Standard 12 month dialectical behaviour therapy for adults with borderline personality disorder in a public community mental health setting

Abstract

BackgroundDialectical behaviour therapy (DBT) is noted to be an intervention with a growing body of evidence that demonstrates its efficacy in treating individuals diagnosed with borderline personality disorder (BPD). Evidence for the effectiveness of DBT in publicly funded community mental health settings is lacking however. No study to our knowledge has been published on the effectiveness of a 12 month standard DBT programme without adaptations for individuals with BPD in a publicly funded community mental health setting and no study has included data across multiple time-points. The main objective of the current study was to determine if completion of a 12 month DBT programme is associated with improved outcomes in terms of borderline symptoms, anxiety, hopelessness, suicidal ideation, depression and quality of life. A secondary objective includes assessing client progress across multiple time-points throughout the treatment.MethodsFifty-four adult participants with BPD completed the standard DBT programme across four sites in community mental health settings in the Republic of Ireland. Data was collected by the DBT therapists working with participants and took place at 8 week intervals across the 12 month programme. To explore the effects of the intervention for participants, linear mixed-effects models were used to estimate change utilising data available from all time-points.ResultsAt the end of the 12 month programme, significant reductions in borderline symptoms, anxiety, hopelessness, suicidal ideation and depression were observed. Increases in overall quality of life were also noted. In particular, gains were made during the first 6 months of the programme. There was a tendency for scores to slightly regress after the six-month mark which marks the start of the second delivery of the group skills cycles.ConclusionsThe current study provides evidence for the effectiveness of standard DBT in publicly funded community mental health settings. As participants were assessed at the end of every module, it was possible to observe trends in symptom reduction during each stage of the intervention. Despite real-world limitations of applying DBT in community settings, the results of this study are comparable with more tightly controlled studies.Trial registrationClinicalTrials.gov ID: NCT03166579; Registered May 24th 2017 ‘retrospectively registered’Electronic supplementary materialThe online version of this article (doi:10.1186/s40479-017-0070-8) contains supplementary material, which is available to authorized users.

Dialectical behaviour therapy for treating adults and adolescents with emotional and behavioural dysregulation: study protocol of a coordinated implementation in a publicly funded health service

“…Examples of such barriers include lack of support from public mental health authorities and programme leaders, and absence of organisational support (including staff turnover, and funding for administration, training and supervision). Given positive research outcomes on effectiveness of DBT in a separate study across four sites in the south of Ireland [ 40 ], a National Office for Suicide Prevention (established specifically to drive suicide and self-harm prevention strategies in the public health service in Ireland) agreed to fund and support a project team to coordinate a multi-site implementation of DBT in community settings at a national level [ 41 ]. As a result, the National DBT Project, Ireland was established in 2013.…”

Exploring dialectical behaviour therapy clinicians’ experiences of team consultation meetings

“…It has the highest number of randomised controlled trials (RCTs) investigating its efficacy in treating this disorder [ 1 ]. Both the UK Department of Health [ 2 ] and the American Psychiatric Association [ 3 ] advocate it as one of the leading treatments for BPD, and recent research supports its application in community settings [ 4 ].…”

Evaluating the national multisite implementation of dialectical behaviour therapy in a community setting: A mixed methods approach

“…Comtois and colleagues [23] were the first to evaluate the effectiveness of DBT in a community mental health setting. Their study and subsequent effectiveness evaluations [24][25][26][27] have reported positive outcomes for individuals with BPD who participate in community based DBT programmes. In line with this, best practice guidelines for the delivery of evidence-based interventions in mental health services also recommend DBT for the treatment of BPD in community settings [28][29].…”