Comparison of 8-vs-12 weeks, adapted dialectical behavioral therapy (DBT) for borderline personality disorder in routine psychiatric inpatient treatment-A naturalistic study.


Journal

Scientific reports
ISSN: 2045-2322
Titre abrégé: Sci Rep
Pays: England
ID NLM: 101563288

Informations de publication

Date de publication:
17 May 2024
Historique:
received: 20 10 2023
accepted: 09 05 2024
medline: 18 5 2024
pubmed: 18 5 2024
entrez: 17 5 2024
Statut: epublish

Résumé

Dialectical behavior therapy (DBT) is widely acknowledged as an effective treatment for individuals with borderline personality disorder (BPD). However, the optimal treatment duration within DBT remains a topic of investigation. This retrospective, naturalistic non-randomized study aimed to compare the efficacy of 8 week and 12 week DBT interventions with equivalent content, focusing on the change of BPD-specific symptomatology as the primary outcome and depressive symptoms as the secondary outcome. Overall, 175 patients who participated in DBT and received either 8 week or 12 week intervention were included in the analysis. Routine inpatient treatment was adapted from standard DBT with the modules: skill training, interpersonal skills, dealing with feelings, and mindfulness. Measurements were taken at baseline, mid-point, and endpoint. The borderline symptom list-23 (BSL-23) was used for the assessment of borderline-specific symptoms, while the Beck depression inventory-II (BDI-II) was used for the assessment of depressive symptoms. Statistical analysis was conducted using linear mixed models. Effect sizes were calculated for both measures. The results of the analysis indicated an improvement in both groups over time. Effect sizes were d = 1.29 for BSL-23 and d = 1.79 for BDI-II in the 8 week group, and d = 1.16 for BSL-23 and d = 1.58 for BDI-II in the 12 week group. However, there were no differences in the change of BPD-specific symptoms or the severity of depressive symptoms between the 8 week and 12 week treatment duration groups. Based on these findings, shorter treatment durations, like 8 weeks, could be a viable alternative, offering comparable therapeutic benefits, potential cost reduction, and improved accessibility. However, further research is needed to explore factors influencing treatment outcomes and evaluate the long-term effects of different treatment durations in DBT for BPD.Trial registration: drks.de (DRKS00030939) registered 19/12/2022.

Identifiants

pubmed: 38760498
doi: 10.1038/s41598-024-61795-9
pii: 10.1038/s41598-024-61795-9
doi:

Types de publication

Journal Article Comparative Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

11264

Informations de copyright

© 2024. The Author(s).

