The Effectiveness of 6 versus 12 Months of Dialectical Behavior Therapy for Borderline Personality Disorder: A Noninferiority Randomized Clinical Trial

Abstract

<b><i>Introduction:</i></b> Evidence-based psychotherapies for borderline personality disorder (BPD) are lengthy, posing a barrier to their access. Brief psychotherapy may achieve comparable outcomes to long-term psychotherapy for BPD. Evidence is needed regarding the comparative effectiveness of short- versus long-term psychotherapy for BPD. <b><i>Objective:</i></b> The aim was to determine if 6 months of Dialectical Behavior Therapy (DBT) is noninferior to 12 months of DBT in terms of clinical effectiveness. <b><i>Methods:</i></b> This two-arm, single-blinded, randomized controlled noninferiority trial with suicidal or self-harming patients with BPD was conducted at two sites in Canada. Participants (<i>N</i> = 240, <i>M</i> (SD)<sub>age</sub> = 28.27 (8.62), 79% females) were randomized to receive either 6 (DBT-6) or 12 months (DBT-12) of comprehensive DBT. Masked assessors obtained measures of clinical effectiveness at baseline and every 3 months, ending at month 24. DBT-6 and DBT-12 were outpatient treatments consisting of weekly individual therapy sessions, weekly DBT skills training group sessions, telephone consultation as needed, and weekly therapist consultation team meetings. <b><i>Results:</i></b> The noninferiority hypothesis was supported for the primary outcome, total self-harm (6 months: margin = −1.94, <i>M</i><sub>diff</sub> [95% CI] = 0.16 [−0.14, 0.46]; 12 months: margin = −1.47, <i>M</i><sub>diff</sub> [95% CI] = 0.04 [−0.17, 0.23]; 24 months: margin = −1.25, <i>M</i><sub>diff</sub> [95% CI] = 0.12 [−0.02, 0.36]). Results also supported noninferiority of DBT-6 for general psychopathology and coping skills at 24 months. Furthermore, DBT-6 participants showed more rapid reductions in BPD symptoms and general psychopathology. There were no between-group differences in dropout rates. <b><i>Conclusions:</i></b> The noninferiority of a briefer yet comprehensive treatment for BPD has potential to reduce barriers to treatment access.

BPD compass: A randomized controlled trial of a short-term, personality-based treatment for borderline personality disorder.

“…Furthermore, extant treatments for BPD typically require extensive training for therapists and, as a result, access to specialist providers with the expertise in providing these more intensive, evidence-based treatments for BPD is limited (Iliakis et al, 2019). Thus, less intensive treatments may be appropriate and more accessible for many people with BPD, and, in fact, shorter courses of care that can be easily applied in generalist mental health settings are efficacious for this population (e.g., Black et al, 2004;Gunderson et al, 2018;Laporte et al, 2018;Zanarini et al, 2017), including for individuals who endorse acute suicide risk (McMain et al, 2009(McMain et al, , 2022.…”

Mentalizing the therapist – Therapist experiences with short-term mentalization-based therapy for borderline personality disorder: A qualitative study

“…Whether patients with more severe personality pathology (or psychopathology in general) need longer treatment is still unknown ( 36 ). A randomized clinical trial assessing the effects of six versus 12 months of dialectical behavioral therapy (DBT) for BPD patients was recently published ( 37 ) in which it was concluded, that short-term DBT was non-inferior to long-term DBT when assessing the primary outcome, total self-harm, as well as other secondary outcomes. Hence, whether this could be true for MBT as well is still unknown.…”

Implementation of a brief online skills group of dialectical behaviour therapy for emotional dysregulation in Latinx: a withdrawal experimental single-case design

“…One explanation is that a larger treatment dose may be necessary to ensure lasting change in all the areas measured by the GEDM such as changing invalidating environments, approaching emotions in the present moment with flexibility, and stabilizing longstanding erratic and unpredictable behaviours (Newhill et al ., 2004). Eight DBT group and individual sessions are a relatively small dose, given that the evidence base for this therapy is based upon the standard program with weekly individual and group therapy over 12 months (Linehan et al ., 1991; Linehan et al ., 1999) or more recently, a briefer 6-month program (McMain et al ., 2022; Pasieczny and Connor, 2011; Stanley et al ., 2007).…”