Impact of therapist change after initial contact and traumatic burden on dropout in a naturalistic sample of inpatients with borderline pathology receiving dialectical behavior therapy

Abstract

BackgroundThis study focused on the predictors of therapy dropout in a naturalistic sample of patients with borderline pathology receiving dialectical behavior therapy (DBT) in an inpatient setting. We assumed that the change of the therapist between DBT-briefing and start of DBT-treatment as well as comorbid posttraumatic stress disorder (PTSD) and childhood trauma history were associated with elevated dropout.MethodsEighty-nine participants with borderline pathology (≥ 3 borderline personality disorder criteria) receiving an inpatient DBT program completed a quality assurance questionnaire set assessing demographic information and pretreatment psychopathology during the days of their inpatient stay. Beyond that, changes of therapists were documented. The predictor analyses were investigated with generalized estimating equations.ResultsThe dropout rate was 24.7%. A change of therapist between DBT-briefing and treatment as well as high childhood emotional abuse was associated with premature termination of treatment. Higher values of physical neglect during childhood were associated with a protective effect on treatment dropout. Surprisingly, this was also true for comorbid PTSD.ConclusionsThis study supports the importance of therapy process variables as predictors of therapy dropout in borderline pathology. A change of therapist between DBT-briefing and treatment was associated with an increased vulnerability for dropping out of treatment and should therefore be avoided if possible. Against our hypotheses, a comorbid PTSD was even protective with regard to DBT dropout. Therefore, this severely suffering patient group should not be rejected from treatment assuming them to be too unstable for psychotherapy. However, results need to be replicated. ClinicalTrials.gov Identifier: NCT03018639, retrospectively registered on January 9, 2017.

Childhood Trauma and Treatment Implications in Major Depressive Disorder in South Korea: Comparison with Medical Outpatients and Two-Year Follow-Up

“…One study noted and supported our finding in that CEA was by far the strongest ACE that discriminate the depressed patients from non-psychiatric control group [23]. Likewise, only a history of CEA not physical and sexual abuse mediated a relationship between adult life stress and depressive symptoms [24]. In addition, Hankin found that only CEA not physical and sexual abuse predicted later changes in depressive symptoms and that this was mediated by attachment style, negative life events and cognitive styles [25].…”

“…Another study found that dropout from psychotherapy for bulimia has been dose-dependently associated with childhood trauma but did not find specificity to certain types of trauma [38]. Steuwe et al [24] have reported that CEA was associated with dropout from dialectical behavior therapy among inpatients with borderline personality, whereas CPN was protective against dropout. This study is in line with our finding that only CEA stood out in terms of dropout from treatment, but it contradicted our report on the association of CPN was associated with less time stayed in therapy.…”

Narrative Exposure Therapy in Patients With Posttraumatic Stress Disorder and Borderline Personality Disorder in a Naturalistic Residential Setting: A Randomized Controlled Trial

“…The value of trauma-focused treatment in this patient group also becomes apparent in the dropout rates found in this study, which was significantly lower in NET. The high dropout rate in DBT-bt needs to be interpreted with caution, because DBT-bt is the standard treatment in our ward and the dropout rate is usually lower on our ward (45). NET was only available within the study conditions and it is nearly impossible for our seriously ill patients to access outpatient trauma-focused treatment.…”

Tagesklinische dialektisch-behaviorale Therapie: Eine Verlaufsuntersuchung nach Entlassung. Gibt es Prädiktoren für eine Verschlechterung?

“…Bedics et al [2015] konnten an 101 Frauen mit einer BPS über eine 1-JahresSpanne zeigen, dass die Stärke der therapeutischen Allianz die Suizidalität beeinflusst und damit auch den Therapieerfolg. Diese Ergebnisse konnten auch Steuwe et al [2017] replizieren. Links et al [2013] untersuchten das Suizidrisiko von 108 Teilnehmern eines 1-jährigen DBT-Programms.…”