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Personalized digital training to enhance personality functioning during psychotherapy for depression: Protocol for a randomized controlled pilot trial (PERFUNC-PILOT)
ABSTRACT
Background:
Psychotherapy for depressed patients with comorbid impairments in personality functioning has proven less effective than for those without personality dysfunction, leaving patients with higher symptom load at discharge and more frequent readmissions. The introduction of the dimensional model of personality functioning in the ICD-11 and DSM-5 offers opportunities to develop new approaches for improving personality functioning. Digital interventions for depression as well as for personality disorders have been effective in reducing symptom load, but digital interventions using the new conceptualization of personality disorders are still lacking. This study addresses this gap by evaluating the newly developed digital blended-care intervention PERFUNC, for patients with depression and comorbid personality functioning in an inpatient setting as well as after discharge.
Objective:
The aim of this pilot study is to evaluate the feasibility, acceptance and preliminary indicators of efficacy of the digital blended-care intervention PERFUNC in a randomized controlled pilot trial.
Methods:
In this multicenter randomized controlled feasibility trial N=40 patients diagnosed with a depressive disorder and a comorbid personality dysfunction are randomly assigned to either the intervention group (hospital treatment as usual + PERFUNC, n=20) or the control group (hospital treatment as usual n=20). PERFUNC includes a web-based program with five modules, with exercises to improve key personality domains as well as a daily monitoring to foster self-reflection. Feasibility metrics (e.g. recruitment, utilization) will be assessed throughout the usage of PERFUNC and clinical outcomes will be assessed at baseline, discharge, and 12 weeks after discharge.
Results:
The development of PERFUNC was finalized in January 2025. Recruitment and data collection started in April 2025 and are ongoing. Data collection is expected to be completed in December 2026 and results for this pilot study are expected in 2027.
Conclusions:
PERFUNC was developed to enhance therapeutic outcomes of depressed patients with a comorbid personality dysfunction, support continuity of care and reduce the relapse risk in a population with high clinical need. The findings of this pilot study will provide insights into the feasibility and accessibility of PERFUNC and will inform the planning of a subsequent confirmatory randomized controlled trial. Clinical Trial: German Clinical Trials Register ID: DRKS00034953; https://www.drks.de/DRKS00034953.
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