A new study analyzed the long-term effects of psychotherapy on borderline personality disorder. Authors report the effect of Dialectical Behavior Therapy (DBT) versus treatment-as-usual (TAU) on inpatient service use, and a follow-up 6 months after the end of treatment.
Data on psychiatric hospitalization were collected by interviewing patients at two monthly intervals using the Client Service Receipt Inventory, which was then triangulated with data from electronic patient records. In the year prior to treatment, 24 patients had been hospitalized with the number of inpatient days ranging from 0 to 365 (mean 20.5, SD 63.1).
The number of inpatient days in the year prior to treatment did not differ between conditions. During the 12-month intervention period, 2 patients allocated to
Dialectical Behavior Therapy
and 11 allocated to
were hospitalized. For the 2 patients hospitalized in the DBT condition, 1 was hospitalized following dropping out of Dialectical Behavior Therapy, while the other was a long-term inpatient when beginning DBT, and remained so for the first 3 months of treatment.
A logistic regression showed that the odds of hospitalization during the intervention period were significantly higher in patients allocated to the TAU condition. This difference remained significant after adjusting for whether patients had been hospitalized in the year prior to treatment.
A standardized self-harm interview was also used to assess self-harm frequency during the follow-up period. The mean number of days with self-harm in the last 2 months of treatment for DBT completers was 1.79 (SD 3.68) whilst the mean number of days with self-harm during the 6 months after treatment was 1 (SD 1.80), i.e. a rate of 0.33 days per 2-month period. A Wilcoxon signed-rank test showed that this was not a significant difference (z = 1.42, p = 0.16). No DBT completers had any inpatient hospitalizations during the 6-month follow-up period. For treatment dropouts, the rate of follow-up was too low (8 of 21 participants) to render statistical comparison valid.
These findings on hospitalization concur with international RCTs that have shown DBT can reduce hospitalization, but are in contrast with another UK RCT which found hospitalization days did not differ between DBT and TAU. Treatments which reduce the use of inpatient resources are particularly important, given that patients with Borderline Personality Disorder have been found in several studies to make greater use of inpatient psychiatric services than patients with major depressive disorder or other personality disorders.
The high healthcare costs (and presumably patient distress) resulting from such frequent hospitalization render the implementation of interventions that can reduce hospitalization an important priority for this patient group. They conclude DBT should be considered an effective intervention for keeping self-harming patients with BPD out of hospital, and that positive effects on self-harm and hospitalization are sustained once treatment is over.
Citation: Barnicot K, Savill M, Bhatti N, Priebe S. A Pragmatic Randomised Controlled Trial of Dialectical Behaviour Therapy: Effects on Hospitalisation and Post-Treatment Follow-Up. Psychother Psychosom 2014;83:192-193 DOI:10.1159/000357365
- PHYSICAL SCIENCES
- EARTH SCIENCES
- LIFE SCIENCES
- SOCIAL SCIENCES
Subscribe to the newsletter
Stay in touch with the scientific world!
Know Science And Want To Write?
- Sexual Fantasies: Threesomes Are Normal, Golden Showers Not So Much
- Ghost Light From Dead Galaxies - A Hubble Halloween
- Mediterranean Diet Linked To Better Kidney Health
- Greenpeace Says Its GMOs Are Better Than Science's GMOs, Still Hates Golden Rice
- Cyclone Nilofar Looks More Like A Comet
- US Wildlife Bans On GMOs And Neonics Lack Transparency And Scientific Rationale
- Game Theory: When Are Groups Social? Or Insufferable?
- "Always love reading your articles Hank :) and any knowledgeable person about science knows what..."
- "Ah - sorry, but regardless that this may be taken as disdain again by you, you seem to simply have..."
- "Twelve years in a major urban public school system, and I couldn't once bring myself to eat a school..."
- "Hardly a day goes by without some creative new take on the eternal Evil White Man meme. Without..."
- "There would be no controversy if it were all balloons and ponies stories like that. But I hope..."
- Battle of Britain: NGOs and scientists clash over proposal to loosen EU GMO restrictions
- Genetically modified clean energy from bacteria
- Designer babies: You can screen for cystic fibrosis but intelligence is a ways off
- Science as profane: What superstition of 1752 and 2014 share in common
- What’s so “natural” about “natural crop breeding”?
- Worried you have cancer? Take a Google pill!
- Report examines health care challenges for pregnant women enrolled in covered California
- NYU research: Majority of high school seniors favor more liberal marijuana policies
- ESA Frontiers November preview
- Sexual fantasies: Are you normal?
- Synthetic lethality offers a new approach to kill tumor cells, explains Moffitt researcher