Which Factors Are Relevant for Treatment Outcome in Dialectical Behaviour Therapy for Borderline Personality Disorder?
Study Details
Study Description
Brief Summary
The objective of this project is to investigate factors that contribute to the success and lack of success in DBT among individuals with BPD and a history of self-harm in a clinical psychiatric setting.
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Do certain personality factors and identity disturbance predict the treatment outcome of DBT in individuals with BPD?
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Do changes in identity disturbance, self-hate, or emotion regulation mediate the treatment outcome of DBT in individuals with BPD?
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Do specific personality profiles moderate the treatment outcomes of DBT for individuals with BPD?
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When does the primary treatment effect occur, and does this effect persist after a 12-month follow-up period?
Condition or Disease | Intervention/Treatment | Phase |
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Detailed Description
Borderline Personality Disorder (BPD) is a complex and enduring mental health condition characterized by a range of symptoms. The consequences of BPD are severe, causing individual suffering, impairments in daily functioning, and increased mortality rates. Dialectical behavior therapy (DBT) is one of the most widely used treatment models for BPD and self-harm. DBT has demonstrated positive outcomes but not all individuals benefit equally from this therapy, highlighting the need for further exploration. Specifically, there is a knowledge gap regarding what predicts positive treatment response. Research exploring this topic, has highlighted the potential significance of emotion regulation, personality profiles, self-concept, and identity disturbance in understanding the outcomes of individuals with BPD.
The primary objective of this research project is to investigate the factors that contribute to the success and lack of success in DBT.
All individuals referred to DBT-treatment in the Adult psychiatric clinic in Lund will be offered participation in the study. All study participants receive the same treatment as those who chose not to participate. Measures will commence after treatment contracts have been negotiated and the treatment will continue up to a maximum treatment length of one year.
Data will be retrieved from databases, medical records as well as collected as self-report forms. Self-report measures will be conducted every three months, at end of treatment and at follow up 12 months after end of treatment. Data from registries and charts will be collected at time of consent and at follow up 12 months after treatment.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Individuals with BPD Individuals with BPD, as defined by the DSM-V, and a recent history (past 12 months) of self-harming behaviour. |
Behavioral: Dialectibal Behaviour Therapy
Standard Dialectical Behaviour Therapy of up to 12 months as described Professor Linehan
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Outcome Measures
Primary Outcome Measures
- Five Self-harm Behaviour Groupings Measure (5S-HM) [Treatment start, 3,6,9 and at end of treatment and at follow up at 24 months.]
Indirect and direct self-harm
Secondary Outcome Measures
- The World Health Organization Disability Assessment Schedule II (WHODAS 2) [Treatment start, 3,6,9 and at end of treatment and at follow up at 24 months.]
Daily functioning and impairment
- The Borderline Symptom List-23 (BSL-23) [Treatment start, 3,6,9 and at end of treatment and at follow up at 24 months.]
Borderline symptoms
- The Level of Personality Functioning Scale-Brief Form 2.0 (LPFS 2.0) [Treatment start, 3,6,9 and at end of treatment and at follow up at 24 months.]
Personality functioning
- The Personality Inventory for DSM-V Brief Form (PID-5-BF) [Treatment start, 3,6,9 and at end of treatment and at follow up at 24 months.]
Personality structure
- Hospitilization days [Treatment at end of treatment and at follow up at 24 months.]
Days admitted to a psychiatric ward past year
Eligibility Criteria
Criteria
Inclusion Criteria:
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Borderline personality disorder as defined by the DSM-V
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Self-harm over the past 12 months
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Offered DBT at the Lund adult psychiatric clinic
Exclusion Criteria:
- Unable to read or communicate in Swedish
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | Lund adult psychiatric hospital | Lund | Skåne | Sweden | 22185 |
Sponsors and Collaborators
- Region Skane
- Department of Clinical Sciences, Malmö. Faculty of Medicine, Lund University.
- Department of Psychology. Lund University.
- University of Toronto
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
- Alvarez-Tomas I, Ruiz J, Guilera G, Bados A. Long-term clinical and functional course of borderline personality disorder: A meta-analysis of prospective studies. Eur Psychiatry. 2019 Feb;56:75-83. doi: 10.1016/j.eurpsy.2018.10.010. Epub 2018 Dec 24.
- Chen SY, Cheng Y, Zhao WW, Zhang YH. Effects of dialectical behaviour therapy on reducing self-harming behaviours and negative emotions in patients with borderline personality disorder: A meta-analysis. J Psychiatr Ment Health Nurs. 2021 Dec;28(6):1128-1139. doi: 10.1111/jpm.12797. Epub 2021 Sep 20.
