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Cited by 82Personality Disorders and PsychopathologyPsychotherapy Techniques and ApplicationsBipolar Disorder and Treatment

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

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McMain, Shelley F., Chapman, Alexander L., Kuo, Janice R., Guimond, Tim, Streiner, David L., Dixon-Gordon, Katherine L., Isaranuwatchai, Wanrudee, Hoch, Jeffrey S.·2018·BMC Psychiatry
DOI 10.1186/s12888-018-1802-zPMC PMC6050694
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Abstract

BACKGROUND: Although Dialectical Behaviour Therapy (DBT) is an evidence-based psychosocial treatment for borderline personality disorder (BPD), the demand for it exceeds available resources. The commonly researched 12-month version of DBT is lengthy; this can pose a barrier to its adoption in many health care settings. Further, there are no data on the optimal length of psychotherapy for BPD. The aim of this study is to examine the clinical and cost-effectiveness of 6 versus 12 months of DBT for chronically suicidal individuals with BPD. A second aim of this study is to determine which patients are as likely to benefit from shorter treatment as from longer treatment. METHODS/DESIGN: Powered for non-inferiority testing, this two-site single-blind trial involves the random assignment of 240 patients diagnosed with BPD to 6 or 12 months of standard DBT. The primary outcome is the frequency of suicidal or non-suicidal self-injurious episodes. Secondary outcomes include healthcare utilization, psychiatric and emotional symptoms, general and social functioning, and health status. Cost-effectiveness outcomes will include the cost of providing each treatment as well as health care and societal costs (e.g., missed work days and lost productivity). Assessments are scheduled at pretreatment and at 3-month intervals until 24 months. DISCUSSION: This is the first study to directly examine the dose-effect of psychotherapy for chronically suicidal individuals diagnosed with BPD. Examining both clinical and cost effectiveness in 6 versus 12 months of DBT will produce answers to the question of how much treatment is good enough. Information from this study will help to guide decisions about the allocation of scarce treatment resources and recommendations about the benefits of briefer treatment. TRIAL REGISTRATION: NCT02387736 . Registered February 20, 2015.

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  • Briefer DBT formats have the advantage of being more feasible, cost-effective, and easily implementable in clinical settings.

    “Moreover, briefer formats have the advantage of being more feasible, cost-effective, and easily implementable in clinical settings (McMain et al., 2018).”

    From Feasibility, Acceptability and Preliminary Efficacy of Dialectical Behavior Therapy for Autistic Adults without Intellectual Disability: A Mixed Methods Study (2022) · cites this paper as McMain et al., 2018

    The Background describes the potential cost-effectiveness and ease of delivery of six-month DBT, and the Discussion says it could be a less resource-intensive alternative if outcomes are comparable. But the Background also says its health-economic impact has not been evaluated, so the paper does not establish cost-effectiveness or easier implementation as demonstrated advantages. (LLM, conf=0.88)

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2 of the 100 references couldn’t be matched to a known paper.

Research works printed but not linked: 5

  1. [37](UK) NCCfMH Borderline Personality Disorder: Treatment and Management 2009 Leicester British Psychological Society 21796831
  2. [52]Association Psychiatric Association Diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV) 1994 4 Washington, DC American Psychiatric Association Press
  3. [55]First MBSR Gibbon M Williams J Structured clinical interview for DSM-IV Axis I disorders, research version, patient edition (SCIDI/P) 2002 New York Biometrics Research, New York State Psychiatric Institute
  4. [72]Kind P Spilker B The EuroQoL instrument: an index of health-related quality of life Quality of Life and Pharmacoeconomics in Clinical Trials Second Edition 1996 Philadelphia Lippincott-Raven Publishers
  5. [90]Rabe-Hesketh S, Skrondal A. Multilevel and longitudinal modeling using Statab, Second edition: Stata press; 2008.

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Authors
McMain, S. F., Chapman, A. L., Kuo, J. R., Guimond, T., Streiner, D. L., Dixon-Gordon, K. L., Isaranuwatchai, W., & Hoch, J. S.
Affiliations
  • Centre for Addiction and Mental Health (CA)
  • Simon Fraser University (CA)
  • Toronto Metropolitan University (CA)
  • University of Toronto (CA)
  • St. Michael's Hospital (CA)
Corresponding author
McMain, Shelley F.
ORCID
Venue
BMC Psychiatry
Publisher
Springer Science and Business Media LLC
Published
2018-07-17
Volume
18
Issue
1
Pages
230-230
ISSN
1471-244X (ISSN-L)
DOI
10.1186/s12888-018-1802-z
PMC
PMC6050694
OpenAlex
W2883241531
Cited by
82
References
100
Citations by year
2026: 10 · 2025: 6 · 2024: 12 · 2023: 27 · 2022: 6 · 2021: 10 · 2020: 9 · 2019: 2
FWCI
6.15
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Psychiatry (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • TSpace (University of Toronto) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • eScholarship (California Digital Library) (submittedVersion)
  • eScholarship (California Digital Library) (submittedVersion, cc-by)
Funders
Canadian Institutes of Health Research (133428)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
Keywords
dialectical behavior therapy, borderline personality disorder, treatment duration, brief psychotherapy, suicidal behavior, non-suicidal self-injury, cost-effectiveness, dose-response relationship, treatment allocation, non-inferiority
MeSH terms
Dialectical Behavior Therapy, Adult, Borderline Personality Disorder, Cost-Benefit Analysis, Feasibility Studies, Female, Humans, Prospective Studies, Time Factors, Single-Blind Method, Treatment Outcome, Suicidal Ideation

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