Abstract
Objective: Deliberate self-harm (DSH), general hospital admission and psychiatric hospital admission are common in women meeting criteria for borderline personality disorder (BPD). Dialectical behaviour therapy (DBT) has been reported to be effective in reducing DSH and hospitalization.
Method: A randomized controlled trial of 73 female subjects meeting criteria for BPD was carried out with intention-to-treat analyses and per-protocol analyses. The intervention was DBT and the control condition was treatment as usual plus waiting list for DBT (TAU+WL), with outcomes measured after 6 months. Primary outcomes were differences in proportions and event rates of: any DSH; general hospital admission for DSH and any psychiatric admission; and mean difference in length of stay for any hospitalization. Secondary outcomes were disability and quality of life measures.
Results: Both groups showed a reduction in DSH and hospitalizations, but there were no significant differences in DSH, hospital admissions or length of stay in hospital between groups. Disability (days spent in bed) and quality of life (Physical, Psychological and Environmental domains) were significantly improved for the DBT group.
Conclusion: DBT produced non-significant reductions in DSH and hospitalization when compared to the TAU+WL control, due in part to the lower than expected rates of hospitalization in the control condition. Nevertheless, DBT showed significant benefits for the secondary outcomes of improved disability and quality of life scores, a clinically useful result that is also in keeping with the theoretical constructs of the benefits of DBT.
Acknowledgements
Our thanks go to several people for their contributions to the Hunter DBT Project: Dr Chris Hayes, University of Newcastle and Ms Susan Burgoyne as investigators in the initial project development; to Peter Sneesby as Masters of Clinical Psychology student, University of Newcastle, assisting with the initial phases of data collection; to Natalia Carter and Gillian Maddock who helped with data extraction from the clinical records; to Dr Kerrie Clover, University of Newcastle, for assistance with instrument scoring and data cleaning; and to Ben Britton who assisted with linear mixed effect models. Our thanks also go to all the staff who contributed clinical services: individual therapists Danielle Adams, Marianne Ayre, Dr Nick Bendit, Susan Burgoyne, Jennifer Evans, Dr Howard Johnson, Jennifer Koorey, Natalie McCall, Chris McCrory, Jane Taylor and Chris Willcox; and skills trainers Marianne Ayre, Dr Nick Bendit, Linda Bragg, Michael Currie, Annabel Kelly, Michelle Meyer, Ruth Spence and Don Stewart; and also to Dr Neil Port and Dr Howard Johnson, who undertook the baseline clinical interviews. We also appreciated the input from external honorary consultants Dr Marsha Linehan and Dr Kelly Koerner, University of Washington, USA; and several episodes of supplementary training of DBT therapists by Dr Kate Comtois and Dr Kelly Koerner, University of Washington, USA. Finally, without the support and clinical leadership of Dr Howard Johnson, Director of the Centre for Psychotherapy, this study would not have been possible.
Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.