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Lau P, Amestoy ME, Roth M, Monson C. Patient-related factors associated with patient retention and non-completion in psychosocial treatment of borderline personality disorder: A systematic review. Personal Ment Health 2024. [PMID: 38807472 DOI: 10.1002/pmh.1627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/22/2024] [Accepted: 05/12/2024] [Indexed: 05/30/2024]
Abstract
The potential efficacy of psychosocial interventions in the treatment of borderline personality disorder (BPD) is impacted by significant treatment non-completion (TNC), with meta-analytic studies reporting rates of attrition of between 25% and 28%. Increasing patient retention could facilitate outcomes and improve resource utilization, given limited healthcare services. A systematic search of PsycINFO, CINAHL, EMBASE, CENTRAL, and Web of Science Core Collection identified 33 articles that met the criteria for inclusion. Although substantial heterogeneity in terms of methodology and quality of analysis limited conclusions that could be drawn in the narrative review, a few consistent patterns of findings were elucidated, such as Cluster B personality disorder comorbidities and lower therapeutic alliance were associated with TNC. Interestingly, the severity of BPD symptoms was not a predictor of TNC. These findings are discussed in terms of their potential theoretical contribution to TNC. Clinically, there may be value in applying mindfulness and motivational interviewing strategies early on in treatment for individuals who present uncertainty about engaging in treatment. Further research to develop this empirical landscape includes focusing on high-powered replications, examining burgeoning lines of research, and investigating dynamic predictors of TNC.
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Affiliation(s)
- Parky Lau
- Toronto Metropolitan University (formerly Ryerson University), Toronto, ON, Canada
| | - Maya E Amestoy
- University of Toronto Scarborough, Scarborough, ON, Canada
| | - Maya Roth
- Toronto Metropolitan University (formerly Ryerson University), Toronto, ON, Canada
- St Joseph's Healthcare London, London, ON, Canada
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Candice Monson
- Toronto Metropolitan University (formerly Ryerson University), Toronto, ON, Canada
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Steuwe C, Berg M, Driessen M, Beblo T. Therapeutic alliance and dropout in patients with borderline pathology receiving residential dialectical behavior therapy. BMC Psychiatry 2023; 23:605. [PMID: 37596568 PMCID: PMC10439653 DOI: 10.1186/s12888-023-05061-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 07/28/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND This study focused on the impact of therapeutic alliance on therapy dropout in a naturalistic sample of patients with borderline pathology receiving dialectical behavior therapy (DBT) in a residential setting. We assumed that low therapeutic alliance shortly after admission would be associated with elevated dropout. METHODS 44 participants with borderline pathology (≥ 3 DSM-5 borderline personality disorder criteria) in a residential DBT program completed a quality assurance questionnaire set assessing demographic information, pretreatment psychopathology and therapeutic alliance during the first seven days of their residential stay. Predictors of dropout were investigated using binary logistic regression analyses. RESULTS The dropout rate was 34.1% (n = 15). In binary logistic regression analyses with variables covering demographic and clinical characteristics, comorbidities and childhood trauma history, only the therapeutic alliance significantly predicted dropout (z = -2.371, p = .018). CONCLUSIONS This study supports the importance of therapy process variables, here the therapeutic alliance at the beginning of treatment, as predictors of therapy dropout in borderline pathology. If this finding is replicated, it shows the potential importance of monitoring the therapeutic relationship throughout the therapeutic process. CLINICALTRIALS gov Identifier: NCT05289583, retrospectively registered on March 11, 2022.
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Affiliation(s)
- Carolin Steuwe
- Department of Psychiatry and Psychotherapy, Bielefeld University, Bielefeld, Germany.
| | - Michaela Berg
- Department of Psychiatry and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Martin Driessen
- Department of Psychiatry and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Thomas Beblo
- Department of Psychiatry and Psychotherapy, Bielefeld University, Bielefeld, Germany
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Jörg C, Clemm von Hohenberg C, Schmahl C. [Evidence-based inpatient psychotherapy in borderline personality disorder]. DER NERVENARZT 2023; 94:206-212. [PMID: 36735037 DOI: 10.1007/s00115-023-01438-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Borderline personality disorder (BPD) is frequent (prevalence in Germany between 0.7% and 4.5%) [11] and is associated with a high level of psychological stress and frequent emergency inpatient admissions. The provision of disorder-specific outpatient psychotherapy is still insufficient also in Germany. OBJECTIVE This article provides an overview of the available data on the effectiveness of inpatient psychotherapy for BPD. MATERIAL AND METHODS A qualitative review on the effectiveness and therapy outcome predictors was conducted based on a literature search in PubMed. RESULTS Overall, very few randomized controlled trials are available; in contrast uncontrolled studies are predominant. Most evidence is available for dialectical behavior therapy (DBT) but other approaches, including psychodynamic procedures, have also been studied. DISCUSSION The currently available data suggest an efficacy of inpatient psychotherapy for BPD; however, randomized trials with larger samples and sufficient representation including male patients are largely lacking. There is also no substantial direct evidence for the superiority of inpatient compared to outpatient psychotherapy.
