Effectiveness of online family connections for family members of people with BPD: a naturalistic comparison with the face-to-face format

INTRODUCTION: Borderline Personality Disorder (BPD) is a common condition with significant negative impacts on relatives due to its interpersonal instability and suicidal behaviors. Family Connections (FC) is currently the most empirically supported intervention for family members of individuals with BPD. However, access to FC remains limited. Online delivery could overcome geographic barriers, as digital formats have shown efficacy in psychotherapies for patients, though little is known about their effectiveness for family-oriented interventions. During the COVID-19 crisis, rapid adaptations of psychotherapeutic programs such as FC to online formats created an opportunity to collect data. This study aimed to compare the effectiveness of the online FC with face-to-face format. METHOD: This multicenter naturalistic study extended a previous project involving French-speaking FC participants. The program was first delivered face-to-face (n = 141) and then online (n = 27). FC is a 12-week group intervention providing psychoeducation about BPD and teaching coping skills derived from Dialectical Behavior Therapy. RESULTS: Groups were comparable at baseline, except for certain variables. Controlling for baseline scores, multiple linear regressions showed no significant group differences for post-intervention burden (b=-0.59, p = 0.825) or depression (b = 1.37, p = 0.398). However, the online group improved more in emotion dysregulation (b=-9.05, p = 0.003) but less in coping (b=-0.79, p < 0.000). DISCUSSION: Findings support the online FC format as comparably effective to the face-to-face version, suggesting its potential to enhance accessibility without compromising outcomes. Replication in randomized designs is warranted.