2018-07-10
Effectiveness of step-down versus outpatient dialectical behaviour therapy for patients with severe levels of borderline personality disorder
Publication
Publication
A pragmatic randomized controlled trial
BMC Musculoskeletal Disorders , Volume 2018 - Issue 5:12 p. 1- 10
Background: Step-down dialectical behaviour therapy (DBT) is a treatment consisting of 3 months of residential
DBT plus 6 months of outpatient DBT. The program was specifically developed for people suffering from severe
borderline personality disorder (BPD). The present study examines the effectiveness and cost-effectiveness of stepdown
DBT compared to 12 months of regular, outpatient DBT.
Methods: Eighty-four participants reporting high levels of BPD-symptoms (mean age 26 years, 95% female) were
randomly assigned to step-down versus standard DBT. Measurements were conducted at baseline and after 3, 6, 9
and 12 months. The Lifetime Parasuicide Count and BPD Severity Index (BPDSI) were used to assess suicidal behaviour,
non-suicidal self-injury (NSSI) and borderline severity. Costs per Quality Adjusted Life Year (QALY) were calculated using
data from the EQ-5D-3L and the Treatment Inventory Cost in Psychiatric Patients (TIC-P).
Results: In step-down DBT, 95% of patients started the program, compared to 45% of patients in outpatient DBT. The
probability of suicidal behaviour did not change significantly over 12 months. The probability of NSSI decreased
significantly in step-down DBT, but not in outpatient DBT. BPDSI decreased significantly in both groups, with the
improvement leveling off at the end of treatment. While step-down DBT was more effective in increasing quality
of life, it also cost significantly more. The extra costs per gained QALY exceeded the €80,000 threshold that is
considered acceptable for severely ill patients in the Netherlands.
Conclusions: A pragmatic randomized controlled trial in the Netherlands showed that 9 months of step-down
DBT is an effective treatment for people suffering from severe levels of BPD. However, step-down DBT is not
more effective than 12 months of outpatient DBT, nor is it more cost-effective. These findings should be considered
tentative because of high noncompliance with the treatment assignment in outpatient DBT. Furthermore, the longterm
effectiveness of step-down DBT, and moderators of treatment response, remain to be evaluated.
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doi.org/10.1186/s40479-018-0089-5, hdl.handle.net/1765/110267 | |
BMC Musculoskeletal Disorders | |
Organisation | Katholieke Universiteit Leuven |
Sinnaeve, R., van den Bosch, L., Hakkaart-van Roijen, L., & Vansteelandt, K. (2018). Effectiveness of step-down versus outpatient dialectical behaviour therapy for patients with severe levels of borderline personality disorder. BMC Musculoskeletal Disorders, 2018(5:12), 1–10. doi:10.1186/s40479-018-0089-5 |