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Affiliation(s)
- Christian Jörg
- Klinik für Psychosomatik und Psychotherapeutische Medizin, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
| | - Christian Clemm von Hohenberg
- Klinik für Psychosomatik und Psychotherapeutische Medizin, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
| | - Christian Schmahl
- Klinik für Psychosomatik und Psychotherapeutische Medizin, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland.
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4
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Rizvi SL, Fitzpatrick S. Changes in suicide and non-suicidal self-injury ideation and the moderating role of specific emotions over the course of dialectical behavior therapy. Suicide Life Threat Behav 2021; 51:429-445. [PMID: 32969037 DOI: 10.1111/sltb.12691] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 06/12/2020] [Accepted: 07/30/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Dialectical behavior therapy (DBT) targets suicidal behavior and non-suicidal self-injury (NSSI) as well as urges/ideation to engage in these behaviors. However, it remains unclear which specific suicidal ideation (SI) and NSSI ideation domains (i.e., frequency, worst intensity, average intensity, perceived likelihood of future ideation, and duration of ideation), if any, are impacted, and whether specific emotions moderate these effects. METHOD 73 individuals with borderline personality disorder (BPD), enrolled in six months of DBT, completed interviews of suicide and NSSI ideation and self-report measures of specific emotions at baseline, mid-treatment, and post-treatment. RESULTS Generalized estimation equations revealed that all domains of suicidal ideation decreased over the course of DBT, but for NSSI domains, only ideation intensity decreased. Higher levels of shame/guilt predicted less, and higher fear predicted more, reduction in SI and NSSI ideation frequency. Higher shame/guilt also predicted more reduction in worst SI intensity. Higher sadness predicted greater reductions in SI intensity and duration, but less reductions in the perceived likelihood of future NSSI ideation. CONCLUSIONS These findings suggest that DBT effectively reduces several facets of SI, but more work is required to target NSSI ideation. Results also suggest that targeting shame/guilt may be important to reducing SI and NSSI ideation.
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Affiliation(s)
- Shireen L Rizvi
- Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, NJ, USA
| | - Skye Fitzpatrick
- Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, NJ, USA.,Department of Psychology, York University, Toronto, ON, Canada
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Pec O, Bob P, Pec J, Ludvikova I. Psychodynamic day treatment program for borderline personality disorder: factors that predict outcome and dropout: An observational study. Medicine (Baltimore) 2021; 100:e25186. [PMID: 33726008 PMCID: PMC7982198 DOI: 10.1097/md.0000000000025186] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/24/2021] [Indexed: 01/05/2023] Open
Abstract
The objective of this study was to ascertain changes in symptoms of patients with borderline personality disorder undergoing psychodynamic day treatment with a duration of 9 months and the factors that predict clinical outcome or dropouts from the program.In an observational study, demographic characteristics (age, number of psychiatric hospitalizations, number of suicide attempts, current involvement in work or study activities), day doses of antipsychotic and antidepressant medication, psychiatric symptoms, and social functioning (Health of the Nation Outcome Scales), and symptoms of dissociation (Dissociative Experiences Scale) were assessed in patients at the beginning of treatment (N = 105). Further, psychiatric symptoms and social functioning were assessed at 3 stages: beginning of the program, end of the program, and 1-year follow-up. To study the differences between baseline values and values at the end of the treatment and follow-up values, the Wilcoxon signed-rank test was used. To discover baseline factors related to the effect of the treatment, Spearman correlation coefficients were calculated. To evaluate the differences between patients who completed the program (N = 67) and patients who dropped out (N = 38), differences in baseline factors between both groups were compared, using the Mann-Whitney test for independent samples.Improvement in symptoms (Health of the Nation Outcome Scales - version for external evaluators) at the end of the therapy (N = 67, P < .001) and at the 1-year follow-up (N = 46, P < .001) was found. Experience of an intimate relationship was positively related to clinical improvement at follow-up examinations (P < .001). Predictors of dropout included a higher number of psychiatric hospitalizations (P = .004), suicide attempts (P = .004), more severe pretreatment symptoms (P = .002), and symptoms of dissociation (P = .046).The results indicate that a psychodynamic day treatment is feasible for the treatment of less clinically disturbed patients with a history of intimate relationships. Patients with a higher number of previous psychiatric hospitalizations, more suicide attempts in the past, more severe pretreatment symptoms, and symptoms of dissociation are more likely not to complete the program.
