Effectiveness of a 5-Week Inpatient Dialectical Behavior Therapy for Borderline Personality Disorder

Abstract

The goal of this study was to evaluate whether symptoms are reduced and emotion regulation improves when patients with borderline personality disorder (BPD) receive a 5-week course of inpatient dialectical behavioral therapy (DBT) and if changes in emotion regulation are associated with changes in symptoms. Methods: Forty-four patients with BPD receiving a 5-week course of DBT in a German psychiatry clinic participated. The short version of the "Borderline Symptom List" (BSL-23) was the patient-reported outcome. To measure emotion regulation, the "Self-Report Measure for the Assessment of Emotion Regulation Skills" (SEK-27) was administered. Wilcoxon tests were performed to evaluate whether pre-post changes in the BSL-23 and SEK-27 reached statistical significance. Effect sizes (d) were calculated and correlations between the prepost differences for both measures were computed to test associations between changes in emotion regulation and changes in symptoms. Completer (n = 33) and intention-to-treat (n = 43) analyses were performed. Results: Symptoms (BSL-23) were reduced and emotion regulation (SEK-27) improved during the 5-week inpatient DBT treatment (completer and intention-to-treat analysis: P < 0.001). Effect sizes reached d = 0.47 for the BSL-23 and d = 0.84 for the SEK-27 in the completer analysis, and d = 0.38 for the BSL-23 and d = 0.68 for the SEK-27 in the intention-to-treat analysis. Improvements in emotion regulation (SEK-27) were correlated with reductions in symptoms (BSL-23) in both the completer (r = 0.54; P = 0.001) and the intention-to-treat (r = 0.59; P < 0.001) analyses. Conclusions: These findings indicate that a 5-week course of inpatient DBT can effectively reduce symptoms in patients with BPD and that the more patients' emotion regulation improves, the more the patients benefit from the therapy.

Applying adherent DBT Principles to treatment in a partial hospital setting: An analysis over 5‐years of outcomes from intake to discharge

“…The utilization of DBT skills has also been associated with positive outcomes for individuals with bipolar disorder, primarily by increasing coping skills and decreasing associated emotion dysregulation (Eisner et al, 2017). Additionally, Probst et al (2019) 5-week inpatient adaptation of DBT is associated with decreases in BPD symptom severity and increases in emotion regulation (Probst et al, 2019).…”

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

“…In comparison to the literature, the estimated effect sizes in the current studies were larger. Probst et al 35 found effect sizes between d = 0.38 and d = 0.47 for intention to treat analysis and completers using the BSL-23 while conducting a 5 week inpatient DBT treatment. Also, Probst et al 35 compared their effect sizes with effects reported in previous studies.…”

“…For instance, 25% of patients seemed to refrain from self-harm within the first week of therapy 34 . Additionally, Probst et al 35 showed that a 5 weeks inpatient DBT therapy showed a significant reduction in BPD specific symptoms and improved emotion regulation. In addition, results indicate that symptom and functional improvement for shortened therapies were stable at 5 year follow-ups with annual measurements and readmission rates remained low after treatment completion 26,27 .…”

Intensive Dialectical Behavior Treatment for Individuals With Borderline Personality Disorder With and Without Substance Use Disorders

“…General dysfunction is a key target in DBT therapy and predictor for individuals with personality disorders. Difficulties establishing and maintaining emotional regulation (e.g., negative affect, acceptance of emotions) (Probst et al, 2019 ) can be heightened if there is a co-occurring SUD (Grant et al, 2004 ). The preliminary findings of the current study indicate that while emotional dysfunction significantly decreased in both groups, the improvement was more modest among those with SUD.…”