Predictors of Dropout From a 20-Week Dialectical Behavior Therapy Skills Group for Suicidal Behaviors and Borderline Personality Disorder

Abstract

Treatment dropout among individuals with borderline personality disorder (BPD) is associated with negative psychosocial outcomes. Identifying predictors of dropout among this population is critical to understanding how to improve treatment retention. The present study extends the current literature by examining both static and dynamic predictors of dropout. Chronically suicidal outpatients diagnosed with BPD (N = 42) were randomly assigned to a 20-week dialectical behavior therapy (DBT) skills training group. Static and dynamic predictors were assessed at baseline, 5, 10, 15, 20 weeks, and 3 months post-intervention. A post-hoc two-stage logistic regression analysis was conducted to predict dropout propensity. Receiving disability benefits at baseline and decreases in mindfulness were associated with significantly increased probability of dropout. Clinicians working with chronically self-harming outpatients diagnosed with BPD would benefit from prioritizing clinical interventions that enhance mindfulness in order to decrease dropout propensity.

The relationship between the therapeutic alliance in psychotherapy and suicidal experiences: A systematic review

“…However, in two studies, there was a non‐significant relationship between number of suicide attempts prior to group psychotherapy and therapeutic alliance measured in Session 1 (Stratton et al, 2020; Tsai et al, 2014) and Session 5 (Tsai et al, 2014). In a third study, frequency of lifetime suicide attempts at baseline had no relationship with the therapeutic alliance after 3 months of psychotherapy (Goldman & Gregory, 2009).…”

“…Power was possibly compromised in four studies where the primary study aim did not include examining the relationship between the therapeutic alliance and suicidal experiences (Goldman & Gregory, 2009; Haddock et al, 2019; Ibrahim et al, 2018; Stratton et al, 2020). Two studies included variables of suicidal ideation (Ibrahim et al, 2018) or suicide attempts (Stratton et al, 2020) as one of nine covariates. Furthermore, the Goldman and Gregory (2009) study was considerably underpowered to detect a significant relationship with data only available for eight or five participants in respective analyses.…”

“…of suicide attempts prior to psychotherapy and therapeutic alliance measured at the first psychotherapy session(Gysin-Maillart et al, 2017), but by the third session, this negative relationship had diminished. Notably, only three or four sessions were offered as part of this specific psychotherapy.However, in two studies, there was a non-significant relationship between number of suicide attempts prior to group psychotherapy and therapeutic alliance measured in Session 1(Stratton et al, 2020;Tsai et al, 2014) and Session 5(Tsai et al, 2014). In a third study, T A B L E 2 (Continued) same RCT sample.…”

The Effectiveness of Group Dialectical Behavior Therapy on Borderline Personality Disorder: A Systematic Review

“…Although group DBT has been proved to be effective in treating patients with BPD, there are still some aspects of concern. At a college counselling service, a pilot study has been conducted on 17 college students with BPD using short-term DBT, revealing a reduction in symptoms of depression and BPD symptoms and an increase in adaptive coping skills such as problemsolving and constructive self-talk, but no reduction in anxiety [17]. This peculiar result suggests that DBT may work better on some certain outcomes rather than others.…”

فاعلیة برنامج إرشادی سلوکی جدلی فی خفض السلوک الاندفاعی لدى طلاب الجامعة ذوی أعراض اضطراب الشخصیة الحدیة

“…‫ثبُ‬ ‫٣ْؼو‬ ‫ؽ٤ش‬ ‫ّ٢ء،‬ ًَ ‫ك٢‬ ‫مار٢‬ ‫ّؼٞه‬ ‫ُل٣ٚ‬ ٌ٤ُ ‫ٝأٗٚ‬ ‫اُؾلٝك‬ ‫ٓؼوكخ‬ ‫اُٞاهغ‬ ‫ك٢‬ ‫لواؽ‬ (Stratton et al, 2020;Wetterborg, et al, 2020 (Linehan, 1993a;Harley, et al, 2016;Rathu & Miller, 2014 (Koerner & Dimeff, 2007;Linehan, 1993a; (Harley, et al, 2016;Linehan, 1993a;Rathu & Miller, 2014 (Buerger, et al, 2019;Keefe, et al, 2020;Guillén Botella, et al, 2020;Mohamadizadeh et al, 2018;Wetterborg, et al, 2020 (Bohus, et al, 2007;Bohus, et al, 2009 Berenson, et al, 2016;Euler, ( Terzi, et al, Lepouriel, et al, 2019;Richmond et al 2020;-Richard 19;et al, 20 2017) ‫اَُِٞى‬ ‫فل٘‬ ‫ك٢‬ ‫اُغلُ٢‬ ‫اًَُِٞ٢‬ ‫اُؼ٬ط‬ ‫ػِ٠‬ ‫هبئٔخ‬ ‫ئهّبك٣خ‬ ‫ثوآظ‬ ‫ر٘بُٝذ‬ ‫كهاٍبد‬ ‫ٜٝٓ٘ب‬ ، ‫ٓضَ:‬ ‫اُؾل٣خ،‬ ‫اُْقٖ٤خ‬ ‫اٙطواة‬ ‫أػواٗ‬ ‫مٝ١‬ ‫ُلٟ‬ ‫ا٫ٗلكبػ٢‬ (Buerger, et al, 2019; Wetterborg, et al, 2020) ‫أٗٞاع‬ ‫ٓغ‬ ‫اُغلُ٢‬ ‫اًَُِٞ٢‬ ‫اُؼ٬ط‬ ‫ثٔوبهٗخ‬ ‫اٛزٔذ‬ ‫كهاٍبد‬ ‫ٜٝٓ٘ب‬ ، ‫(ٓضَ:‬ ‫اُؼ٬عبد‬ ٖٓ ‫أفوٟ‬ ‫طبد)‬ َّ ‫قط‬ ُ ‫ثبُٔ‬ ‫ٝاُؼ٬ط‬ ‫اُؼٞاٛق،‬ ‫ر٘ظ٤ْ‬ ‫ػِ٢‬ ‫ٝاُزله٣ت‬ ‫اُلٝائ٢،‬ ‫اُؼ٬ط‬ ‫ٓضَ:‬ ‫ا٫ٗلكبػ٢،‬ ‫اَُِٞى‬ ‫ُقل٘‬ (Keefe, et al, 2020;Guillén Botella, et al, 2020;Mohamadizadeh et al, 2018) . (Keefe, et al, 2020;Guillén Botella, et al, 2020;Mohamadizadeh et al, 2018) .…”