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Randomized Controlled Trial
. 2022;91(6):382-397.
doi: 10.1159/000525102. Epub 2022 Jun 23.

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

Shelley F McMain  1   2 , Alexander L Chapman  3   4 , Janice R Kuo  5 , Katherine L Dixon-Gordon  6 , Timothy Henry Guimond  1   2 , Cathy Labrish  1 , Wanrudee Isaranuwatchai  7   8 , David L Streiner  2   9
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Free article
Randomized Controlled Trial

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

Shelley F McMain et al. Psychother Psychosom. 2022.
Free article

Abstract

Introduction: 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.

Objective: 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.

Methods: 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 (N = 240, M (SD)age = 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.

Results: The noninferiority hypothesis was supported for the primary outcome, total self-harm (6 months: margin = -1.94, Mdiff [95% CI] = 0.16 [-0.14, 0.46]; 12 months: margin = -1.47, Mdiff [95% CI] = 0.04 [-0.17, 0.23]; 24 months: margin = -1.25, Mdiff [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.

Conclusions: The noninferiority of a briefer yet comprehensive treatment for BPD has potential to reduce barriers to treatment access.

Keywords: Borderline personality disorder; Dialectical behavior therapy; Noninferiority; Psychotherapy outcome research; Suicidality.

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