Objectives: Dialectical Behaviour Therapy (DBT) has become the gold standard for psychotherapeutic treatment of Borderline Personality Disorder (BPD). To date, there have been very few RCTS comparing DBT to other active treatments. This trial compares DBT with the Conversational Model (CM), a psychodynamic model, developed specifically for treatment of BPD. It was hypothesised that DBT would be more effective at reducing non-suicidal self-injury and suicidal behaviour than CM, but less effective at reducing depression.
Methods: The setting is the Centre for Psychotherapy, a specialist service for BPD within public sector mental health in Newcastle, Australia. Participants were persons with a diagnosis of BPD and a minimum of 3 episodes of suicidal behaviour and/or non-suicidal self-injury in the past 12 months who were randomised to either DBT or CM for 14 months of treatment. Assessments occurred at baseline, mid-treatment, post-treatment and are continuing for 1, 2, and 5 year follow-up. Assessments included structured clinical interviews and self-report questionnaires measuring self-harm, depression, dissociation, service utilisation, general functioning, interpersonal functioning, mindfulness and difficulties with emotion regulation. The total sample included 162 participants. Analyses utilised intention to treat analysis using generalised estimating equations.
Results: In terms of primary outcomes, there was a significant reduction over time for both non-suicidal self-injury and suicidal behaviour, but no significant differences between treatment models. For depression, there was a significant reduction over time, with DBT improving more rapidly than the Conversational Model. Secondary outcomes will also be discussed.
Conclusions: There have been only a few effectiveness trials of any standardised therapy for BPD. This was the first trial of CM against an active psychotherapy, and showed that both DBT and CM led to reductions in non-suicidal self-injury, suicidal behaviour and depression. Discussion will focus on issues in relation to the ‘real world’ setting.