. J., Feliu-Soler, A., Martín-Blanco, A., Carmona, C., & Soler, J. (2016). Impact of mindfulness training on Borderline Personality Disorder: a randomized trial. Mindfulness, 7(3), 584-595. Doi: 10.1007/s12671-016-0492-1

Estes, W. K. (1956). The problem of inference from curves based on group data. Psychological Bulletin, 53(2), 134-140. Doi: 10.1037/h0045156

Feliu‐Soler, A., Pascual, J. C., Borràs, X., Portella, M. J., Martín‐Blanco, A., Armario, A., Alvarez, E., Perez, V., & Soler, J. (2014). Effects of Dialectical Behaviour Therapy‐mindfulness training on emotional reactivity in Borderline Personality Disorder: preliminary results. Clinical Psychology & Psychotherapy, 21(4), 363-370. Doi: 10.1002/cpp.1837

First, M. B., Spitzer, R. L., Gibbon, M., Williams, J. B. W., & Benjamin, L. S. (1994). Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II), Version 2.0. New York State Psychiatric Institute, Biometrics Research Department, NY.

Gratz, K. L., Bardeen, J. R., Levy, R., Dixon-Gordon, K. L., & Tull, M. T. (2015). Mechanisms of change in an emotion regulation group therapy for deliberate self-harm among women with Borderline Personality Disorder. Behaviour Research and Therapy, 65, 29-35. Doi: 10.1016/j.brat.2014.12.005

Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41-54. Doi: 10.1023/B:JOBA.0000007455.08539.94

Hölzel, B. K., Lazar, S. W., Gard, T., Schuman-Olivier, Z., Vago, D. R., & Ott, U. (2011). How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives on Psychological Science, 6(6), 537-559.

Homan, K. J., Sim, L. A., Fargo, J. D., & Twohig, M. P. (2017). Five-year prospective investigation of self-harm/suicide-related behaviors in the development of Borderline Personality Disorder. Personality Disorders: Theory, Research, and Treatment, 8(2), 183-188. Doi: 10.1037/per0000169

Jacobson, N. S., & Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59(1), 12-19. Doi: 10.1037/0022-006X.59.1.12

Karterud, S. (2015a). Mentalization-Based Group Therapy (MBT-G): A theoretical, clinical, and research manual. Oxford, UK: Oxford University Press.

Karterud, S. (2015b). On structure and leadership in mentalization-based group therapy and group analysis. Group Analysis, 48(2), 137-149. Doi: 10.1177/0533316415577339

Lane, P. (2008). Handling drop‐out in longitudinal clinical trials: a comparison of the LOCF and MMRM approaches. Pharmaceutical Statistics, 7(2), 93-106. Doi: 10.1002/pst.267

Lazarus, S. A., Southward, M. W., & Cheavens, J. S. (2016). Do Borderline Personality Disorder features and rejection sensitivity predict social network outcomes over time? Personality and Individual Differences, 100, 62-67. doi: 10.1016/j.paid.2016.02.032

Leichsenring, F., Leibing, E., Kruse, J., New, A. S., & Leweke, F. (2011). Borderline Personality Disorder. The Lancet, 377(9759), 74-84. Doi: 10.1016/S0140-6736(10)61422-5

Lenzenweger, M. F., Johnson, M. D., & Willett, J. B. (2004). Individual growth curve analysis illuminates stability and change in Personality Disorder features. The Longitudinal Study of Personality Disorders. Archives of General Psychiatry, 61(10), 1015-1024. Doi: 10.1001/archpsyc.61.10.1015

Linehan, M. M. (1993). Cognitive behavioral treatment of Borderline Personality Disorder. New York, NY: Guilford Press.

Linehan, M. M. (2014). DBT® Skills Training Manual, Second Edition. New York, NY: Guilford Press.

Linehan, M. M., Korslund, K. E., Harned, M. S., Gallop, R. J., Lungu, A., Neacsiu, A. D., McDavid, J., Comtois, K. A., & Murray-Gregory, A. M. (2015). Dialectical Behavior Therapy for high suicide risk in individuals with Borderline Personality Disorder: a randomized clinical trial and component analysis. JAMA Psychiatry, 72(5), 475. Doi: 10.1001/jamapsychiatry.2014.3039

Longo, M. (1985). Il gruppo esperienziale come strumento di formazione: dal “Pollaiolo” al corso di laurea in Psicologia [The experiential group as a training tool: from the “Pollaiolo” to the graduation course in Psychology]. In Croce, E. B. (Ed.), Funzione analitica e formazione alla psicoterapia di gruppo [Analytic function and training in group psychotherapy], Rome, IT: Borla.

