Evaluation of a Modified Dialectical Behavior Therapy Program
Condition: Borderline Personality Disorder
MeSH terms: Personality Disorders; Borderline Personality Disorder
Study type: Observational

Summary: 
      The goal of this pilot project is to offer outpatient Dialectical Behavior Therapy (DBT)
      treatment as described in Linehan's text (1993), which is considered an effective treatment
      of borderline personality disorder. This treatment consists of weekly individual
      psychotherapy, weekly group skills training, 24 hour telephone consultation, and weekly team
      consultation meetings for therapists. The investigators program is able to offer all of these
      components except the 24 hour phone consultation (which has been modified due to
      employment/union guidelines of interdisciplinary staff working within the investigators
      health care system). This project intends to offer the treatment for a period of 6 months.

      As such, this proposed research project seeks to assess the feasibility of implementing an
      outpatient DBT program within a public health care setting in Canada. This study also aims to
      evaluate this DBT program for clinical effectiveness in its modified format. Specifically,
      the investigators will examine relevant outcomes related to patient functioning (e.g.,
      depression, self-harm and suicidal behaviors, and admissions to hospital/ER visits) and
      improvement (e.g., improved quality of life, meeting work/employment goals) pre and post
      completion of this 6 month treatment program.

      The investigators hypotheses are that each patient will show improvement in all outcome
      variables (e.g., improved mood and quality of life, decreased self-harm, decreased ER visits
      and hospitalization visits, etc). The investigators also hypothesize that the investigators
      modified program will produce comparable results to those from studies of standard outpatient
      DBT.
    

Detailed description: 
      Standard DBT includes four modes of intervention: weekly individual psychotherapy; weekly
      skills group; 24 hour phone consultation to the patient; and consultation team meetings. The
      skills group is focused on teaching skills (mindfulness, emotional regulation, distress
      tolerance, and interpersonal effectiveness), and facilitating the replacement of maladaptive
      behaviors with adaptive behaviors (Neasciu, Rizvi, & Linehan, 2010). Individual therapy
      sessions focus on reducing target problem behaviors (e.g., life threatening behavior, therapy
      interfering behavior, quality of life interfering behaviors). Phone consultation is to aid
      the client in generalizing skill use to their every day life. The consultation team meetings
      are for the therapists, to provide support, and to aid therapists in staying adherent to a
      DBT frame of treatment.

      This project will be utilizing a convenience sample. Patients are referred to the program by
      their psychiatrist/family doctor. They are assessed by a Clinical Psychologist to determine
      if they meet criteria for a diagnosis of Borderline Personality Disorder via clinical
      interview and a semi-structured diagnostic interview. They must also meet the
      inclusion/exclusion criteria for participation in the program, which are as follows:

      Inclusion Criteria

        -  18 years or older

        -  Borderline personality disorder diagnosis

        -  Chronic suicidal ideation or parasuicidal acts, or other self-destructive, impulsive
           behaviors

        -  Must be willing to sign DBT contract and commit to 6-month duration of treatment of both
           individual therapy and skills training group.

      Exclusion Criteria

        -  Active psychosis

        -  Severe developmental delays, cognitive impairment or learning disabilities

        -  No violent behaviors will be tolerated. Patients with a history of dangerous or
           aggressive behaviors towards others, history of medical harm to previous therapists may
           not be considered.

      Following this, they must agree to participate in the program and to the program requirements
      (weekly individual therapy, skills group, etc). Once this has occurred, they will be
      approached by a research assistant to discuss with them their voluntary participation in this
      research study. Once consent is provided, the patient will complete several baseline
      measures. These same measures will be completed at post treatment (6 months) and then again
      at 12 months and 18 months for follow-up. Each patient will also complete a weekly diary
      card, which asks them to record several aspects of daily functioning, as well as self-harm
      urges and behaviors, and use of skills taught in DBT.
    

Intervention name(s): Dialectical Behavior therapy
Intervention type(s): Behavioral
Intervention description(s): Weekly psychotherapy of both individual and group sessions
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        The participants will be selected from the community.
      
Keywords: borderline personality disorder; dialectical behavior therapy; psychological treatment