Dialectical Behavior Therapy for Patients with Borderline Personality Disorder and Drug‐Dependence

Abstract

A randomized clinical trial was conducted to evaluate whether Dialectical Behavior Therapy (DBT), an effective cognitive-behavioral treatment for suicidal individuals with borderline personality disorder (BPD), would also be effective for drug-dependent women with BPD when compared with treatment-as-usual (TAU) in the community. Subjects were randomly assigned to either DBT or TAU for a year of treatment. Subjects were assessed at 4, 8, and 12 months, and at a 16-month follow-up. Subjects assigned to DBT had significantly greater reductions in drug abuse measured both by structured interviews and urinalyses throughout the treatment year and at follow-up than did subjects assigned to TAU. DBT also maintained subjects in treatment better than did TAU, and subjects assigned to DBT had significantly greater gains in global and social adjustment at follow-up than did those assigned to TAU. DBT has been shown to be more effective than treatment-as-usual in treating drug abuse in this study, providing more support for DBT as an effective treatment for severely dysfunctional BPD patients across a range of presenting problems.

Effectiveness and Cost-Effectiveness of Dialectical Behaviour Therapy for Self-Harming Patients with Personality Disorder: A Pragmatic Randomised Controlled Trial

“…This was statistically significant, and the 95% confidence interval indicated only a small margin of measurement error between 8 and 11%. The finding is congruous with two previous RCTs in which DBT was associated with a favourable reduction of self-harm over time [8,10], but in contrast to all other RCTs, which have failed to demonstrate an effect of DBT on self-harm [6,7,9,11,12,13]. …”

“…DBT therapists were found to be adherent to the DBT framework ensuring that the intervention delivered was DBT as prescribed by the treatment manual. In accordance with the pragmatic nature of the trial, the selection criteria and TAU condition were designed to reflect the real-world equivalents; this is in contrast to previous RCTs of DBT which employed stringent selection criteria, commonly excluding males [6,7,8,9,10,11] and those with a substance use disorder [6,8,12,13], and sometimes had unrepresentative and costly control conditions. Finally, this is the first RCT to assess the cost-effectiveness of DBT in the NHS in the UK, where all care is free at the point of entry and patients in TAU as well as dropouts of DBT have a range of alternative treatment options.…”

“…In retrospective recall, frequently occurring events over periods of 6 months are often underreported [34], and the regular data collection every 2 months allowed a more reliable and accurate measure of self-harm over a year-long course of DBT compared to when patients have to recall frequency of self-harm over longer periods of time [6,7,8,9,10,11,12,13]. Although more than 50% of patients in DBT did not start DBT or dropped out of treatment, outcome data were still obtained for most of the participants.…”

“…Of 8 RCTs, 2 found significant effects of DBT on the reduction of self-harm or suicidal behaviours, respectively [6,11] and a third showed that patients receiving DBT had a greater reduction in self-harm frequency over time than those receiving TAU [10]. The remaining 5 RCTs, however, found no significant effect of DBT on the frequency of self-harm [7,8,9,12,13]. Whilst early literature reviews painted a largely positive picture of the effects of DBT on self-harm reduction [3,15], recent thinking has been more cautious, including suggestions that DBT has been taken up by health care systems in both the USA and the UK relatively quickly despite minimal evidence [13].…”

“…In the UK, DBT is the only psychosocial treatment recommended by the National Institute for Health and Clinical Excellence as a treatment for women with BPD who engage in recurrent self-harm [5]. Empirical support for DBT has been demonstrated in a number of randomised controlled trials (RCTs) comparing DBT with control conditions including treatment as usual (TAU), comprehensive validation therapy and treatment by experts [6,7,8,9,10,11,12,13]. A meta-analysis of 16 DBT studies found a moderate effect size for DBT on self-harm in patients with BPD.…”