Naturalistic outcomes of evidence-based therapies for borderline personality disorder at a university clinic: A quasi randomized trial
Gregory, R.J., Chlebowski, S., Kang, D., Remen, A.L., Soderberg, M.G., Stepkovich J., & Virk, S. (2008): A controlled trial of psychodynamic psychotherapy for co-occuring borderline personality disorder and alcohol use disorder. Psychotherapy: Theory, Research, Practice, Training, 45, 28-41.
Gregory, R.J., Delucia-Deranja, E. & Mogle, J.A. (2010): Dynamic deconstructive psychotherapy versus optimized community care for borderline personality disorder and alcohol use disorders: 30-month follow-up. Journal of Nervous and Mental Disease, 198, 292-298.
Both Dialectical Behavior Therapy (DBT) and Dynamic Deconstructive Psychotherapy (DDP) are listed in the National Registry of Evidence-based Programs and Practices based on independent reviews of their performance in randomized controlled trials for borderline personality disorder. However, little is known about their effectiveness in real-world settings. DDP is a newer treatment with demonstrated efficacy, but has been less extensively applied than DBT. In a twelve month-controlled trial, thirty subjects with Borderline Personality Disorder (BPD) and co-occuring active alcohol use disorders were randomized to either DDP or optimized community care. Almost half the subjects also met criteria for antisocial personality disorder (Gregory et al. 2008). Following twelve-months of active treatment with DDP, they were then evaluated after an additional eighteen months of naturalistic care in the community. Al applied in treating this low-functioning and highly comorbid BPD population, DDP demonstrated relatively good retention rates and large between-group treatment effects for core symptoms of BPD, depression, parasuicide behavior, alcohol misuse, recreational drug use, inpatient care, and perceived social support (Gregory, Delucia-Deranja, and Mogle, 2010). Although both, DDP and DBT activate autobiographical memory by reviewing specific emotionally charged incidents and behaviors, the therapist stance differs substancially. Whereas the DDP therapist tries to be nondirective and exploratory, thereby supporting individuation, the DBT therapist tries to be validating, directive, educative and pragmatic.
The present study attempts to fill a gap in the literature by using a quasi-randomized design comparing naturalistic twelve-month outcomes of two manual-based treatments for BPD-DBT and DDP-in the real-world setting of a university clinic. A third group of patients, treated with unstructured eclectic individual psychotherapy, served as a control. This study is the first to compare two manual-based treatments for BPD in a real-world setting.
Clients receiving DDP or comprehensive DBT demonstrated significant improvement in symptoms of BPD over time in the intent-to-treat sample, but those receiving TAU did not. Moreover, both of the manual-based treatments achieved significantly greater improvement in symptoms of depression and disability than was found in those receiving TAU. Symptoms of BPD, as assessed by the BEST, improved to a significantly greater degree for clients treated with DDP as compared to DBT demonstrated significantly greater improvement in depressive symptoms, disability and nonsuicidal self-injury than DBT.
A possible explanation for the differences in outcome between DDP and DBT is that CEBI is a specialized tertiary care program that attracts a particularly refractory and comorbid subgroup of BPD clients who have not been preselected for willingness to participate in a research study. In the treatment of severely impaired BPD clients with active co-occuring alcohol use disorders, DDP has demonstrated strongly positive outcomes and relatively good retention (Gregory et al. 2008).
Both DBT and DDP can be effective for borderline personality disorder in the real-world setting of a tertiary care clinic. However, DDP may lead to greater improvement in symptoms and functioning than DBT in this setting.
713 Harrison Street, Syracuse, NY 13202