![]() ![]() ![]() Furthermore, private insurance often does not fully cover comprehensive DBT. Public health care systems often lack the resources to develop and sustain DBT programs thus, the vast majority of individuals with BPD are left without access to evidence-based treatments. Īlthough DBT is effective, and cost-effective, the treatment remains lengthy (often 12 months or longer) and comprehensive, requiring substantial resources to implement. Due to its robust support, international guidelines for effective psychosocial treatment have identified DBT as a treatment for BPD that has accumulated the most evidence, particularly for individuals with self-injurious behaviours. Standard DBT is lengthy and resource intensive but it is associated with reduced overall cost burden associated with BPD. Recent meta-analyses demonstrate that DBT is associated with medium to large effects in terms of improvements in self-injurious behaviours, anger, and overall mental health. In addition, DBT has shown comparable efficacy to other structured BPD-specific treatments. As well, one trial demonstrated the superiority of DBT to non-behavioural treatment by experts in terms of reducing self-injurious behaviours, treatment dropouts, and hospitalizations among suicidal patients with BPD. Results support the effectiveness of DBT relative to treatment as usual for reducing self-injurious behaviours and treatment dropout among BPD patients. Several randomized controlled trials have evaluated a standard 12-month version of DBT. DBT involves weekly hour-long individual therapy, weekly group skills training (typically 2–2.5 h), between-session telephone consultation as needed to coach the patient in the use of behavioural skills (typically by phone or other communication media), and weekly therapist consultation team meetings designed to support, motivate, and enhance the skills of therapists. Īmong the psychosocial treatments showing efficacy for BPD, dialectical behaviour therapy (DBT), a comprehensive cognitive behavioural treatment, has accrued the most empirical support. Together, these factors make BPD a particularly costly disorder to treat. Furthermore, individuals with BPD frequently have difficulties with social and occupational functioning, and disproportionately utilize social assistance. As such, BPD is a serious health concern that heavily taxes the mental health system. Notably, individuals with BPD are overrepresented in primary care and mental health care settings. ![]() Of particular concern, BPD is associated with exceedingly high rates (80%) of self-injury and suicide-related mortality (9–33%) comprising 28–47% of all mortalities by suicide. Registered February 20, 2015.īorderline personality disorder (BPD) is a serious and debilitating psychiatric condition affecting 1 to 6% of the population. Information from this study will help to guide decisions about the allocation of scarce treatment resources and recommendations about the benefits of briefer treatment. Examining both clinical and cost effectiveness in 6 versus 12 months of DBT will produce answers to the question of how much treatment is good enough. This is the first study to directly examine the dose-effect of psychotherapy for chronically suicidal individuals diagnosed with BPD. Assessments are scheduled at pretreatment and at 3-month intervals until 24 months. Cost-effectiveness outcomes will include the cost of providing each treatment as well as health care and societal costs (e.g., missed work days and lost productivity). Secondary outcomes include healthcare utilization, psychiatric and emotional symptoms, general and social functioning, and health status. The primary outcome is the frequency of suicidal or non-suicidal self-injurious episodes. Powered for non-inferiority testing, this two-site single-blind trial involves the random assignment of 240 patients diagnosed with BPD to 6 or 12 months of standard DBT. A second aim of this study is to determine which patients are as likely to benefit from shorter treatment as from longer treatment. The aim of this study is to examine the clinical and cost-effectiveness of 6 versus 12 months of DBT for chronically suicidal individuals with BPD. Further, there are no data on the optimal length of psychotherapy for BPD. The commonly researched 12-month version of DBT is lengthy this can pose a barrier to its adoption in many health care settings. Although Dialectical Behaviour Therapy (DBT) is an evidence-based psychosocial treatment for borderline personality disorder (BPD), the demand for it exceeds available resources. ![]()
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