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Affiliation(s)
- Ondrej Pec
- Center for Neuropsychiatric Research of Traumatic Stress, Department of Psychiatry and UHSL, First Faculty of Medicine, and Department of Psychiatry, Faculty of Medicine Pilsen, Charles University
- ESET, Psychotherapeutic and Psychosomatic Clinic, Prague, Czech Republic
| | - Petr Bob
- Center for Neuropsychiatric Research of Traumatic Stress, Department of Psychiatry and UHSL, First Faculty of Medicine, and Department of Psychiatry, Faculty of Medicine Pilsen, Charles University
| | - Jan Pec
- ESET, Psychotherapeutic and Psychosomatic Clinic, Prague, Czech Republic
| | - Irena Ludvikova
- ESET, Psychotherapeutic and Psychosomatic Clinic, Prague, Czech Republic
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Herzog P, Feldmann M, Voderholzer U, Gärtner T, Armbrust M, Rauh E, Doerr R, Rief W, Brakemeier EL. Drawing the borderline: Predicting treatment outcomes in patients with borderline personality disorder. Behav Res Ther 2020; 133:103692. [PMID: 32801095 DOI: 10.1016/j.brat.2020.103692] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 04/22/2020] [Accepted: 06/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND A routinely collected big data set was analyzed to determine the effectiveness of naturalistic inpatient treatment and to identify predictors of treatment outcome and discontinuation. METHODS The sample included 878 patients with borderline personality disorder who received non-manualized dialectic behavioral therapy in a psychosomatic clinic. Effect sizes (Hedge's g) were calculated to determine effectiveness. A bootstrap-enhanced regularized regression with 91 potential predictors was used to identify stable predictors of residualized symptom- and functional change and treatment discontinuation. Results were validated in a holdout sample and repeated cross validation. RESULTS Effect sizes were small to medium (g = 0.28-0.51). Positive symptom-related outcome was predicted by low affect regulation skills and no previous outpatient psychotherapy. Lower age, absence of work disability, high emotional and physical role limitations and low bodily pain were associated with greater improvement in functional outcome. Higher education and comorbid recurrent depressive disorder were the main predictors of treatment completion. The predictive quality of the models varied, with the best being found for symptom-related outcome (R2 = 18%). CONCLUSION While the exploratory process of variable selection replicates previous findings, the validation results suggest that tailoring treatment to the individual patient might not be based solely on sociodemographic, clinical and psychological baseline data.
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Affiliation(s)
- Philipp Herzog
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032, Marburg, Germany.
