EXPLORING THE EFFECTIVENESS OF SCHEMA-FOCUSED THERAPY (SFT) IN MANAGING BORDERLINE PERSONALITY DISORDER IN PAKISTAN: THE ROLE OF SOCIO-CULTURAL FACTORS AND MENTAL HEALTH ACCESSIBILITY

Abstract

Background: Borderline Personality Disorder (BPD) is a complex psychiatric condition characterized by emotional instability, impulsivity, and interpersonal dysfunction, significantly impairing an individual’s quality of life. While Schema-Focused Therapy (SFT) has demonstrated efficacy in Western populations, its applicability in culturally diverse settings remains underexplored. In Pakistan, socio-cultural barriers, including stigma, family influence, gender norms, and limited access to mental health care, pose significant challenges to treatment engagement. Understanding these factors is crucial for adapting SFT to the Pakistani context and improving therapeutic outcomes.

Objective: This study aimed to evaluate the effectiveness of SFT in treating BPD in Pakistan and to examine the influence of socio-cultural factors on treatment engagement, accessibility, and outcomes.

Methods: A mixed-methods design was employed, integrating quantitative and qualitative analyses. The study recruited 30 clinically diagnosed BPD patients using purposive sampling, ensuring representation from both urban and rural settings. Participants underwent 12–16 weekly SFT sessions, with therapy adapted to accommodate cultural considerations. Standardized psychometric assessments, including the Borderline Personality Disorder Severity Index (BPDSI), Global Assessment of Functioning (GAF), and Outcome Questionnaire-45 (OQ-45), were conducted at baseline and post-treatment. Additionally, semi-structured interviews and focus group discussions explored patients' experiences, cultural influences, and barriers to mental health care. Quantitative data were analyzed using paired-sample t-tests, while qualitative data underwent thematic analysis to identify recurring patterns.

Results: Post-treatment assessments revealed a statistically significant reduction in BPD symptoms. The mean BPDSI score decreased from 45.7 to 25.2 (p < 0.001), indicating improved emotional regulation and reduced impulsivity. Psychological functioning improved, as reflected by an increase in GAF scores from 40.5 to 65.3 (p < 0.001). Overall well-being showed marked enhancement, with OQ-45 scores decreasing from 72.4 to 48.1 (p < 0.001). Qualitative findings highlighted key socio-cultural influences on therapy, including family involvement, mental health stigma, gender expectations, and disparities in mental health accessibility. Rural participants reported greater barriers to therapy, including logistical challenges and cultural resistance, while urban participants exhibited better engagement.

Conclusion: SFT proved to be an effective therapeutic intervention for BPD in Pakistan, demonstrating substantial symptom reduction and improved psychological well-being. However, socio-cultural barriers significantly influenced treatment engagement and outcomes. To enhance the effectiveness of SFT, culturally adaptive strategies such as family psychoeducation, stigma reduction initiatives, teletherapy expansion, and gender-sensitive therapeutic approaches should be integrated into mental health care frameworks in Pakistan.