Références

Linehan, M. M. Cognitive-Behavioral Treatment of Borderline Personality Disorder (Guilford Press, 1993).
Choi-Kain, L. W., Finch, E. F., Masland, S. R., Jenkins, J. A. & Unruh, B. T. What works in the treatment of borderline personality disorder. Curr. Behav. Neurosci. Rep. 4, 21–30 (2017).
doi: 10.1007/s40473-017-0103-z pubmed: 28331780 pmcid: 5340835
Jacobi, F., Grafiadeli, R., Volkmann, H. & Schneider, I. Krankheitslast der borderline-persönlichkeitsstörung: Krankheitskosten, somatische komorbidität und mortalität. Nervenarzt 92, 660–669. https://doi.org/10.1007/s00115-021-01139-4 (2021).
doi: 10.1007/s00115-021-01139-4 pubmed: 34097089
Leichsenring, F., Leibing, E., Kruse, J., New, A. S. & Leweke, F. Borderline personality disorder. Lancet 377(9759), 74–84. https://doi.org/10.1016/s0140-6736(10)61422-5 (2011).
doi: 10.1016/s0140-6736(10)61422-5 pubmed: 21195251
Temes, C. M., Frankenburg, F. R., Fitzmaurice, G. M. & Zanarini, M. C. Deaths by suicide and other causes among patients with borderline personality disorder and personality-disordered comparison subjects over 24 years of prospective follow-up. J. Clin. Psychiatry https://doi.org/10.4088/jcp.18m12436 (2019).
doi: 10.4088/jcp.18m12436 pubmed: 30688417
Shah, R. & Zanarini, M. C. Comorbidity of borderline personality disorder. Psychiatr. Clin. N. Am. 41(583–593), 2018. https://doi.org/10.1016/j.psc.2018.07.009 (2018).
doi: 10.1016/j.psc.2018.07.009
Bohus, M. Borderline-Störung (Hogrefe, 2019).
doi: 10.1026/02853-000
Fiedler, P. Epidemiologie und verlauf von persönlichkeitsstörungen. Z. Für Psychiatr. Psychol. Und Psychother. https://doi.org/10.1024/1661-4747/a000344 (2018).
doi: 10.1024/1661-4747/a000344
Grant, B. F. et al. Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J. Clin. Psychiatry 69, 533–545. https://doi.org/10.4088/jcp.v69n0404 (2008).
doi: 10.4088/jcp.v69n0404 pubmed: 18426259 pmcid: 2676679
Grabe, H. J. & Giertz, K. Die borderline-persönlichkeitsstörung in den psychosozialen, psychotherapeutischen und psychiatrischen versorgungssystemen von Deutschland. Psychother. Forum 24, 100–107. https://doi.org/10.1007/s00729-020-00147-0 (2020).
doi: 10.1007/s00729-020-00147-0
Richter, C., Steinacher, B., Zum Eschenhoff, A. & Bermpohl, F. Stationäre und teilstationäre DBT-angebote für patienten mit borderline-persönlichkeitsstörung—Ergebnisse einer deutschlandweiten umfrage. Verhaltenstherapie 24, 265–271 (2014).
doi: 10.1159/000369425
Schindler, A., Neshatrooh, P. & Krog, K. Integrierte versorgung für borderline-patient*innen. Psychother. Forum https://doi.org/10.1007/s00729-020-00156-z (2020).
doi: 10.1007/s00729-020-00156-z
Iliakis, E. A., Sonley, A. K. I., Ilagan, G. S. & Choi-Kain, L. W. Treatment of borderline personality disorder: Is supply adequate to meet public health needs?. Psychiatr. Serv. 70(9), 772–781. https://doi.org/10.1176/appi.ps.201900073 (2019).
doi: 10.1176/appi.ps.201900073 pubmed: 31138059
Bode, K., Vogel, R., Walker, J. & Kröger, C. Health care costs of borderline personality disorder and matched controls with major depressive disorder: A comparative study based on anonymized claims data. Eur. J. Health Econ. 18(9), 1125–1135. https://doi.org/10.1007/s10198-016-0858-2 (2016).
doi: 10.1007/s10198-016-0858-2 pubmed: 27990594
Wagner, T. et al. The societal cost of treatment-seeking patients with borderline personality disorder in Germany. Eur. Arch. Psychiatry Clin. Neurosci. 272(4), 741–752. https://doi.org/10.1007/s00406-021-01332-1 (2021).
doi: 10.1007/s00406-021-01332-1 pubmed: 34605983 pmcid: 9095542
DGPPN. S3-Leitlinie Borderline Persönlichkeitsstörung. Long form. 14 Nov 2022. Retrieved 28 Mar 2023, https://dgppn.de/_Resources/Persistent/84133864d93723edfa4bf6655127a382ee940aa7/038-015l_S3_Borderline-Persoenlichkeitsst%C3%B6rungen_2022-11.pdf , (2022).
Simonsen, S. B. et al. European guidelines for personality disorders: Past, present and future. Borderline Pers. Disord. Emot. Dysregul. https://doi.org/10.1186/s40479-019-0106-3 (2019).
doi: 10.1186/s40479-019-0106-3
Taubner, S., Fonagy, P. & Bateman, A. W. Mentalisierungsbasierte Therapie (Hogrefe Verlag, 2019).
doi: 10.1026/02834-000
Arntz, A. & Van Genderen, H. Schema Therapy for Borderline Personality Disorder (John Wiley and Sons, 2020).
doi: 10.1002/9781119101161
Rameckers, S. A. et al. Effectiveness of psychological treatments for borderline personality disorder and predictors of treatment outcomes: A multivariate multilevel meta-analysis of data from all design types. J. Clin. Med. 10(23), 5622. https://doi.org/10.3390/jcm10235622 (2021).
doi: 10.3390/jcm10235622 pubmed: 34884324 pmcid: 8658126
