Introduction: Evidence-based psychotherapies for borderline personality disorder (BPD) are lengthy, posing a barrier to their access. Brief psychotherapy may achieve comparable outcomes to long-term psychotherapy for BPD. Evidence is needed regarding the comparative effectiveness of short- versus long-term psychotherapy for BPD. Objective: The aim was to determine if 6 months of Dialectical Behavior Therapy (DBT) is noninferior to 12 months of DBT in terms of clinical effectiveness. Methods: This two-arm, single-blinded, randomized controlled noninferiority trial with suicidal or self-harming patients with BPD was conducted at two sites in Canada. Participants (N = 240, M (SD)_age = 28.27 (8.62), 79% females) were randomized to receive either 6 (DBT-6) or 12 months (DBT-12) of comprehensive DBT. Masked assessors obtained measures of clinical effectiveness at baseline and every 3 months, ending at month 24. DBT-6 and DBT-12 were outpatient treatments consisting of weekly individual therapy sessions, weekly DBT skills training group sessions, telephone consultation as needed, and weekly therapist consultation team meetings. Results: The noninferiority hypothesis was supported for the primary outcome, total self-harm (6 months: margin = −1.94, M_diff [95% CI] = 0.16 [−0.14, 0.46]; 12 months: margin = −1.47, M_diff [95% CI] = 0.04 [−0.17, 0.23]; 24 months: margin = −1.25, M_diff [95% CI] = 0.12 [−0.02, 0.36]). Results also supported noninferiority of DBT-6 for general psychopathology and coping skills at 24 months. Furthermore, DBT-6 participants showed more rapid reductions in BPD symptoms and general psychopathology. There were no between-group differences in dropout rates. Conclusions: The noninferiority of a briefer yet comprehensive treatment for BPD has potential to reduce barriers to treatment access.
Psychother Psychosom

中文翻译：

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边缘性人格障碍辩证行为疗法 6 个月与 12 个月的有效性：一项非劣效性随机临床试验

简介：针对边缘性人格障碍 (BPD) 的循证心理疗法耗时较长，对他们的获取构成了障碍。BPD 的短期心理治疗可能会取得与长期心理治疗相当的结果。需要证据证明 BPD 的短期心理治疗与长期心理治疗的有效性比较。目的：目的是确定 6 个月的辩证行为疗法 (DBT) 在临床有效性方面是否不劣于 12 个月的 DBT。方法：这项双臂、单盲、随机对照的非劣效性试验在加拿大的两个地点进行，试验对象为有自杀倾向或自残行为的 BPD 患者。参与者 ( N = 240, M (SD)_年龄= 28.27 (8.62)，79% 女性）被随机分配接受 6 (DBT-6) 或 12 个月 (DBT-12) 的综合 DBT。蒙面评估员在基线和每 3 个月获得临床有效性测量值，截至第 24 个月结束。DBT-6 和 DBT-12 是门诊治疗，包括每周一次的个体治疗课程、每周一次的 DBT 技能培训小组课程、根据需要进行电话咨询，以及每周治疗师咨询小组会议。结果：主要结果支持非劣效性假设，总自伤（6 个月：margin = −1.94，M _diff [95% CI] = 0.16 [−0.14, 0.46]；12 个月：margin = −1.47，M _diff [95% CI] = 0.04 [−0.17, 0.23]；24 个月：margin = −1.25, M _diff[95% CI] = 0.12 [−0.02, 0.36]）。结果还支持 DBT-6 在 24 个月时的一般精神病理学和应对技能方面的非劣效性。此外，DBT-6 参与者在 BPD 症状和一般精神病理学方面表现出更快的减少。辍学率没有组间差异。结论：针对 BPD 的更简短而全面的治疗的非劣效性有可能减少获得治疗的障碍。
心理医生