Borderline Personality Disorder Clinical Trial
Official title:
Evaluation of a Modified Dialectical Behavior Therapy Program for Borderline Personality Disorder
The goal of this pilot project is to offer outpatient Dialectical Behavior Therapy (DBT)
treatment as described in Linehan's text (1993), which is considered an effective treatment
of borderline personality disorder. This treatment consists of weekly individual
psychotherapy, weekly group skills training, 24 hour telephone consultation, and weekly team
consultation meetings for therapists. The investigators program is able to offer all of
these components except the 24 hour phone consultation (which has been modified due to
employment/union guidelines of interdisciplinary staff working within the investigators
health care system). This project intends to offer the treatment for a period of 6 months.
As such, this proposed research project seeks to assess the feasibility of implementing an
outpatient DBT program within a public health care setting in Canada. This study also aims
to evaluate this DBT program for clinical effectiveness in its modified format.
Specifically, the investigators will examine relevant outcomes related to patient
functioning (e.g., depression, self-harm and suicidal behaviors, and admissions to
hospital/ER visits) and improvement (e.g., improved quality of life, meeting work/employment
goals) pre and post completion of this 6 month treatment program.
The investigators hypotheses are that each patient will show improvement in all outcome
variables (e.g., improved mood and quality of life, decreased self-harm, decreased ER visits
and hospitalization visits, etc). The investigators also hypothesize that the investigators
modified program will produce comparable results to those from studies of standard
outpatient DBT.
Standard DBT includes four modes of intervention: weekly individual psychotherapy; weekly
skills group; 24 hour phone consultation to the patient; and consultation team meetings. The
skills group is focused on teaching skills (mindfulness, emotional regulation, distress
tolerance, and interpersonal effectiveness), and facilitating the replacement of maladaptive
behaviors with adaptive behaviors (Neasciu, Rizvi, & Linehan, 2010). Individual therapy
sessions focus on reducing target problem behaviors (e.g., life threatening behavior,
therapy interfering behavior, quality of life interfering behaviors). Phone consultation is
to aid the client in generalizing skill use to their every day life. The consultation team
meetings are for the therapists, to provide support, and to aid therapists in staying
adherent to a DBT frame of treatment.
This project will be utilizing a convenience sample. Patients are referred to the program by
their psychiatrist/family doctor. They are assessed by a Clinical Psychologist to determine
if they meet criteria for a diagnosis of Borderline Personality Disorder via clinical
interview and a semi-structured diagnostic interview. They must also meet the
inclusion/exclusion criteria for participation in the program, which are as follows:
Inclusion Criteria
- 18 years or older
- Borderline personality disorder diagnosis
- Chronic suicidal ideation or parasuicidal acts, or other self-destructive, impulsive
behaviors
- Must be willing to sign DBT contract and commit to 6-month duration of treatment of
both individual therapy and skills training group.
Exclusion Criteria
- Active psychosis
- Severe developmental delays, cognitive impairment or learning disabilities
- No violent behaviors will be tolerated. Patients with a history of dangerous or
aggressive behaviors towards others, history of medical harm to previous therapists may
not be considered.
Following this, they must agree to participate in the program and to the program
requirements (weekly individual therapy, skills group, etc). Once this has occurred, they
will be approached by a research assistant to discuss with them their voluntary
participation in this research study. Once consent is provided, the patient will complete
several baseline measures. These same measures will be completed at post treatment (6
months) and then again at 12 months and 18 months for follow-up. Each patient will also
complete a weekly diary card, which asks them to record several aspects of daily
functioning, as well as self-harm urges and behaviors, and use of skills taught in DBT.
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