Mazumdar, S., Tang, G., Houck, P. R., Dew, M. A., Begley, A. E., Scott, J., Mulsant, B. H., & Reynolds, C. F. (2007). Statistical analysis of longitudinal psychiatric data with dropouts. Journal of Psychiatric Research, 41(12), 1032-1041. Doi: 10.1016/j.jpsychires.2006.09.007

Maffei, C., Fossati, A., Agostoni, I., Barraco, A., Bagnato, M., Deborah, D., Namia, C., Novella, L., & Petrachi, M. (1997). Interrater reliability and internal consistency of the structured clinical interview for DSM-IV axis II personality disorders (SCID-II), version 2.0. Journal of Personality Disorders, 11(3), 279-284.

Mcleod, P. L., & Kettner-Polley, R. B. (2004). Contributions of psychodynamic theories to understanding small groups. Small Group Research, 35(3), 333-361. Doi: 10.1177/1046496404264973

McMain, S. F., Guimond, T., Streiner, D. L., Cardish, R. J., & Links, P. S. (2012). Dialectical Behavior Therapy compared with General Psychiatric Management for Borderline Personality Disorder: clinical outcomes and functioning over a 2-year follow-up. American Journal of Psychiatry, 169(6), 650-661. Doi: 10.1176/appi.ajp.2012.11091416

Moher, D., Hopewell, S., Schulz, K. F., Montori, V., Gøtzsche, P. C., Devereaux, P. J., Elbourne, D., Egger, M., & Altman, D. G. (2010). CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. BMJ: British Medical Journal, 340, c869. Doi: 10.3736/jcim20100801

Muthén, B. O., & Curran, P. J. (1997). General longitudinal modeling of individual differences in experimental designs: A latent variable framework for analysis and power estimation. Psychological Methods, 2(4), 371-402. Doi: 10.1037/1082-989X.2.4.371

National Collaborating Centre for Mental Health (2009). Borderline Personality Disorder: treatment and management. Leicester, UK: British Psychological Society.

Document retrieved from

Neacsiu, A. D., Lungu, A., Harned, M. S., Rizvi, S. L., & Linehan, M. M. (2014). Impact of Dialectical Behavior Therapy versus community treatment by experts on emotional experience, expression, and acceptance in Borderline Personality Disorder. Behaviour Research and Therapy, 53, 47-54. Doi: 10.1016/j.brat.2013.12.004

Neacsiu, A. D., Rizvi, S. L., & Linehan, M. M. (2010). Dialectical behavior therapy skills use as a mediator and outcome of treatment for Borderline Personality Disorder. Behaviour Research and Therapy, 48(9), 832-839. Doi: 10.1016/j.brat.2010.05.017

Neri, C. (1998). Group. London, UK: Jessica Kingsley Publishers.

Oldham, J. M. (2006). Borderline Personality Disorder and suicidality. American Journal of Psychiatry, 163(1), 20-26. Doi: 10.1176/appi.ajp.163.1.20

Patton, J. H., Stanford, M. S., & Barratt, E. S. (1995). Factor structure of the Barratt Impulsiveness Scale. Journal of Clinical Psychology, 51(6), 768-774. Doi: 10.1002/1097-4679(199511)51:6<768::AID-JCLP2270510607>3.0.CO;2-1

Preti, E., Richetin, J., Suttora, C., & Pisani, A. (2016). Individual differences in components of impulsivity and effortful control moderate the relation between Borderline Personality Disorder traits and emotion recognition in a sample of university students. Psychiatry Research, 238, 109-115. Doi: 10.1016/j.psychres.2016.02.037

Raudenbush, S. W., & Bryk, A. S. (2002). Hierarchical Linear Models: Applications and data analysis methods. Second Edition. Thousand Oaks, CA: Sage Publications.

Roder, E., Visintini, R., & Maffei, C. (2017, September). Modeling treatment changes in two structured therapeutic programs for Borderline Personality Disorder: a preliminary study relating process to outcomes. In Austin, S. B., & Johnson, B. N. (Chairs), Understanding and treating core features of Borderline Personality Disorder: International perspectives from future research leaders. Symposium conducted at the 15th Congress of the International Society for the Study of Personality Disorders, Heidelberg, GE. Abstract retrieved online at

Sansone, R. A., Wiederman, M. W., & Sansone, L. A. (1998). The Self-Harm Inventory (SHI): development of a scale for identifying self-destructive behaviors and borderline personality disorder. Journal of Clinical Psychology, 54(7), 973-983. Doi: 10.1002/(SICI)1097-4679(199811)54:7<973::AID-JCLP11>3.0.CO;2-H

Scheibner, H. J., Spengler, S., Kanske, P., Roepke, S., & Bermpohl, F. (2016). Behavioral assessment of mindfulness difficulties in Borderline Personality Disorder. Mindfulness, 7(6), 1316-1326. Doi: 10.1007/s12671-016-0572-2

Shorey, R. C., Elmquist, J., Wolford-Clevenger, C., Gawrysiak, M. J., Anderson, S., & Stuart, G. L. (2016). The relationship between dispositional mindfulness, borderline personality features, and suicidal ideation in a sample of women in residential substance use treatment. Psychiatry Research, 238, 122-128. Doi: 10.1016/j.psychres.2016.02.040

Singer J. D., & Willett J. B. (2003). Applied Longitudinal Data Analysis: Modeling Change and Event Occurrence. New York, NY: Oxford University Press.

Soeteman, D. I., & Kim, J. J. (2013). Cost-effectiveness of psychotherapy for Personality Disorders: treatment recommendations and implementation. Expert Review of Pharmacoeconomics & Outcomes Research, 13(1), 73-81. Doi: 10.1586/erp.12.87

Soler, J., Pascual, J. C., Tiana, T., Cebriá, A., Barrachina, J., Campins, M. J., Gich, I., Alvarez, E., & Pérez, V. (2009). Dialectical Behaviour Therapy skills training compared to standard group therapy in Borderline Personality Disorder: A 3-month randomised controlled clinical trial. Behaviour Research and Therapy, 47(5), 353-358. Doi: 10.1016/j.brat.2009.01.013

Spiegelhalter, D. J., Best, N. G., Carlin, B. P., & Linde, A. (2014). The deviance information criterion: 12 years on. Journal of the Royal Statistical Society: Series B (Statistical Methodology), 76(3), 485-493. Doi: 10.1111/rssb.12062

Stoffers, J. M., Völlm, B. A., Rücker, G., Timmer, A., Huband, N., & Lieb, K. (2012). Psychological therapies for people with Borderline Personality Disorder. Cochrane Database of Systemativ Reviews, 8(8), 1-255. Doi: 10.1002/14651858.CD005652.pub2

Streiner, D. V. L. (2002). The case of the missing data: methods of dealing with dropouts and other research vagaries. The Canadian Journal of Psychiatry, 47(1), 70-77.

Treasure, T., & MacRae, K. D. (1998). Minimisation: the platinum standard for trials? Randomisation doesn’t guarantee similarity of groups; minimisation does. BMJ: British Medical Journal, 317(7155), 362.

Tsur, N., Berkovitz, N., & Ginzburg, K. (2016). Body awareness, emotional clarity, and authentic behavior: The moderating role of mindfulness. Journal of Happiness Studies, 17(4), 1451-1472. Doi: 10.1007/s10902-015-9652-6

Visintini, R., Baldin, E., Carretta, I., Gaj, N., & Segrini, M. (2019). “Gruppi Esperienziali Terapeutici (GET): un trattamento finalizzato alla regolazione emotiva”. In: Giusto, G. (Ed.), La fattoria terapeutica. Milan: Mondadori.

Visintini, R., Carretta, I., Roder, E., Fantoni, G., Passaquindici, O., Ramazzi, R., & Gaj, N. (2014, October). A randomized controlled study of DBT in borderline subjects treated in a day-hospital program. In C. Maffei (Chair), Contributions of empirical research on Dialectical Behavior Therapy (DBT) in Latin Europe. Symposium conducted at the 3rd International Congress on Borderline Personality Disorder and allied disorders, Rome, IT.

Velotti, P., Garofalo, C., & Bizzi, F. (2015). Emotion dysregulation mediates the relation between mindfulness and rejection sensitivity. Psychiatria Danubina, 27(3), 259-272.

Wells, A. (2000). Emotional disorders and metacognition: Innovative cognitive therapy. Hoboken, NJ: John Wiley & Sons.

West, S. G., Ryu, E., Kwok, O. M., & Cham, H. (2011). Multilevel modeling: Current and future applications in personality research. Journal of Personality, 79(1), 2-50. Doi: 10.1111/j.1467-6494.2010.00681.x

Wilks, C. R., Korslund, K. E., Harned, M. S., & Linehan, M. M. (2016). Dialectical Behavior Therapy and domains of functioning over two years. Behaviour Research and Therapy, 77, 162-169. Doi: 10.1016/j.brat.2015.12.013

WHOQoL Group, The (1998). Development of the World Health Organization WHOQoL-BREF quality of life assessment. Psychological Medicine, 28(3), 551-558. Doi: 10.1017/S0033291798006667

Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy. New York, NY: Basic Books.



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