| | - Matthias Feldmann
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032, Marburg, Germany
| | - Ulrich Voderholzer
- Schön-Klinik Roseneck, Psychosomatic Clinic, Am Roseneck 6, D-83209, Prien Am Chiemsee, Germany
| | - Thomas Gärtner
- Schön-Klinik Bad Arolsen, Psychosomatic Clinic, Hofgarten 10, D-34454, Bad Arolsen, Germany
| | - Michael Armbrust
- Schön-Klinik Bad Bramstedt, Psychosomatic Clinic, Birkenweg 10, D-24576, Bad Bramstedt, Germany
| | - Elisabeth Rauh
- Schön-Klinik Bad Staffelstein, Psychsomatic Clinic, Am Kurpark 11, D-96231, Bad Staffelstein, Germany
| | - Robert Doerr
- Schön-Klinik Berchtesgadener Land, Psychosomatic Clinic, Malterhöh 1, D-83471, Schönau Am Königssee, Germany
| | - Winfried Rief
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032, Marburg, Germany
| | - Eva-Lotta Brakemeier
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032, Marburg, Germany
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Busmann M, Wrege J, Meyer AH, Ritzler F, Schmidlin M, Lang UE, Gaab J, Walter M, Euler S. Alternative Model of Personality Disorders (DSM-5) Predicts Dropout in Inpatient Psychotherapy for Patients With Personality Disorder. Front Psychol 2019; 10:952. [PMID: 31114528 PMCID: PMC6502965 DOI: 10.3389/fpsyg.2019.00952] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 04/10/2019] [Indexed: 11/13/2022] Open
Abstract
Objective Criterion A serves as the fundamental diagnostic criterion of the Alternative Model of Personality Disorders in section III of the Diagnostic and Statistical Manual 5. Consisting of a self- and an interpersonal dimension, it defines the construct of personality functioning as a general and dimensional factor of personality disorders. This study aimed to explore criterion A along with well-established treatment dropout predictors, e.g., sociodemographic factors, personality disorder diagnosis, symptom severity, and the therapeutic alliance. Methods The sample consisted of 132 patients diagnosed with personality disorder in a psychotherapeutic inpatient treatment. Cox proportional hazard regression models and a lasso model were applied. Results 28% of the sample prematurely discontinued treatment. The risk for dropout was 2.3 times higher for patients with high impairments in self-functioning as assessed with criterion A. Moreover, a positive therapist-rated therapeutic alliance was associated with a lower dropout risk. Conclusion The study suggests criterion A is a useful clinical indicator by identifying patients with personality disorder with a higher risk for dropout. An individualized therapeutic approach for such patients might be required.
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Affiliation(s)
- Mareike Busmann
- Department of Psychosomatics and Psychotherapy, Psychiatric University Hospital Basel, University of Basel, Basel, Switzerland
| | - Johannes Wrege
- Department of Psychosomatics and Psychotherapy, Psychiatric University Hospital Basel, University of Basel, Basel, Switzerland
| | - Andrea H Meyer
- Department of Psychology, University of Basel, Basel, Switzerland
| | - Franziska Ritzler
- Department of Psychosomatics and Psychotherapy, Psychiatric University Hospital Basel, University of Basel, Basel, Switzerland
| | - Moira Schmidlin
- Department of Psychosomatics and Psychotherapy, Psychiatric University Hospital Basel, University of Basel, Basel, Switzerland
| | - Undine E Lang
- Department of Psychosomatics and Psychotherapy, Psychiatric University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jens Gaab
- Department of Psychology, University of Basel, Basel, Switzerland
| | - Marc Walter
- Department of Psychosomatics and Psychotherapy, Psychiatric University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sebastian Euler
- Department of Psychosomatics and Psychotherapy, Psychiatric University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Consultation Psychiatry and Psychosomatics, University Hospital Zürich, Zurich, Switzerland
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8
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Richter C. Tagesklinische dialektisch-behaviorale Therapie: Eine Verlaufsuntersuchung nach Entlassung. Gibt es Prädiktoren für eine Verschlechterung? VERHALTENSTHERAPIE 2018. [DOI: 10.1159/000488360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Steuwe C, Berg M, Driessen M, Beblo T. Impact of therapist change after initial contact and traumatic burden on dropout in a naturalistic sample of inpatients with borderline pathology receiving dialectical behavior therapy. Borderline Personal Disord Emot Dysregul 2017. [PMID: 28649383 PMCID: PMC5480417 DOI: 10.1186/s40479-017-0067-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study focused on the predictors of therapy dropout in a naturalistic sample of patients with borderline pathology receiving dialectical behavior therapy (DBT) in an inpatient setting. We assumed that the change of the therapist between DBT-briefing and start of DBT-treatment as well as comorbid posttraumatic stress disorder (PTSD) and childhood trauma history were associated with elevated dropout. METHODS Eighty-nine participants with borderline pathology (≥ 3 borderline personality disorder criteria) receiving an inpatient DBT program completed a quality assurance questionnaire set assessing demographic information and pretreatment psychopathology during the days of their inpatient stay. Beyond that, changes of therapists were documented. The predictor analyses were investigated with generalized estimating equations. RESULTS The dropout rate was 24.7%. A change of therapist between DBT-briefing and treatment as well as high childhood emotional abuse was associated with premature termination of treatment. Higher values of physical neglect during childhood were associated with a protective effect on treatment dropout. Surprisingly, this was also true for comorbid PTSD. CONCLUSIONS This study supports the importance of therapy process variables as predictors of therapy dropout in borderline pathology. A change of therapist between DBT-briefing and treatment was associated with an increased vulnerability for dropping out of treatment and should therefore be avoided if possible. Against our hypotheses, a comorbid PTSD was even protective with regard to DBT dropout. Therefore, this severely suffering patient group should not be rejected from treatment assuming them to be too unstable for psychotherapy. However, results need to be replicated. ClinicalTrials.gov Identifier: NCT03018639, retrospectively registered on January 9, 2017.
