Predicting dropout in outpatient dialectical behavior therapy with patients with borderline personality disorder receiving psychiatric disability

Landes, Sara J.; Chalker, Samantha A.; Comtois, Katherine Anne

doi:10.1186/s40479-016-0043-3

Cited by 37 publications

(39 citation statements)

References 46 publications

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“…Strengths of the present research included the high consent and follow-up rates and recruitment of participants from multiple different services implementing DBT and MBT in a real-world setting, thus increasing the external validity of the findings. Drop-out rates from both treatment modalities, and in particular from DBT, were high, but in keeping with trials of MBT conducted by the treatment developers (Bateman & Fonagy, 1999 and with studies in which DBT was implemented in routine community services (Feigenbaum et al, 2012;Landes, Chalker, & Comtois, 2016;Priebe et al, 2012). Additionally, participants were followed up after treatment dropout, with intention-to-treat analysis used to ensure that treatment dropouts were well represented in the dataset.…”

Section: Discussionmentioning

confidence: 76%

Posttraumatic Stress Disorder in Patients With Borderline Personality Disorder: Treatment Outcomes and Mediators

Barnicot

Crawford

2018

Journal of Traumatic Stress

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Posttraumatic stress disorder (PTSD) is highly comorbid with personality disorder (PD). We evaluated whether comorbid PTSD has a negative effect on patients’ ability to benefit from evidence‐based psychological treatments for PD and tested potential mediators of any effect. The effect of PTSD on self‐harm and borderline PD symptoms was evaluated in 90 patients with borderline PD who were receiving dialectical behavior therapy or mentalization‐based therapy. Self‐report and interview measures were administered every 3 months over a 12‐month period. Three‐quarters of participants met criteria for PTSD. In the 12 months after beginning treatment, participants with PTSD did not engage in self‐harm more often or present with more severe borderline PD symptoms. However, a higher level of PTSD symptom severity at baseline was associated with more frequent self‐harm during follow‐up, incidence rate ratio = 1.03, 95% CI [1.01, 1.06], p = .005. Participants whose PTSD did not improve or worsened were more likely to still self‐harm, odds ratio (OR) = 0.91, 95 % CI [0.85, 0.97], p = .004, and report more severe borderline PD symptoms, b = 0.53, 95% CI [0.34, 0.73], p < .001, at the end of 12 months. The negative effects of PTSD symptoms remained significant after adjusting for potential confounders and were partially mediated by high ongoing levels of emotional dysregulation, indirect effect b = 0.32, 95% CI [0.19, 0.50]. These findings identify subgroups at risk of poorer outcomes from evidence‐based psychological treatments for PD and support the idea that treating PTSD may improve outcomes.

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Section: Discussionmentioning

confidence: 76%

Posttraumatic Stress Disorder in Patients With Borderline Personality Disorder: Treatment Outcomes and Mediators

Barnicot

Crawford

2018

Journal of Traumatic Stress

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“…Younger age has been associated with higher dropout rates [27, 29]. However, other studies did not find evidence for an influence of demographic factors [5].…”

Section: Introductionmentioning

confidence: 99%

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

Steuwe

Berg

Drießen

et al. 2017

bord personal disord emot dysregul

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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.

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“…We found better outcomes on borderline symptom severity and general psychopathology among young adults (18-25 years) with BPD 2 Series of one way between-group analyses of covariance comparing post-treatment scores on self-report measures among completers of young adult only DBT (n = 19) and similar aged young adult completers of general adult DBT (n = 11) after adjusting for baseline scores and prior hospitalization as covariates. Partial eta squared (η p 2 ) is used as a measure of effect size in both programmes (20.8% and 15.4%, respectively) was somewhat surprising since younger age has previously been associated with higher dropout for adults in DBT (Landes, Chalker, & Comtois, 2016).…”

Section: Discussionmentioning

confidence: 99%

Outcomes for 18 to 25‐year‐olds with borderline personality disorder in a dedicated young adult only DBT programme compared to a general adult DBT programme for all ages 18+

Lyng

Swales

Hastings

et al. 2019

Early Intervention Psych

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Aim: Targeting young adults with borderline personality disorder (BPD) for treatment may carry significant social and clinical benefits. We aimed to evaluate a community-based Dialectical Behaviour Therapy (DBT) programme delivered exclusively to young adults with BPD. Methods: We describe a naturally occurring non-equivalent, quasi-experimental comparison of outcomes for young adults (18-25 years) with BPD following 1 year of treatment in either a young adult only DBT programme or a general adult DBT programme (18+ years). Twenty-four young adults enrolled in a community-based young adult DBT programme open only to 18-to 25-year-olds with BPD. Another 13 young adults, also 18-25 years, enrolled in a general adult DBT programme open to all ages above 18 years. Both treatment conditions offered all modes of standard DBT for 1 year. Participants completed a battery of self-report measures on mental health symptoms at baseline and again at treatment completion after 1 year. Discharge rates at 2 years post-treatment completion were also recorded. Results: Better outcomes were found on borderline symptom severity and general psychopathology among completers of young adult DBT, with a large effect size for treatment condition as well as greater clinically significant change. Discharge rates from mental health services 24 months later were also higher for completers of young adult DBT. Conclusions: There may be advantages in delivering DBT to young adults in an age-specific programme, possibly due to group cohesion. Methodological limitations apply, such as small sample size and non-randomization. Further controlled research is needed. K E Y W O R D S 18-25-year-olds, borderline personality disorder, dialectical behaviour therapy, young adult

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Predicting dropout in outpatient dialectical behavior therapy with patients with borderline personality disorder receiving psychiatric disability

Cited by 37 publications

References 46 publications

Posttraumatic Stress Disorder in Patients With Borderline Personality Disorder: Treatment Outcomes and Mediators

Posttraumatic Stress Disorder in Patients With Borderline Personality Disorder: Treatment Outcomes and Mediators

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

Outcomes for 18 to 25‐year‐olds with borderline personality disorder in a dedicated young adult only DBT programme compared to a general adult DBT programme for all ages 18+

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