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Dialectical Behavior Therapy Is Specifically Effective for Self-Destructive Behavior

It remains the first-line treatment for borderline personality disorder.

Dialectical behavior therapy (DBT), a form of combined individual and group cognitive-behavioral therapies, reduces self-destructive behaviors and those that interfere with treatment continuation in patients with borderline personality disorder. In a randomized study of DBT and community treatment by experts (CTBE) among 101 women with borderline personality disorder, researchers compared specific aspects of DBT with the nonspecific effects of treatment by highly experienced therapists.

DBT consisted of 1 hour weekly of individual therapy and 2.5 hours weekly of group skills training; the therapists had weekly group clinical supervision. In CTBE, local experts used their typical therapies for treating the disorder (at least one weekly session), with nonmandatory group clinical supervision. Current comorbidities included major depression (72% of patients), panic disorder (41%), PTSD (50%), and substance-use disorder (30%). Patients were evaluated every 4 months during 1 year of treatment and 1 year of follow-up.

Both groups had equivalent reductions in the rate of nonsuicidal self-injury and in mean depression scores over 2 years. Compared with CTBE recipients, DBT recipients had half the rate of suicide attempts, significantly decreased use of psychotropic medications, and significantly fewer emergency department visits and hospitalizations for psychiatric reasons. CTBE recipients were three times as likely to drop out as DBT recipients.

Comment: The use of skillful, experienced community therapists in the less-beneficial control arm suggests that the specific content of DBT accounts for its effectiveness. However, the study did not control for the amount of therapy, and no community therapists used cognitive-behavioral therapy. Other forms of cognitive-behavioral therapy, or more-frequent patient contact and use of group therapy, might produce results similar to DBT. Nevertheless, patients’ substantial comorbidities did not interfere with DBT’s effectiveness, and DBT should be considered a first-line treatment for this disorder.

— Steven Dubovsky, MD

Published in Journal Watch Psychiatry August 14, 2006

Citation(s):

Linehan MM et al. Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Arch Gen Psychiatry 2006 Jul; 63:757-66.

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