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

Abstract

Background: A primary goal of dialectical behaviour therapy (DBT) is to reduce self-harm, but findings from empirical studies are inconclusive. The aim of this study was to assess the effectiveness and cost-effectiveness of DBT in reducing self-harm in patients with personality disorder. Methods: Participants with a personality disorder and at least 5 days of self-harm in the previous year were randomised to receive 12 months of either DBT or treatment as usual (TAU). The primary outcome was the frequency of days with self-harm; secondary outcomes included borderline personality disorder symptoms, general psychiatric symptoms, subjective quality of life, and costs of care. Results: Forty patients each were randomised to DBT and TAU. In an intention-to-treat analysis, there was a statistically significant treatment by time interaction for self-harm (incidence rate ratio 0.91, 95% CI 0.89–0.92, p < 0.001). For every 2 months spent in DBT, the risk of self-harm decreased by 9% relative to TAU. There was no evidence of differences on any secondary outcomes. The economic analysis revealed a total cost of a mean of 5,685 GBP (6,786 EUR) in DBT compared to a mean of 3,754 GBP (4,481 EUR) in TAU, but the difference was not significant (95% CI –603 to 4,599 GBP). Forty-eight per cent of patients completed DBT. They had a greater reduction in self-harm compared to dropouts (incidence rate ratio 0.78, 95% CI 0.76–0.80, p < 0.001). Conclusions: DBT can be effective in reducing self-harm in patients with personality disorder, possibly incurring higher total treatment costs. The effect is stronger in those who complete treatment. Future research should explore how to improve treatment adherence.

Psychosocial interventions following self-harm in adults: a systematic review and meta-analysis

“…For information on the effectiveness of the remaining interventions not covered in this report the reader is instead referred to our review in the Cochrane Library. 13 A total of 29 trials were therefore included in the present review (Figure 1; Supplementary Document SD3), comprising 18 trials of cognitive behavioural-based psychotherapy (CBT), [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] three trials of dialectical behaviour therapy (DBT), [36][37][38] and four trials each of case management [39][40][41][42] and postcards. [43][44][45][46] (Insert Figure 1 about here)…”

“…[36][37][38] There was no evidence of a significant treatment effect for DBT on the proportions of participants repeating self-harm at post-intervention (OR 0·59, 95% CI 0·16 to 2·15; N=267; Figure 4) nor at 12 months in two of these trials (OR 0·36, 95% CI 0·05 to 2·47; N=172; Figure 4). There was no evidence of a significant treatment effect for DBT on suicide at postintervention, although only one such event was observed (OR 3·00, 95% CI 0·12 to 76·49; N=317; Figure 4).…”

Psychoeducation with problem-solving (PEPS) therapy for adults with personality disorder: a pragmatic randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of a manualised intervention to improve social functioning

“…Economic evaluations of interventions for PD are few in number, although cost-effectiveness analyses of specific therapies, psychotherapy more generally and whole programmes have been conducted. [74][75][76] The objectives of the economic evaluation in this study were:…”

Økonomisk evaluering av behandling for ungdom med villet egenskade – hvorfor og hvordan?

“…DBT medførte også noe (men ikke signifikant) høy-ere totale behandlingskostnader fordi DBT-gruppen mottok mer psykoterapi. DBT hadde altså en bedre behandlingsmessig effekt (med hensyn til reduksjon av selvskading), men kanskje til en noe høyere kostnad (Priebe et al, 2012).…”