Dialectical behavior therapy for suicide and self-harm

Table 1. Systematic reviews that included patients with borderline.

BPD = Borderline personality disorder; DBT = Dialectical behaviour therapy; MBT = Mentalization based therapy; RCT = Randomized controlled trial; SMD = Standardized mean difference; TAU = Treatment as usual
Included studies	Population/Intervention	Outcome
Storebø et al. 2020. [1]
Study design: Included only randomised controlled trials. Included studies: The review included 75 studies, where of 24 investigated the effect of DBT.	Population: Persons of all ages with a diagnosis of BPD. At least 70% of sample had to have a formal diagnosis. Control: Outcomes listed are versus a treatment as usual control group. Full review also includes other analysis with active psychotherapeutic controls. Intervention: Any psychological intervention designed for BPD treatment (including DBT).	Self-harm SMD: –0.28 (–0.48 to –0.07). n = 376, 7 RCT. GRADE: Low Suicide-related outcomes: SMD: –0.23 (–0.68 to 0.23). n = 231, 5 RCTs. Other included outcomes: BPD symptom severity, Psychosocial functioning, Anger, Affective instability, Chronic feelings of emptiness, Impulsivity, Interpersonal problems, Dissociation and psychotic-like symptoms, Depression, Attrition, Adverse effects
Authors conclusion: We found no unequivocal, high-quality evidence to support one BPD-specific therapy over another in the treatment of BPD; our subgroup analyses showed no differences in effect estimates between the different types of therapies. However, compared to TAU, we observed significant effects in favour of DBT for the primary outcomes of BPD severity, self-harm, and psychosocial functioning, and in favour of MBT for self-harm, suicidality, and depression. We rated the quality of the evidence for these outcomes as low, meaning that the true magnitude of these effects is uncertain

Table 2. Systematic reviews that only included adolescents.

BPD = Borderline personality disorder; DBT = Dialectical behaviour therapy; DBT-A = Dialectical behaviour therapy – adolescent; MD = Mean difference; OR = Odds ratio; RCT = Randomized controlled trial; SMD = Standardized mean difference; TAU = Treatment as usual
Included studies	Population/Intervention	Outcome
Witt et al. 2021. [2]
Study design: Only included randomised controlled trials. Included studies: The review included 17 studies, whereof 4 investigated the effect of DBT	Population: Children and adolescent (<18 years) with a recent (< 6 months) presentation to hospital or clinical services for self-harm (SH). 49.1% of the included participants were diagnosed with borderline personality disorder. Comparator: All relevant studies included had a requirement of a history of multiple episodes of SH. Intervention: 1. Individual CBT-based psychotherapy; 2. Dialectical behavioural therapy; 3. Mentalisation therapy; 4. Group-based psychotherapy; 5. Enhanced assessment approaches; 6. Compliance enhancement approaches; 7. Family interventions; 8. Remote contact interventions.	Repetition of self-harm OR: 0.46 (0.26 to 0.82) n = 270, 4 RCTs. GRADE: High Comparator TAU: OR 2.55 (0.20 to 31.86) Comparator EUC: OR 0.29 (0.10 to 0.85) Comparator AT: OR 0.50 (0.25 to 0.98) Frequency of self-harm: MD: –0.71 (–1.55 to 0.14) n = 271, 4 RCTs. Secondary outcomes: Number of individual, group, telephone or family therapy sessions attended. Depressions scores Hopelessness scores General functioning Suicidal ideation
Author’s conclusion: “On the basis of data from four trials, DBT for adolescents (DBT-A) reduces repetition of SH at post-intervention compared with TAU, EUC, and alternative psychotherapy.” “...We also found some positive effects of DBT-A, but methodological factors limit confidence in the generalizability of the results. We recommend further evaluation of these approaches to assess the impact of these interventions in different samples and settings”

References

1. Storebø OJ, Stoffers-Winterling JM, Völlm BA, Kongerslev MT, Mattivi JT, Jørgensen MS, et al. Psychological therapies for people with borderline personality disorder. Cochrane Database Syst Rev. 2020:Issue 5. Art. No.: CD012955.
2. Witt KG, Hetrick SE, Rajaram G, