Protocol for a parallel-group superiority randomized controlled trial comparing Sage- a couple psychotherapy- to supportive individual psychotherapy for borderline personality disorder.
10 affiliations
- 1Department of Psychology, York University, 4700 Keele St., Toronto, ON, M3J 1P3, Canada. [email protected].
- 2Department of Psychology, York University, 4700 Keele St., Toronto, ON, M3J 1P3, Canada.
- 3Division of Women's Mental Health, McLean Hospital, 115 Mill St, Belmont, MA, 02478, USA.
- 4Department of Psychology, University of Winnipeg, 515 Portage Avenue, Winnipeg, MB, R3B 2E9, Canada.
- 5Department of Psychology, University of Windsor, 401 Sunset Drive, Windsor, ON, N9B 3P4, Canada.
- 6Department of Psychological Science, Kennesaw State University, 1000 Chastain Road, Kennesaw, GA, 30144, USA.
- 7Borderline Personality Disorder Clinic, Centre for Addiction and Mental Health, 1001 Queen St W, Toronto, ON, M6J 1H4, Canada.
- 8Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada.
- 9Department of Psychology Toronto Metropolitan University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada.
- 10The Sashbear Foundation, 25 Hartfield Rd, Toronto, ON, M9A 3C8, Canada.
Abstract
Background
Although borderline personality disorder (BPD) is associated with substantial mortality and morbidity, frontline BPD interventions are difficult to access and have suboptimal efficacy. Therefore, there is a pressing need to develop and test brief, optimized BPD interventions. BPD is associated with disrupted intimate relationships, and recent theoretical models suggest that such disruptions may play a central role in driving BPD pathology. This led to the development of Sage, a protocolized, conjoint psychotherapeutic intervention delivered to people with BPD and their intimate partners to treat BPD and simultaneously improve relationship conflict and intimate partner's mental health. While preliminary research supports the efficacy of Sage, a key next step is identifying whether Sage is more efficacious compared to standard care in improving its targets. This manuscript outlines the study protocol for a single-blind, parallel two-arm randomized controlled trial (RCT) comparing Sage to a supportive psychotherapy that is delivered separately to people with BPD and their intimate partners.Methods
Couples wherein one member has BPD (target N = 152 couples) are actively being recruited. After eligibility and baseline assessments are complete, couples are randomized to Sage or Supportive Individual Psychotherapy. Weekly supervision meetings are held for both conditions by independent supervisors to ensure intervention adherence and prevent drift. Primary (BPD symptoms), secondary (relationship conflict, partner mental health), and exploratory outcomes (e.g. people with BPD's emotion dysregulation, suicidal ideation, suicidal and self-injurious behaviors, relationship satisfaction) are assessed by masked assessors at baseline, mid-intervention, post-intervention, and at a one-, three, and six-month follow-up. Generalized mixed linear models using an intent-to-treat philosophy will be conducted to examine differences between study outcomes across conditions.Discussion
Results will illuminate whether Sage is an efficacious means of treating BPD and expanding intervention outcomes to include relationship conflict and partner mental health in a short timeframe.Trial registration
ClinicalTrials.gov (ID NCT06458933, registered on June 12, 2024).
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BibTeX
@article{fitzpatrick2026protocol,
title = {{Protocol for a parallel-group superiority randomized controlled trial comparing Sage- a couple psychotherapy- to supportive individual psychotherapy for borderline personality disorder.}},
author = {Skye Fitzpatrick and Vinushini Arunagiri and Jenna M Traynor and Beverley K Fredborg and Alexander R Daros and Alexander O Crenshaw and Danielle Fitzpatrick and Shelley F McMain and Candice M Monson and Lynn Courey and Rachel E Liebman},
journal = {BMC psychiatry},
year = {2026},
month = jul,
doi = {10.1186/s12888-026-08374-6},
url = {https://europepmc.org/article/MED/42897533},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Protocol for a parallel-group superiority randomized controlled trial comparing Sage- a couple psychotherapy- to supportive individual psychotherapy for borderline personality disorder.
AU - Skye Fitzpatrick
AU - Vinushini Arunagiri
AU - Jenna M Traynor
AU - Beverley K Fredborg
AU - Alexander R Daros
AU - Alexander O Crenshaw
AU - Danielle Fitzpatrick
AU - Shelley F McMain
AU - Candice M Monson
AU - Lynn Courey
AU - Rachel E Liebman
PY - 2026
DA - 2026/07/01
JO - BMC psychiatry
DO - 10.1186/s12888-026-08374-6
UR - https://europepmc.org/article/MED/42897533
AB - Background Although borderline personality disorder (BPD) is associated with substantial mortality and morbidity, frontline BPD interventions are difficult to access and have suboptimal efficacy. Therefore, there is a pressing need to develop and test brief, optimized BPD interventions. BPD is associated with disrupted intimate relationships, and recent theoretical models suggest that such disruptions may play a central role in driving BPD pathology. This led to the development of Sage, a protocolized, conjoint psychotherapeutic intervention delivered to people with BPD and their intimate partners to treat BPD and simultaneously improve relationship conflict and intimate partner's mental health. While preliminary research supports the efficacy of Sage, a key next step is identifying whether Sage is more efficacious compared to standard care in improving its targets. This manuscript outlines the study protocol for a single-blind, parallel two-arm randomized controlled trial (RCT) comparing Sage to a supportive psychotherapy that is delivered separately to people with BPD and their intimate partners.Methods Couples wherein one member has BPD (target N = 152 couples) are actively being recruited. After eligibility and baseline assessments are complete, couples are randomized to Sage or Supportive Individual Psychotherapy. Weekly supervision meetings are held for both conditions by independent supervisors to ensure intervention adherence and prevent drift. Primary (BPD symptoms), secondary (relationship conflict, partner mental health), and exploratory outcomes (e.g. people with BPD's emotion dysregulation, suicidal ideation, suicidal and self-injurious behaviors, relationship satisfaction) are assessed by masked assessors at baseline, mid-intervention, post-intervention, and at a one-, three, and six-month follow-up. Generalized mixed linear models using an intent-to-treat philosophy will be conducted to examine differences between study outcomes across conditions.Discussion Results will illuminate whether Sage is an efficacious means of treating BPD and expanding intervention outcomes to include relationship conflict and partner mental health in a short timeframe.Trial registration ClinicalTrials.gov (ID NCT06458933, registered on June 12, 2024).
SN - 1471-244X
ER -