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Affiliation(s)
- Carolin Steuwe
- Research Department, Clinic of Psychiatry and Psychotherapy, Ev. Kliníkum Bethel, Bielefeld, Germany.,Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Michaela Berg
- Research Department, Clinic of Psychiatry and Psychotherapy, Ev. Kliníkum Bethel, Bielefeld, Germany
| | - Martin Driessen
- Research Department, Clinic of Psychiatry and Psychotherapy, Ev. Kliníkum Bethel, Bielefeld, Germany.,Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Thomas Beblo
- Research Department, Clinic of Psychiatry and Psychotherapy, Ev. Kliníkum Bethel, Bielefeld, Germany.,Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
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Landes SJ, Chalker SA, Comtois KA. Predicting dropout in outpatient dialectical behavior therapy with patients with borderline personality disorder receiving psychiatric disability. Borderline Personal Disord Emot Dysregul 2016; 3:9. [PMID: 27588205 PMCID: PMC5007727 DOI: 10.1186/s40479-016-0043-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 07/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rates of treatment dropout in outpatient Dialectical Behavior Therapy (DBT) in the community can be as high as 24 % to 58 %, making dropout a great concern. The primary purpose of this article was to examine predictors of dropout from DBT in a community mental health setting. METHODS Participants were 56 consumers with borderline personality disorder (BPD) who were psychiatrically disabled participating in a larger feasibility trial of Dialectical Behavior Therapy- Accepting the Challenges of Exiting the System. The following variables were examined to see whether they predicted dropout in DBT: age, education level, baseline level of distress, baseline level of non-acceptance of emotional responses, and skills module in which a consumer started DBT skills group. These variables were chosen based on known predictors of dropout in consumers with BPD and in DBT, as well as an interest in what naturally occurring variables might impact dropout. RESULTS The dropout rate in this sample was 51.8 %. Results of the logistic regression show that younger age, higher levels of baseline distress, and a higher level of baseline non-acceptance of emotional responses were significantly associated with dropout. The DBT skills module in which an individual started group did not predict dropout. CONCLUSIONS The implications of these findings are that knowledge of consumer age and pretreatment levels of distress and non-acceptance of emotional responses can impact providers' choice of commitment and treatment strategies to reduce dropout. Future research should examine these strategies, as well as the impact of predictor variables on outcome and reasons for dropout.
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Affiliation(s)
- Sara J Landes
- Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Box 359911, 325 Ninth Avenue, Seattle, WA 98104 USA ; Department of Psychiatry, Division of Health Services Research, University of Arkansas for Medical Sciences, 4301 W. Markham St., #755, Little Rock, AR 72205 USA ; VISN 16 Mental Illness Research, Education, and Clinical Center (MIRECC), Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, 72114 AR USA
| | - Samantha A Chalker
- Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Box 359911, 325 Ninth Avenue, Seattle, WA 98104 USA ; Department of Psychology, The Catholic University of America, O'Boyle Hall, Room 339, 620 Michigan Ave. NE, Washington, DC, 20064 USA
| | - Katherine Anne Comtois
- Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Box 359911, 325 Ninth Avenue, Seattle, WA 98104 USA
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Ansell EB, Wright AGC, Markowitz JC, Sanislow CA, Hopwood CJ, Zanarini MC, Yen S, Pinto A, McGlashan TH, Grilo CM. Personality disorder risk factors for suicide attempts over 10 years of follow-up. Personal Disord 2015; 6:161-7. [PMID: 25705977 DOI: 10.1037/per0000089] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Identifying personality disorder (PD) risk factors for suicide attempts is an important consideration for research and clinical care alike. However, most prior research has focused on single PDs or categorical PD diagnoses without considering unique influences of different PDs or of severity (sum) of PD criteria on the risk for suicide-related outcomes. This has usually been done with cross-sectional or retrospective assessment methods. Rarely are dimensional models of PDs examined in longitudinal, naturalistic prospective designs. In addition, it is important to consider divergent risk factors in predicting the risk of ever making a suicide attempt versus the risk of making an increasing number of attempts within the same model. This study examined 431 participants who were followed for 10 years in the Collaborative Longitudinal Personality Disorders Study. Baseline assessments of personality disorder criteria were summed as dimensional counts of personality pathology and examined as predictors of suicide attempts reported at annual interviews throughout the 10-year follow-up period. We used univariate and multivariate zero-inflated Poisson regression models to simultaneously evaluate PD risk factors for ever attempting suicide and for increasing numbers of attempts among attempters. Consistent with prior research, borderline PD was uniquely associated with ever attempting. However, only narcissistic PD was uniquely associated with an increasing number of attempts. These findings highlight the relevance of both borderline and narcissistic personality pathology as unique contributors to suicide-related outcomes.
