Dialectical behaviour therapy v. mentalisation-based therapy for borderline personality disorder

Abstract

BackgroundDialectical behaviour therapy (DBT) and mentalisation-based therapy (MBT) are both widely used evidence-based treatments for borderline personality disorder (BPD), yet a head-to-head comparison of outcomes has never been conducted. The present study therefore aimed to compare the clinical outcomes of DBT v. MBT in patients with BPD.MethodsA non-randomised comparison of clinical outcomes in N = 90 patients with BPD receiving either DBT or MBT over a 12-month period.ResultsAfter adjusting for potentially confounding differences between participants, participants receiving DBT reported a significantly steeper decline over time in incidents of self-harm (adjusted IRR = 0.93, 95% CI 0.87–0.99, p = 0.02) and in emotional dysregulation (adjusted β = −1.94, 95% CI −3.37 to −0.51, p < 0.01) than participants receiving MBT. Differences in treatment dropout and use of crisis services were no longer significant after adjusting for confounding, and there were no significant differences in BPD symptoms or interpersonal problems.ConclusionsWithin this sample of people using specialist personality disorder treatment services, reductions in self-harm and improvements in emotional regulation at 12 months were greater amongst those receiving DBT than amongst those receiving MBT. Experimental studies assessing outcomes beyond 12 months are needed to examine whether these findings represent differences in the clinical effectiveness of these therapies.

Exploring the Effectiveness of Dialectical Behavior Therapy Versus Systems Training for Emotional Predictability and Problem Solving in a Sample of Patients With Borderline Personality Disorder

“…These results are in line with those found by Barnicot and Crawford (2019), where they compared DBT versus MBT in a nonrandomized comparison in 90 patients with BPD over a 12-month period. The results of the current study showed reductions in self-harm and improvements in emotional regulation were greater among those receiving DBT than among those receiving MBT.…”

“…Although numerous RCTs using DBT have been published, in many studies this treatment program is compared with a waiting list condition (Safer et al, 2001) or with TAU (Blum et al, 2008;Linehan, Armstrong, Suarez, Allmon, & Heard, 1991;Priebe et al, 2012) or a delayed-treatment control (Hill, Craighead, & Safer, 2011). Few studies have compared the differential efficacy of the application of DBT with other active treatment programs, such as DBT versus mentalization-based treatment (MBT) (Barnicot & Crawford, 2019). Thus, it is necessary to compare DBT versus other active treatment programs, in order to evaluate which is more effective in resolving specific problems.…”

Psychotherapy for Borderline Personality Disorder: Does the Type of Treatment Make a Difference?

“…[32] A third RCT suggested that MBT produced similar gains in clinical outcomes to DBT. [33] Tests of MBT's effectiveness in ordinary practice settings are also positive. [34,35] Nevertheless, other results have been somewhat less encouraging; a randomized, partly controlled study of MBT compared with supportive psychotherapy showed similar outcomes between treatments on all but one primary outcome measure, [36] and another recent RCT suggested no difference in outcome between MBT and "specialist treatment as usual."…”

“…[71,72] Similarly, DBT, not just TFP, shows favorable outcomes for self-concept coherence and defensive functioning. [33,73,74] Even though some studies show differences between treatments in rates of improvement for different symptoms, these effects are inconsistent from trial to trial and sometimes from one measurement to another. For instance, a recent non-randomized trial found that DBT led to faster reductions in self-harm than MBT, but by the end of the study both treatments had achieved the same degree of reduction in this symptom.…”

“…For instance, a recent non-randomized trial found that DBT led to faster reductions in self-harm than MBT, but by the end of the study both treatments had achieved the same degree of reduction in this symptom. [33] As others have pointed out, the specialized, evidence-based psychotherapies for BPD named above -DBT, MBT, ST, and TFP -also have several elements in common. [63,[75][76][77] First, they all explicate a coherent model of the disorder within the therapy (despite the lack of agreement among treatments about these models themselves).…”