Bohus, M. In Dialektisch Behaviorale Therapie Für Borderline-Störungen in Verhaltenstherapie: Grundlagen—Methoden—Anwedungsgebiete (eds Batra, A. et al.) 306–313 (Thieme, 2013).
Cristea, I. A. et al. Efficacy of psychotherapies for borderline personality disorder. JAMA Psychiatry 74(4), 319. https://doi.org/10.1001/jamapsychiatry.2016.4287 (2017).
doi: 10.1001/jamapsychiatry.2016.4287 pubmed: 28249086
Storebø, O. J. et al. Psychological therapies for people with borderline personality disorder. Cochrane Database Syst. Rev. https://doi.org/10.1002/14651858.cd012955 (2020).
doi: 10.1002/14651858.cd012955 pubmed: 32681745 pmcid: 7388313
Stoffers-Winterling, J. M. et al. Psychotherapies for borderline personality disorder: A focused systematic review and meta-analysis. Br. J. Psychiatry 221(3), 538–552. https://doi.org/10.1192/bjp.2021.204 (2022).
doi: 10.1192/bjp.2021.204 pubmed: 35088687
Snoek, A. et al. A randomized controlled trial comparing the clinical efficacy and cost-effectiveness of eye movement desensitization and reprocessing (EMDR) and integrated EMDR-dialectical behavioural therapy (DBT) in the treatment of patients with post-traumatic stress disorder and comorbid (sub)clinical borderline personality disorder: Study design. BMC Psychiatry 20(1), 396. https://doi.org/10.1186/s12888-020-02713-x (2020).
doi: 10.1186/s12888-020-02713-x pubmed: 32762677 pmcid: 7409691
Seow, L. L. Y., Collins, K. R. L., Page, A. C. & Hooke, G. R. Outcomes of brief versions of dialectical behaviour therapy for diagnostically heterogeneous groups in a routine care setting. Psychother. Res. 32(2), 179–194 (2022).
doi: 10.1080/10503307.2021.1933240 pubmed: 34053405
Van Swearingen, K. M. & Lothes, J. E. Symptom reduction in DBT-informed partial hospital, intensive outpatient, and step-down programs: Mindfulness matters. Psychother. Res. 32, 640–651 (2021).
doi: 10.1080/10503307.2021.2001602 pubmed: 34806559
Bloom, J. M., Woodward, E. N., Susmaras, T. & Pantalone, D. W. Use of dialectical behavior therapy in inpatient treatment of borderline personality disorder: A systematic review. Psychiatr. Serv. 63(9), 881–888. https://doi.org/10.1176/appi.ps.201100311 (2012).
doi: 10.1176/appi.ps.201100311 pubmed: 22751905
Kröger, 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. 51(8), 411–416. https://doi.org/10.1016/j.brat.2013.04.008 (2013).
doi: 10.1016/j.brat.2013.04.008 pubmed: 23727659
Bohus, M. et al. Effectiveness of inpatient dialectical behavioral therapy for borderline personality disorder: A controlled trial. Behav. Res. Ther. 42(5), 487–499. https://doi.org/10.1016/s0005-7967(03)00174-8 (2004).
doi: 10.1016/s0005-7967(03)00174-8 pubmed: 15033496
Swenson, C. R., Sanderson, C., Dulit, R. A. & Linehan, M. M. The application of dialectical behavior therapy for patients with borderline personality disorder on inpatient units. Psychiatr. Q. 72(4), 307–324. https://doi.org/10.1023/a:1010337231127 (2001).
doi: 10.1023/a:1010337231127 pubmed: 11525079
Koons, C. R. et al. Efficacy of dialectical behavior therapy in women veterans with borderline personality disorder. Behavior. Ther. 32(2), 371–390. https://doi.org/10.1016/s0005-7894(01)80009-5 (2001).
doi: 10.1016/s0005-7894(01)80009-5
Herzog, P. et al. Drawing the borderline: Predicting treatment outcomes in patients with borderline personality disorder. Behav. Res. Ther. 133, 103692. https://doi.org/10.1016/j.brat.2020.103692 (2020).
doi: 10.1016/j.brat.2020.103692 pubmed: 32801095
Westad, Y. A. S., Hagen, K., Jonsbu, E. & Solem, S. Cessation of deliberate self-harm behavior in patients with borderline personality traits treated with outpatient dialectical behavior therapy. Front. Psychol. 12, 1–12. https://doi.org/10.3389/fpsyg.2021.578230 (2021).
doi: 10.3389/fpsyg.2021.578230
Probst, T. et al. Effectiveness of a 5 week inpatient dialectical behavior therapy for borderline personality disorder. J. Psychiatr. Pract. 25(3), 192–198. https://doi.org/10.1097/PRA.0000000000000383 (2019).
doi: 10.1097/PRA.0000000000000383 pubmed: 31083031
Iliakis, E. A., Ilagan, G. S. & Choi-Kain, L. W. Dropout rates from psychotherapy trials for borderline personality disorder: A meta-analysis. Pers. Disord. 12(3), 193–206. https://doi.org/10.1037/per0000453 (2021).
doi: 10.1037/per0000453
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders 5th edn. (American Psychiatric Association, 2013).
doi: 10.1176/appi.books.9780890425596
First, M. B., Gibbon, M., Spitzer, R. L., Williams, J. B. W. & Benjamin, L. S. Structured Clinical Interview for DSM-IV Axis II Personality Disorders, (SCID-II) (American Psychiatric Association, 1997).