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Affiliation(s)
- Emily B Ansell
- Department of Psychiatry, Yale University School of Medicine
| | | | - John C Markowitz
- Department of Psychiatry, Columbia University College of Physicians and Surgeons
| | | | | | | | - Shirley Yen
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University
| | - Anthony Pinto
- Department of Psychiatry, Columbia University College of Physicians and Surgeons
| | | | - Carlos M Grilo
- Department of Psychiatry, Yale University School of Medicine
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Stiglmayr C, Stecher-Mohr J, Wagner T, Meiβner J, Spretz D, Steffens C, Roepke S, Fydrich T, Salbach-Andrae H, Schulze J, Renneberg B. Effectiveness of dialectic behavioral therapy in routine outpatient care: the Berlin Borderline Study. Borderline Personal Disord Emot Dysregul 2014; 1:20. [PMID: 26401303 PMCID: PMC4579507 DOI: 10.1186/2051-6673-1-20] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 11/13/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dialectical behavior therapy (DBT) has been proven to be an efficacious treatment for borderline personality disorder (BPD) in several randomized controlled trials (RCTs). However, generalizability of this outcome to the routine health care (effectiveness) has rarely been investigated to date. The aim of this study is to examine the effectiveness of DBT for BPD under the routine health care situation in Germany. METHODS The study has a longitudinal design over a course of four years with six assessment points. In this paper, results for the first year of treatment are reported. Outcome was assessed at four times throughout an initial phase (of up to five therapy-sessions) and an additional 12 months of therapy. Overall, n =78 patients started the study, 47 patients completed one year of treatment. Dependent variables were number and duration of inpatient treatment stays, number of suicide attempts and non-suicidal self-injury, severity of borderline symptoms, depression, level of dissociation, and general psychopathology. RESULTS Patients significantly improved regarding self-injurious behaviors, number of inpatient hospital stays, severity of borderline symptoms and psychopathology. At the end of the first treatment year, 77% of the patients no longer met criteria for BPD diagnosis. Fewer therapy discontinuations by patients were observed when therapists participated in consultation teams. CONCLUSIONS Under routine mental health care conditions in Germany, outpatient DBT leads to positive results comparable to those reported in other effectiveness studies and in randomized controlled trials.
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Affiliation(s)
- Christian Stiglmayr
- Arbeitsgemeinschaft fuer Wissenschaftliche Psychotherapie, Witzlebenstraβe 30a, 14057 Berlin, Germany
| | - Julia Stecher-Mohr
- Department of Psychology, Humboldt-Universitaet zu Berlin, Unter den Linden 6, 10999 Berlin, Germany
| | - Till Wagner
- Department of Psychology, Humboldt-Universitaet zu Berlin, Unter den Linden 6, 10999 Berlin, Germany
| | - Jeannette Meiβner
- Department of Psychology, Humboldt-Universitaet zu Berlin, Unter den Linden 6, 10999 Berlin, Germany
| | - Doreen Spretz
- Department of Psychology, Freie Universitaet Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany
| | - Christiane Steffens
- Department of Psychology, Freie Universitaet Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany
| | - Stefan Roepke
- Department of Psychiatry, Charité, Universitaetsmedizin Berlin, Campus Benjamin Franklin, Eschenallee 3, 14050 Berlin, Germany
| | - Thomas Fydrich
- Department of Psychology, Humboldt-Universitaet zu Berlin, Unter den Linden 6, 10999 Berlin, Germany
| | - Harriet Salbach-Andrae
- Department of Psychiatry, Charité, Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Julian Schulze
- Department of Psychology, Freie Universitaet Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany
| | - Babette Renneberg
- Department of Psychology, Freie Universitaet Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany
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