Dialectical behaviour therapy improves emotional regulation in borderline personality disorder
Dialectical behaviour therapy (DBT) in patients with borderline personality disorder (BPD) may yield greater improvements in terms of self-harm and emotional dysregulation compared with mentalization-based therapy (MBT), a recent study reports.
The study included 90 BPD patients (mean age 31 years; 72 percent female) who received either DBT (n=58) or MBT (n=32) over a 12-month period. DBT services involved weekly individual therapy and group skills training, telephone skills coaching, and team consultation. Meanwhile, MBT services provided weekly or fortnightly individual therapy and weekly group therapy. Outcomes investigated included deliberate self-harm, BPD symptom severity, emotional dysregulation, dissociation and interpersonal relationship difficulties.
Patients in the DBT group were more likely to have engaged in self-harm (p=0.01) and/or to have attended accident and emergency services (p<0.01) in the 12 months before treatment, more frequently had comorbid post-traumatic stress disorder (p=0.01), and initiated treatment with significantly higher levels of emotional dysregulation (p=0.03).
Patients receiving DBT vs MBT were less likely to complete ≥12 months of treatment (completion rate, 42 percent vs 72 percent). Yet, at the 12-month follow-up, DBT led to a significantly greater reduction in incidents of self-harm (adjusted incident rate ratio, 0.93; 95 percent CI, 0.87–0.99; p=0.02) and in emotional dysregulation (adjusted β, −1.94; −3.37 to −0.51; p<0.01).
No significant between-group differences were seen in BPD severity, interpersonal relationships or dissociation.
Researchers pointed out that the differences in clinical outcomes observed at follow-up may be explained by the fact that DBT focuses on reducing self-harm as the primary treatment goal and explicitly teaches emotion regulation skills. On the other hand, MBT targets such goals more indirectly, via the promotion of mentalizing.
Experimental studies investigating treatment fidelity, mechanisms and longer-term outcomes are warranted to fully explore potential differences in the clinical and cost-effectiveness of the two treatment approaches, researchers added.