- Cipriano A, Cella S, Cotrufo P. Nonsuicidal Self-injury: A Systematic Review. Front Psychol. 2017 Nov 8;8:1946. doi: 10.3389/fpsyg.2017.01946. eCollection 2017.
- Ellison WD, Rosenstein LK, Morgan TA, Zimmerman M. Community and Clinical Epidemiology of Borderline Personality Disorder. Psychiatr Clin North Am. 2018 Dec;41(4):561-573. doi: 10.1016/j.psc.2018.07.008. Epub 2018 Oct 16.
- Gad MA, Pucker HE, Hein KE, Temes CM, Frankenburg FR, Fitzmaurice GM, Zanarini MC. Facets of identity disturbance reported by patients with borderline personality disorder and personality-disordered comparison subjects over 20 years of prospective follow-up. Psychiatry Res. 2019 Jan;271:76-82. doi: 10.1016/j.psychres.2018.11.020. Epub 2018 Nov 10.
- Gratz KL, Bardeen JR, Levy R, Dixon-Gordon KL, Tull MT. Mechanisms of change in an emotion regulation group therapy for deliberate self-harm among women with borderline personality disorder. Behav Res Ther. 2015 Feb;65:29-35. doi: 10.1016/j.brat.2014.12.005. Epub 2014 Dec 13.
- Kaufman EA, Meddaoui B. Identity pathology and borderline personality disorder: an empirical overview. Curr Opin Psychol. 2021 Feb;37:82-88. doi: 10.1016/j.copsyc.2020.08.015. Epub 2020 Aug 25.
- Kroger C, Harbeck S, Armbrust M, Kliem S. Effectiveness, response, and dropout of dialectical behavior therapy for borderline personality disorder in an inpatient setting. Behav Res Ther. 2013 Aug;51(8):411-6. doi: 10.1016/j.brat.2013.04.008. Epub 2013 May 14.
- Krueger RF, Derringer J, Markon KE, Watson D, Skodol AE. Initial construction of a maladaptive personality trait model and inventory for DSM-5. Psychol Med. 2012 Sep;42(9):1879-90. doi: 10.1017/S0033291711002674. Epub 2011 Dec 8. Erratum In: Psychol Med. 2012 Sep;42(9):1891.
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- McMain SF, Fitzpatrick S, Boritz T, Barnhart R, Links P, Streiner DL. Outcome Trajectories and Prognostic Factors for Suicide and Self-Harm Behaviors in Patients With Borderline Personality Disorder Following One Year of Outpatient Psychotherapy. J Pers Disord. 2018 Aug;32(4):497-512. doi: 10.1521/pedi_2017_31_309. Epub 2017 Sep 14.
- Mehlum L. Mechanisms of change in dialectical behaviour therapy for people with borderline personality disorder. Curr Opin Psychol. 2021 Feb;37:89-93. doi: 10.1016/j.copsyc.2020.08.017. Epub 2020 Aug 25.
- Meuldijk D, McCarthy A, Bourke ME, Grenyer BF. The value of psychological treatment for borderline personality disorder: Systematic review and cost offset analysis of economic evaluations. PLoS One. 2017 Mar 1;12(3):e0171592. doi: 10.1371/journal.pone.0171592. eCollection 2017.
- Schmitgen MM, Niedtfeld I, Schmitt R, Mancke F, Winter D, Schmahl C, Herpertz SC. Individualized treatment response prediction of dialectical behavior therapy for borderline personality disorder using multimodal magnetic resonance imaging. Brain Behav. 2019 Sep;9(9):e01384. doi: 10.1002/brb3.1384. Epub 2019 Aug 14.
- van Asselt AD, Dirksen CD, Arntz A, Severens JL. The cost of borderline personality disorder: societal cost of illness in BPD-patients. Eur Psychiatry. 2007 Sep;22(6):354-61. doi: 10.1016/j.eurpsy.2007.04.001. Epub 2007 Jun 4.
- Weekers LC, Hutsebaut J, Kamphuis JH. The Level of Personality Functioning Scale-Brief Form 2.0: Update of a brief instrument for assessing level of personality functioning. Personal Ment Health. 2019 Feb;13(1):3-14. doi: 10.1002/pmh.1434. Epub 2018 Sep 19.
- Woodbridge J, Reis S, Townsend ML, Hobby L, Grenyer BFS. Searching in the dark: Shining a light on some predictors of non-response to psychotherapy for borderline personality disorder. PLoS One. 2021 Jul 27;16(7):e0255055. doi: 10.1371/journal.pone.0255055. eCollection 2021.
- Dnr 2023-03990-01