Dialectical behavior therapy skills training compared to standard group therapy in borderline personality disorder: A 3-month randomized controlled clinical trial

Department of Psychiatry, Santa Creu i Sant Pau Hospital, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, St. Antoni M. Claret, 167, Barcelona 08025, Spain.
Behaviour Research and Therapy (Impact Factor: 3.85). 02/2009; 47(5):353-8. DOI: 10.1016/j.brat.2009.01.013
Source: PubMed


Dialectical behaviour therapy (DBT) has proven to be an effective treatment in borderline personality disorder (BPD). However, the effectiveness in BPD of DBT skills training (DBT-ST) alone is not known. This study aimed at comparing the efficacy of DBT-ST and standard group therapy (SGT) for outpatients with BPD. Sixty patients meeting the DSM-IV diagnostic criteria for BPD, as assessed by two semi-structured diagnostic interviews, were included in a 3-month, single-blind randomised controlled trial. A total of 13 weekly group psychotherapy sessions of 120 min of either SGT or DBT-ST were conducted. Assessments were carried out every 2 weeks by two blinded evaluators. Observer-rater, self-report scales and behavioural reports were used as outcome measures. DBT-ST was associated with lower dropout rates, 34.5% compared to 63.4% with SGT. It was superior to SGT in improving several mood and emotion areas, such as: depression, anxiety, irritability, anger and affect instability. A reduction in general psychiatric symptoms was also observed. Three-months weekly DBT-ST proved useful. This therapy was associated with greater clinical improvements and lower dropout rates than SGT. DBT-ST seems to play a role in the overall improvement of BPD seen with standard DBT intervention. It allows straightforward implementation in a wide range of mental health settings and provides the additional advantage that it is cost effective.

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    • "For example, Koons et al. (2006) showed pre-follow-up/ post-follow-up effects for a short version of a DBTinformed vocational training for patients with personality disorders, on dimensions like anger control, anger expression and work satisfaction. Soler et al. (2009) found in a 13-session skills training for patients with BPD, compared with a standard group therapy, more symptom reduction for the skills group patients on dimensions such as depression, anxiety, irritability, affective instability and problematic anger. More research is needed for the specific skills training component, in particular conducted by research teams independent from the model developer . "
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    ABSTRACT: Key practitioner message: A 20-session dialectical behaviour therapy (DBT)-informed skills training is a promising adjunct intervention for patients with borderline personality disorder, in particular for reducing problems related to social role. Increases in assertive anger mediate the effects of DBT-informed skills training, whereas rejecting anger remains unchanged over the course of treatment. Short-term objectives for intervention might involve the specific increase of assertive anger in BPD, by using DBT-informed skills training; long-term objectives for intervention might involve a specific decrease of rejecting anger in BPD.
    Clinical Psychology & Psychotherapy 04/2015; DOI:10.1002/cpp.1956 · 2.59 Impact Factor
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    • "First, we cannot say how many patients in these groups obtained other mental health interventions, so it becomes difficult to determine definitively whether the drop-in skills training group reduced CEs or whether participation in some other aspect of the services offered by the mental health clinic caused the reduction. Ideally, a similar analysis could be performed on participants who only attended the drop-in group and did not experience other interventions, similar to the analysis as reported in Soler et al. (2009). Anecdotally, most drop-in group members did not endorse willingness to engage in psychotherapy. "
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    ABSTRACT: Although clinical services designed to address suicide-related behaviors are available to veterans, some factors may limit their effectiveness. Relevant factors include the presence of barriers to accessing existing services and a lack of interventions that address the unique needs of veterans. In an effort to address this gap, a modified DBT distress tolerance drop-in group was offered to a population of military veterans in an outpatient setting. This exploratory study reports clinical outcomes on this skills training group intervention informed by Dialectical Behavior Therapy (DBT) principles among a population of self- and clinician-referred veterans. Findings suggest a significant reduction in suicide-related behaviors among veterans who attended 8 or more skills training groups. Clinical implications of study findings warrant further research into novel adaptations of evidence-based treatments for this population with unique needs.
    Cognitive and Behavioral Practice 04/2014; DOI:10.1016/j.cbpra.2014.04.001 · 1.33 Impact Factor
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    • "The instrument also showed a good capacity to detect changes produced by therapeutic BPD interventions. To assess sensitivity to changes, we carried out a 3-month DBT group therapy program whose effectiveness in BPD patients had been proven in a previous study [28]. This therapeutic intervention, based on self-regulatory skills acquisition, was nearly identical to the program used in the original BSL-23 [19]. "
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    ABSTRACT: Background The Borderline Symptom List-23 (BSL-23) is a reliable and valid self-report instrument for assessing Borderline Personality Disorder (BPD) severity. The psychometric properties of the original version have proven to be adequate. The aim of the present study was to validate the Spanish language version of the BSL-23. Methods The BSL-23 was administered to 240 subjects with BPD diagnosis. Factor structure, reliability, test-retest stability, convergent validity, and sensitivity to change were analyzed. Results The Spanish version of the BSL-23 replicates the one-factor structure of the original version. The scale has high reliability (Cronbach’s alpha=.949), as well as good test-retest stability, which was checked in a subsample (n=74; r=.734; p<.01). The Spanish BSL-23 shows moderate to high correlations with depressive symptomatology, state and trait anxiety, hostility and impulsivity scores and BPD measures. The Spanish BSL-23 is able to discriminate among different levels of BPD severity and shows satisfactory sensitivity to change after treatment, which was verified by assessing change before and after 12 group sessions of Dialectical Behavioral Therapy in a subgroup of 31 subjects. Conclusions Similar to the original BSL-23, the Spanish BSL-23 is a reliable and valid instrument for assessing BPD severity and sensitivity to change.
    BMC Psychiatry 05/2013; 13(1):139. DOI:10.1186/1471-244X-13-139 · 2.21 Impact Factor
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