A mechanism-based group psychotherapy approach to aggressive behavior (MAAP) in borderline personality disorder: a multicenter randomized controlled clinical trial
Abstract Background High levels of trait anger and aggressive behavior are common and problematic phenomena in patients with borderline personality disorder (BPD). In BPD, patterns of reactive aggression often lead to functional impairment affecting important areas of life. Despite the high burden o...
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2025-08-01
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| author | Christine Sigrist Andreas Bechdolf Katja Bertsch Robin Bullenkamp Martin Busse Ute gr. Darrelmann Astrid Dempfle Martin Driessen Thomas Frodl Jan-Michael Kersting Jessica Kesik Burkhart Matzke Corinne Neukel Eva Niessen Svenja Nückel Viola Oertel Frank Padberg Alexandra Philipsen Dorothee Pink Andreas Reif Matthias Reinhard Carolin Steuwe Larissa Wolkenstein Sabine C. Herpertz the MAAP Consortium |
| author_facet | Christine Sigrist Andreas Bechdolf Katja Bertsch Robin Bullenkamp Martin Busse Ute gr. Darrelmann Astrid Dempfle Martin Driessen Thomas Frodl Jan-Michael Kersting Jessica Kesik Burkhart Matzke Corinne Neukel Eva Niessen Svenja Nückel Viola Oertel Frank Padberg Alexandra Philipsen Dorothee Pink Andreas Reif Matthias Reinhard Carolin Steuwe Larissa Wolkenstein Sabine C. Herpertz the MAAP Consortium |
| author_sort | Christine Sigrist |
| collection | DOAJ |
| description | Abstract Background High levels of trait anger and aggressive behavior are common and problematic phenomena in patients with borderline personality disorder (BPD). In BPD, patterns of reactive aggression often lead to functional impairment affecting important areas of life. Despite the high burden on individuals and their social environment, there are no specific, cost-effective treatments to reduce aggression in BPD. In previous studies, we and others have been able to infer specific biobehavioral mechanisms underlying patterns of reactive aggression in BPD that can be used as potential treatment targets. To address this, we developed a mechanism-based anti-aggression psychotherapy (MAAP) for the group setting that specifically targets the biobehavioral mechanisms underlying outward-directed aggression in BPD. A previously conducted proof-of-concept study had suggested beneficial effects for this neglected group of patients. Methods In this multicenter, confirmatory, randomized-controlled-clinical-trial, MAAP, which consists of multifaceted, evidence-based treatment elements adapted from other sophisticated treatment programs such as Dialectical Behavior Therapy and Mentalization-Based Treatment, is tested for efficacy against a non-specific supportive psychotherapy (NSSP) program focusing on non-specific general factors of psychotherapy at seven different sites in Germany. Both treatment arms, based on one individual and 13 group therapeutic sessions (1.5 h per session, twice a week), are delivered over a period of 7–10 weeks. A total of N = 186 patients will be recruited, half of whom will be cluster-randomized to MAAP. Outcomes are assessed at baseline, immediately, and 4, 12, 20, and 24 weeks post-treatment using ecological momentary assessment, clinical interviews, questionnaires, and online tasks. Discussion If proven superior, MAAP can be incorporated into standard psychiatric care, filling a critical gap in the current therapeutic landscape by offering a structured, cost-effective, and evidence-based treatment that directly targets the biobehavioral mechanisms underlying reactive aggression in BPD. By potentially improving clinical outcomes and reducing the burden of reactive aggression in BPD, MAAP could be beneficial for both individuals and their social environments. The study’s large, multicenter design enhances the generalizability of the results, making them more relevant for broader clinical applications. Trial registration This study was registered in the German Clinical Trials Register DRKS (DRKS00031608) on 31.10.2023 ( https://drks.de/search/de/trial/DRKS00031608 ). |
| format | Article |
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| institution | Kabale University |
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| spelling | doaj-art-37d1a075e08248ff8667b6cf1becc3752025-08-20T04:03:00ZengBMCTrials1745-62152025-08-0126111710.1186/s13063-025-08985-6A mechanism-based group psychotherapy approach to aggressive behavior (MAAP) in borderline personality disorder: a multicenter randomized controlled clinical trialChristine Sigrist0Andreas Bechdolf1Katja Bertsch2Robin Bullenkamp3Martin Busse4Ute gr. Darrelmann5Astrid Dempfle6Martin Driessen7Thomas Frodl8Jan-Michael Kersting9Jessica Kesik10Burkhart Matzke11Corinne Neukel12Eva Niessen13Svenja Nückel14Viola Oertel15Frank Padberg16Alexandra Philipsen17Dorothee Pink18Andreas Reif19Matthias Reinhard20Carolin Steuwe21Larissa Wolkenstein22Sabine C. Herpertz23the MAAP ConsortiumDepartment of General Psychiatry, Heidelberg UniversityDepartment of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Am Urban and Vivantes Klinikum Im FriedrichshainDepartment of Psychology, Julius-Maximilians-Universität WürzburgDepartment of General Psychiatry, Heidelberg UniversityDepartment of General Psychiatry, Heidelberg UniversityDepartment of Psychiatry and Psychotherapy, University Hospital BonnInstitute of Medical Informatics and Statistics, Christian-Albrechts University of KielDepartment of Psychiatry and Psychotherapy, Evangelisches Klinikum BethelDepartment of Psychiatry and Psychotherapy, University Hospital Aachen, RWTHDepartment of General Psychiatry, Heidelberg UniversityDepartment of Psychiatry and Psychotherapy, University