Influence of therapist competence and quantity of cognitive behavioural therapy on suicidal behaviour and inpatient hospitalisation in a randomised controlled trial in borderline personality disorder: Further analyses of treatment effects in the BOSCOT study
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Objectives: We investigated the treatment effects reported from a high‐quality randomized controlled trial of cognitive behavioural therapy ( CBT ) for 106 people with borderline personality disorder attending community‐based clinics in the UK N ational H ealth S ervice – the BOSCOT trial. Specifically, we examined whether the amount of therapy and therapist competence had an impact on our primary outcome, the number of suicidal acts, using instrumental variables regression modelling. Design: Randomized controlled trial. Participants from across three sites ( L ondon, G lasgow, and A yrshire/ A rran) were randomized equally to CBT for personality disorders ( CBT pd) plus Treatment as Usual or to Treatment as Usual. Treatment as Usual varied between sites and individuals, but was consistent with routine treatment in the UK N ational H ealth S ervice at the time. CBT pd comprised an average 16 sessions (range 0–35) over 12 months. Method: We used instrumental variable regression modelling to estimate the impact of quantity and quality of therapy received (recording activities and behaviours that took place after randomization) on number of suicidal acts and inpatient psychiatric hospitalization. Results: A total of 101 participants provided full outcome data at 2 years post randomization. The previously reported intention‐to‐treat ( ITT ) results showed on average a reduction of 0.91 (95% confidence interval 0.15–1.67) suicidal acts over 2 years for those randomized to CBT . By incorporating the influence of quantity of therapy and therapist competence, we show that this estimate of the effect of CBT pd could be approximately two to three times greater for those receiving the right amount of therapy from a competent therapist. Conclusions: Trials should routinely control for and collect data on both quantity of therapy and therapist competence, which can be used, via instrumental variable regression modelling, to estimate treatment effects for optimal delivery of therapy. Such estimates complement rather than replace the ITT results, which are properly the principal analysis results from such trials. Practitioner points: Assessing the impact of the quantity and quality of therapy (competence of therapists) is complex. More competent therapists, trained in CBT pd, may significantly reduce the number of suicidal act in patients with borderline personality disorder.
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In psychological treatments, the competence and natural attributes of the therapist assume greater importance compared to those of a practitioner prescribing a drug.
“This is especially important for psychological treatments where the competence and natural attributes of the therapist assume greater importance compared to those of a practitioner prescribing a drug [10].”
From The recording of adverse events from psychological treatments in clinical trials: evidence from a review of NIHR-funded trials (2014) · cites this paper as [10]
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Psychological therapies for people with borderline personality disorder.
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- Authors
- Norrie, J., Davidson, K., Tata, P., & Gumley, A.
- Affiliations
- University of Aberdeen (GB)
- Gartnavel General Hospital (GB)
- Central and North West London NHS Foundation Trust (GB)
- Corresponding author
- Davidson, Kate
- Venue
- Psychology and Psychotherapy: Theory, Research and Practice
- Publisher
- Wiley
- Published
- 2013-02-19
- Volume
- 86
- Issue
- 3
- Pages
- 280-293
- ISSN
- 1476-0835 (ISSN-L)
- 2044-8341
- PMC
- PMC4491320
- OpenAlex
- W2113913717
- Cited by
- 23
- References
- 16
- Citations by year
- 2025: 1 · 2024: 3 · 2023: 2 · 2022: 1 · 2021: 3 · 2020: 2 · 2018: 2 · 2017: 2 · 2016: 2 · 2015: 1 · 2014: 3 · 2012: 1
- FWCI
- 2.22
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Psychology and Psychotherapy Theory Research and Practice (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion)
- Aberdeen University Research Archive (Aberdeen University) (submittedVersion)
- Funders
- Wellcome Trust (064027/Z/01/Z)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Keywords
- borderline personality disorder, cognitive behavioral therapy, suicidal behavior, therapist competence, treatment effects, community-based treatment
- MeSH terms
- Borderline Personality Disorder, Clinical Competence, Female, Follow-Up Studies, United Kingdom, Hospitalization, Humans, Regression Analysis, State Medicine, Suicide, Attempted, Time Factors, Cognitive Behavioral Therapy, Outcome Assessment, Health Care, Age of Onset, Statistics, Nonparametric, Kaplan-Meier Estimate, Intention to Treat Analysis
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