World Health Organization. International Statistical Classification of Diseases and Related Health Problems 10th edn. (World Health Organization, 2016).
Margraf, J. & Cwik, J. Mini-DIPS open access: Diagnostisches Kurzinterview bei psychischen störungen. Bochum: Forschungs-und behandlungszentrum für psychische gesundheit (Ruhr-Universität Bochum). https://doi.org/10.13154/rub.102.91 (2017).
Wolf, M. et al. Kurzversion der borderline-symptom-liste (BSL-23): Entwicklung und überprüfung der psychometrischen eigenschaften. Psychother. Psychosomat. Med. Psychol. 59, 321–324 (2009).
doi: 10.1055/s-0028-1104598
Kleindienst, N., Jungkunz, M. & Bohus, M. A proposed severity classification of borderline symptoms using the borderline symptom list (BSL-23). Borderline Pers. Disord. Emot. Dysregul. https://doi.org/10.1186/s40479-020-00126-6 (2020).
doi: 10.1186/s40479-020-00126-6
Beck, A. T., Steer, R. A. & Brown, G. K. Beck-Depressions-Inventar (BDI–II, dt. Version: M. Hautzinger, F. Keller, C. Kühner, 2. Aufl.). Frankfurt: Pearson Assessment. (2009).
Wintjen, L. & Petermann, F. Beck-depressions-inventar revision (BDI–II). Z. Für Psychiatr. Psychol. Und Psychother. 58(3), 243–245. https://doi.org/10.1024/1661-4747.a000033 (2010).
doi: 10.1024/1661-4747.a000033
Bohus, M. & Wolf-Arehult, M. Interaktives Skillstraining Für Borderline Patienten: Die Software Für Betroffene—Keycard Für Die Download-Version—Akkreditiert Vom Deutschen Dachverband DBT (2.) (Schattauer, 2018).
Barkham, M. et al. Dose-effect relations and responsive regulation of treatment duration: The good enough level. J. Consult. Clin. Psychol. 74(1), 160–167. https://doi.org/10.1037/0022-006x.74.1.160 (2006).
doi: 10.1037/0022-006x.74.1.160 pubmed: 16551153
Baldwin, S. A., Berkeljon, A., Atkins, D. C., Olsen, J. A. & Nielsen, S. L. Rates of change in naturalistic psychotherapy: Contrasting dose–effect and good-enough level models of change. J. Consult. Clin. Psychol. 77(2), 203–211. https://doi.org/10.1037/a0015235 (2009).
doi: 10.1037/a0015235 pubmed: 19309180
Bohus, M. et al. The short version of the borderline symptom list (BSL-23): Development and initial data on psychometric properties. Psychopathology 42(1), 32–39. https://doi.org/10.1159/000173701 (2008).
doi: 10.1159/000173701 pubmed: 19023232
McMain, S. F. et al. The effectiveness of 6 versus 12 months of dialectical behavior therapy for borderline personality disorder: A noninferiority randomized clinical trial. Psychother. Psychosomat. 91(6), 382–397. https://doi.org/10.1159/000525102 (2022).
doi: 10.1159/000525102
Keefe, J. R. et al. Treatment selection in borderline personality disorder between dialectical behavior therapy and psychodynamic psychiatric management. Psychol. Med. 51(11), 1829–1837. https://doi.org/10.1017/s0033291720000550 (2020).
doi: 10.1017/s0033291720000550 pubmed: 32204742
Zimmermann, J. et al. Validating the German version of the personality disorder severity-ICD-11 scale using nominal response models. Psychol. Assess. 35(3), 257–268. https://doi.org/10.1037/pas0001199 (2022).
doi: 10.1037/pas0001199 pubmed: 36455031
Benke, C., Autenrieth, L. K., Asselmann, E. & Pané-Farré, C. A. One year after the COVID-19 outbreak in Germany: Long-term changes in depression, anxiety, loneliness, distress and life satisfaction. Eur. Arch. Psychiatry Clin. Neurosci. https://doi.org/10.1007/s00406-022-01400-0 (2022).
doi: 10.1007/s00406-022-01400-0 pubmed: 35348855 pmcid: 8962282

Auteurs

Milenko Kujovic (M)

Department of Psychiatry and Psychotherapy, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany. milenko.kujovic@lvr.de.

Daniel Benz (D)

Department of Psychiatry and Psychotherapy, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.

Mathias Riesbeck (M)

Department of Psychiatry and Psychotherapy, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.

Devin Mollamehmetoglu (D)

Department of Psychiatry and Psychotherapy, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.

Julia Becker-Sadzio (J)

University Hospital for Psychiatry and Psychotherapy, Neurophysiology & Interventional Neuropsychiatry, Tübingen Center for Mental Health, University Hospital Tübingen, Tübingen, Germany.

Zsofia Margittai (Z)

Department of Psychiatry and Psychotherapy, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.

Christian Bahr (C)

Department of Psychiatry and Psychotherapy, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.

Eva Meisenzahl (E)

Department of Psychiatry and Psychotherapy, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female
Humans United States Aged Cross-Sectional Studies Medicare Part C
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH