None listed
Conditions
Brief summary
Approximately 11% of all psychiatric outpatients and 19% of psychiatric inpatients meet the criteria for Borderline Personality Disorder (BPD). People with this disorder are high utilisers of mental health services and medical services as their condition often involves problems with interpersonal relationships, impulsivity in self-damaging areas such as substance abuse and reckless driving, recurrent suicidal threats and self-harming or self-mutilating behaviours. Approximately 9% of all individuals with BPD commit suicide. DBT has become the gold standard of psychotherapeutic treatment of BPD. Results across a number of trials have consistently shown significant reductions in suicidal and self-mutilating behaviours as well as improvement in quality of life. To date, there have been very few RCTs comparing DBT to other active treatments and very few trials conducted in real world settings. This trial compares DBT with CM, a psychodynamic model, developed specifically for treatment of BPD that has some empirical support, but has not been evaluated against another active treatment. It is hypothesised that DBT will be more effective at reducing self-harm and suicidal behaviour than CM, but less effective at reducing depression.
Interventions
Intervention A: Dialectical Behaviour Therapy (DBT)
The participants will take part in a manualised treatment that combines treatment strategies from behavioural, cognitive and supportive psychotherapies. It will include weekly individual therapy for two months, followed by concurrent weekly individual and group therapy for 12 months. The individual DBT therapy session will be for approximately one hour per week and apply directive, problem-orientated techniques (including behavioural skill tr
Intervention A: Dialectical Behaviour Therapy (DBT) The participants will take part in a manualised treatment that combines treatment strategies from behavioural, cognitive and supportive psychotherapies. It will include weekly individual therapy for two months, followed by concurrent weekly individual and group therapy for 12 months. The individual DBT therapy session will be for approximately one hour per week and apply directive, problem-orientated techniques (including behavioural skill training, contingency management, and cognitive modification) balanced with supportive techniques such as reflection, and acceptance. The emphasis is on teaching participants how to manage emotional experiences. The group therapy will meet once each week for two and a half hours and follow a psycho-educational format. Behavioural skills in three main areas will be taught in three modules as follows: interpersonal effectiveness, distress tolerance, and emotion regulation skills. Each module will be preceded by a two-week focus on Mindfulness, which is the core skill taught over the entire group. The group will include the teaching and application of skills, and the practice of them between classes. Intervention B: Conversational Model (CM) The participants will have twice weekly individual therapy for fourteen months. The individual therapy will be for approximately one hour per session and will be nondirective. The focus will be on understanding the patient’s emotional experience and actively describing that back to the patient. The therapist actively looks for subtle signs of emotionally misunderstanding the patient, leading to mutual self-reflection and repair of the moment of disconnection in the therapeutic relationship. High value is placed on the patient’s real experience (as against socially acceptable experience) and the development of an authentic personal narrative. The patient is encouraged to find links between the maladaptive relationship patterns they have developed in their current social world and the relationship pattern they have with the therapist (and possibly, but not necessarily, the links with their childhood relationships).
Sponsors
Hunter New England Local Health District
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used)
Eligibility
Sex/Gender
All
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
Meet the diagnostic criteria for BPD as measured by SCID-II interview Minimum of three episodes of parasuicidal behaviour in the past 12 months Between 18-65 years of age Fluent in English Live within an hour’s drive of the treatment centre
Exclusion criteria
Disabling organic conditions Acute psychotic illness Antisocial behaviour that poses a significant threat to staff Developmental disability Living more than one hour's drive from Newcastle Unable to speak or read English Prior treatment with DBT or Conversational Model Drug or Alcohol dependence (eligible for entry once no longer meet criteria for dependence)
Outcome results
None listed