Hospital Aachen, RWTHDepartment of General Psychiatry, Heidelberg UniversityDepartment of General Psychiatry, Heidelberg UniversityDepartment of Psychiatry and Psychotherapy, Evangelisches Klinikum BethelDepartment of Psychiatry and Psychotherapy, University Hospital LMUDepartment of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital FrankfurtDepartment of Psychiatry and Psychotherapy, University Hospital LMUDepartment of Psychiatry and Psychotherapy, University Hospital BonnDepartment of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Am Urban and Vivantes Klinikum Im FriedrichshainDepartment of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital FrankfurtDepartment of Psychiatry and Psychotherapy, University Hospital LMUDepartment of Psychiatry and Psychotherapy, Evangelisches Klinikum BethelDepartment of Psychology, LMUDepartment of General Psychiatry, Heidelberg UniversityAbstract Background High levels of trait anger and aggressive behavior are common and problematic phenomena in patients with borderline personality disorder (BPD). In BPD, patterns of reactive aggression often lead to functional impairment affecting important areas of life. Despite the high burden on individuals and their social environment, there are no specific, cost-effective treatments to reduce aggression in BPD. In previous studies, we and others have been able to infer specific biobehavioral mechanisms underlying patterns of reactive aggression in BPD that can be used as potential treatment targets. To address this, we developed a mechanism-based anti-aggression psychotherapy (MAAP) for the group setting that specifically targets the biobehavioral mechanisms underlying outward-directed aggression in BPD. A previously conducted proof-of-concept study had suggested beneficial effects for this neglected group of patients. Methods In this multicenter, confirmatory, randomized-controlled-clinical-trial, MAAP, which consists of multifaceted, evidence-based treatment elements adapted from other sophisticated treatment programs such as Dialectical Behavior Therapy and Mentalization-Based Treatment, is tested for efficacy against a non-specific supportive psychotherapy (NSSP) program focusing on non-specific general factors of psychotherapy at seven different sites in Germany. Both treatment arms, based on one individual and 13 group therapeutic sessions (1.5 h per session, twice a week), are delivered over a period of 7–10 weeks. A total of N = 186 patients will be recruited, half of whom will be cluster-randomized to MAAP. Outcomes are assessed at baseline, immediately, and 4, 12, 20, and 24 weeks post-treatment using ecological momentary assessment, clinical interviews, questionnaires, and online tasks. Discussion If proven superior, MAAP can be incorporated into standard psychiatric care, filling a critical gap in the current therapeutic landscape by offering a structured, cost-effective, and evidence-based treatment that directly targets the biobehavioral mechanisms underlying reactive aggression in BPD. By potentially improving clinical outcomes and reducing the burden of reactive aggression in BPD, MAAP could be beneficial for both individuals and their social environments. The study’s large, multicenter design enhances the generalizability of the results, making them more relevant for broader clinical applications. Trial registration This study was registered in the German Clinical Trials Register DRKS (DRKS00031608) on 31.10.2023 ( https://drks.de/search/de/trial/DRKS00031608 ).https://doi.org/10.1186/s13063-025-08985-6AngerReactive aggressionAggressive behaviorBorderline personality disorderGroup psychotherapyDialectic behavior therapy |
| spellingShingle | Christine Sigrist Andreas Bechdolf Katja Bertsch Robin Bullenkamp Martin Busse Ute gr. Darrelmann Astrid Dempfle Martin Driessen Thomas Frodl Jan-Michael Kersting Jessica Kesik Burkhart Matzke Corinne Neukel Eva Niessen Svenja Nückel Viola Oertel Frank Padberg Alexandra Philipsen Dorothee Pink Andreas Reif Matthias Reinhard Carolin Steuwe Larissa Wolkenstein Sabine C. Herpertz the MAAP Consortium A mechanism-based group psychotherapy approach to aggressive behavior (MAAP) in borderline personality disorder: a multicenter randomized controlled clinical trial Trials Anger Reactive aggression Aggressive behavior Borderline personality disorder Group psychotherapy Dialectic behavior therapy |
| title | A mechanism-based group psychotherapy approach to aggressive behavior (MAAP) in borderline personality disorder: a multicenter randomized controlled clinical trial |
| title_full | A mechanism-based group psychotherapy approach to aggressive behavior (MAAP) in borderline personality disorder: a multicenter randomized controlled clinical trial |
| title_fullStr | A mechanism-based group psychotherapy approach to aggressive behavior (MAAP) in borderline personality disorder: a multicenter randomized controlled clinical trial |
| title_full_unstemmed | A mechanism-based group psychotherapy approach to aggressive behavior (MAAP) in borderline personality disorder: a multicenter randomized controlled clinical trial |
| title_short | A mechanism-based group psychotherapy approach to aggressive behavior (MAAP) in borderline personality disorder: a multicenter randomized controlled clinical trial |
| title_sort | mechanism based group psychotherapy approach to aggressive behavior maap in borderline personality disorder a multicenter randomized controlled clinical trial |
| topic | Anger Reactive aggression Aggressive behavior Borderline personality disorder Group psychotherapy Dialectic behavior therapy |
| url | https://doi.org/10.1186/s13063-025-08985-6 |
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