DBT for Chronically Self-harming Individuals With BPD: Evaluating the Clinical & Cost Effectiveness of a 6 mo. Treatment

NCT02387736 | Completed DMC

• 1 other identifier: 026/2014
• Study Type: interventional
• Target: 240
• Locations: 1 country
• Sites: 2

Brief Summary

Standard one-year dialectical behaviour therapy (DBT), which has four components, is an effective treatment for people with borderline personality disorder. However, such DBT programs are in short supply and costly, resulting in long wait lists. In practice, DBT is often reduced in length or intensity. This study will determine whether shorter DBT treatment is clinically effective and cost-effective. In total, 240 self-harming BPD patients will be randomly assigned to receive either 1 year or 6 months of DBT, with follow-up lasting two years. Rates of suicidal and self-harm behaviours, use of health care and general psychological functioning will be examined.

Conditions

Borderline Personality Disorder

Keywords

BPD; DBT; Dialectical Behaviour Therapy; Borderline Personality Disorder; Suicide; Non-suicidal self injury; NSSI; Randomized Control trials; treatment

Outcome Measures

Primary Outcomes (1)

• Change in frequency of self-harm (suicidal and non-suicidal) behaviours over time as measured by the Suicide Attempt Self-Injury Interview (SASII)

  Records details regarding the frequency, topography, intent, medical severity, social context, precipitating and concurrent events, and outcomes of each self-harm (suicidal and non-suicidal) behavior during a three-month target time period.

  Administered pre-treatment and every three months until 24 months

Secondary Outcomes (8)

• Changes in health care use as measured by the Treatment History Interview-2 (THI-2)

  Administered pre-treatment and every three months until 24 months

• Change in general functioning as measured by the Euroqol-5D

  At pre-treatment and every three months until 24 months

• Change in BPD symptoms as measured by the Borderline Symptom List-23 (BSL-23)

  At pre-treatment and every three months over 24 months

• Change in general psychopathology and symptoms, as measures by the Symptom Checklist 90 Revised (SCL-90R)

  At pre-treatment and every three months over 24 months

• Change in anger as measured by the State-Trait Anger Expression Inventory-2 (STAXI-2)

  At pre-treatment and every three months over 24 months

Study Arms (2)

Dialectical Behaviour Therapy-6 months

EXPERIMENTAL

6 months of standard dialectical behaviour therapy treatment.

Behavioral: Dialectical Behaviour Therapy-6 months

Dialectical Behaviour Therapy-12 months

ACTIVE COMPARATOR

12 months of standard dialectical behaviour therapy treatment

Behavioral: Dialectical Behaviour Therapy-12 months

Interventions

Dialectical Behaviour Therapy-12 months BEHAVIORAL

Modification of behaviours achieved with reframing thoughts and impulses

Also known as: DBT-12

Dialectical Behaviour Therapy-12 months

Dialectical Behaviour Therapy-6 months BEHAVIORAL

Modification of behaviours achieved with reframing thoughts and impulses

Also known as: DBT-6

Dialectical Behaviour Therapy-6 months

Eligibility Criteria

• Age: 18 Years - 65 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Meets DSM-IV criteria for Borderline Personality Disorder.
• Has had at least 2 self-harm episodes (either suicidal or non-suicidal) in the past 5 years, including at least 1 in the past 8 weeks.
• Proficient in English
• Provides informed consent to participate in the study.
• Absence of 8 or more standard weeks of DBT in the past year (individual and group therapy components).
• has had either Ontario Health Insurance Plan (OHIP) coverage or BC Medical Services Plan (MSP) health insurance for 1 year or more
• Absence of a pending criminal court case or charges.
• Has been a resident of Ontario or British Columbia for all of the past 12 months, at least.
• Lives in the Greater Toronto Area/Greater Vancouver Area

You may not qualify if:

• Meets the DSM-IV criteria for bipolar disorder I, dementia, or a psychotic disorder other than psychotic disorder NOS
• IQ less than 70
• Chronic or serious physical health problem requiring hospitalization within the next year (e.g., cancer)
• Plans to move to a province other than Ontario or BC in the next 2 years.

Sponsors & Collaborators

• Centre for Addiction and Mental Health: lead
• Simon Fraser University: collaborator
• Canadian Institutes of Health Research (CIHR): collaborator

Study Sites (2)

Simon Fraser University

Burnaby, British Columbia, V5A IS6, Canada

Location

Center for Addiction and Mental Health

Toronto, Ontario, M5S 2S1, Canada

Location

Related Publications (18)

• American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders 2013; 5 ed. Washington, DC: American Psychiatric Association Press.

  BACKGROUND

• Grant BF, Chou SP, Goldstein RB, Huang B, Stinson FS, Saha TD, Smith SM, Dawson DA, Pulay AJ, Pickering RP, Ruan WJ. Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2008 Apr;69(4):533-45. doi: 10.4088/jcp.v69n0404.

  PMID: 18426259 BACKGROUND

• Soeteman DI, Hakkaart-van Roijen L, Verheul R, Busschbach JJ. The economic burden of personality disorders in mental health care. J Clin Psychiatry. 2008 Feb;69(2):259-65. doi: 10.4088/jcp.v69n0212.

  PMID: 18363454 BACKGROUND

• Bateman AW. Treating borderline personality disorder in clinical practice. Am J Psychiatry. 2012 Jun;169(6):560-3. doi: 10.1176/appi.ajp.2012.12030341. No abstract available.

  PMID: 22684591 BACKGROUND

• Skodol AE, Gunderson JG, Pfohl B, Widiger TA, Livesley WJ, Siever LJ. The borderline diagnosis I: psychopathology, comorbidity, and personality structure. Biol Psychiatry. 2002 Jun 15;51(12):936-50. doi: 10.1016/s0006-3223(02)01324-0.

  PMID: 12062877 BACKGROUND

• Skodol AE, Siever LJ, Livesley WJ, Gunderson JG, Pfohl B, Widiger TA. The borderline diagnosis II: biology, genetics, and clinical course. Biol Psychiatry. 2002 Jun 15;51(12):951-63. doi: 10.1016/s0006-3223(02)01325-2.

  PMID: 12062878 BACKGROUND

• Black DW, Blum N, Pfohl B, Hale N. Suicidal behavior in borderline personality disorder: prevalence, risk factors, prediction, and prevention. J Pers Disord. 2004 Jun;18(3):226-39. doi: 10.1521/pedi.18.3.226.35445.

  PMID: 15237043 BACKGROUND

• Comtois, K. A., Elwood, L., Holdcraft, L. C., Smith, W. R., Simpson, T. L. Effectiveness of dialectical behaviour therapy in a community mental health centre. Cognitive And Behavioral Practice 2007; 14(4):406-14.

  BACKGROUND

• Bateman A, Fonagy P. Health service utilization costs for borderline personality disorder patients treated with psychoanalytically oriented partial hospitalization versus general psychiatric care. Am J Psychiatry. 2003 Jan;160(1):169-71. doi: 10.1176/appi.ajp.160.1.169.

  PMID: 12505818 BACKGROUND

• Zanarini MC, Frankenburg FR, Hennen J, Silk KR. Mental health service utilization by borderline personality disorder patients and Axis II comparison subjects followed prospectively for 6 years. J Clin Psychiatry. 2004 Jan;65(1):28-36. doi: 10.4088/jcp.v65n0105.

  PMID: 14744165 BACKGROUND

• McMain SF, Links PS, Gnam WH, Guimond T, Cardish RJ, Korman L, Streiner DL. A randomized trial of dialectical behavior therapy versus general psychiatric management for borderline personality disorder. Am J Psychiatry. 2009 Dec;166(12):1365-74. doi: 10.1176/appi.ajp.2009.09010039. Epub 2009 Sep 15.

  PMID: 19755574 BACKGROUND

• Linehan MM, Comtois KA, Murray AM, Brown MZ, Gallop RJ, Heard HL, Korslund KE, Tutek DA, Reynolds SK, Lindenboim N. Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Arch Gen Psychiatry. 2006 Jul;63(7):757-66. doi: 10.1001/archpsyc.63.7.757.

  PMID: 16818865 BACKGROUND

• McMain SF, Guimond T, Streiner DL, Cardish RJ, Links PS. Dialectical behavior therapy compared with general psychiatric management for borderline personality disorder: clinical outcomes and functioning over a 2-year follow-up. Am J Psychiatry. 2012 Jun;169(6):650-61. doi: 10.1176/appi.ajp.2012.11091416.

  PMID: 22581157 BACKGROUND

• Linehan, M.M. Cognitive Behavioural Treatment of Borderline Personality Disorder. New York: Guilford Press; 1993.

  BACKGROUND

• Christensen KE, McMain S, Chapman A, Kuo JR. An examination of the role of PTSD and childhood trauma on treatment outcomes for individuals with borderline personality disorder in dialectical behavior therapy. Borderline Personal Disord Emot Dysregul. 2025 Nov 12;12(1):47. doi: 10.1186/s40479-025-00322-2.

  PMID: 41225564 DERIVED

• Witt KG, Hetrick SE, Rajaram G, Hazell P, Taylor Salisbury TL, Townsend E, Hawton K. Psychosocial interventions for self-harm in adults. Cochrane Database Syst Rev. 2021 Apr 22;4(4):CD013668. doi: 10.1002/14651858.CD013668.pub2.

  PMID: 33884617 DERIVED

• Storebo OJ, Stoffers-Winterling JM, Vollm BA, Kongerslev MT, Mattivi JT, Jorgensen MS, Faltinsen E, Todorovac A, Sales CP, Callesen HE, Lieb K, Simonsen E. Psychological therapies for people with borderline personality disorder. Cochrane Database Syst Rev. 2020 May 4;5(5):CD012955. doi: 10.1002/14651858.CD012955.pub2.

  PMID: 32368793 DERIVED

• McMain SF, Chapman AL, Kuo JR, Guimond T, Streiner DL, Dixon-Gordon KL, Isaranuwatchai W, Hoch JS. The effectiveness of 6 versus 12-months of dialectical behaviour therapy for borderline personality disorder: the feasibility of a shorter treatment and evaluating responses (FASTER) trial protocol. BMC Psychiatry. 2018 Jul 17;18(1):230. doi: 10.1186/s12888-018-1802-z.

  PMID: 30016935 DERIVED

Related Links

• The Centre for Addiction and Mental Health (CAMH) is the leading mental health and addictions research facility in Canada, and one of the largest in the world.

MeSH Terms

Conditions

Borderline Personality Disorder; Suicide; Self-Injurious Behavior

Condition Hierarchy (Ancestors)

Personality Disorders; Mental Disorders; Behavioral Symptoms; Behavior

Study Officials

• Shelley McMain, Ph.D

  The Centre for Addiction and Mental Health

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Head, Borderline Personality Disorder Clinic

Study Record Dates

• First Submitted: February 20, 2015
• First Posted: March 13, 2015
• Study Start: February 1, 2015
• Primary Completion: July 1, 2019
• Study Completion: July 1, 2019
• Last Updated: March 27, 2026

Record last verified: 2026-03

Data Sharing

• IPD Sharing: Will not share

Locations

CA (2)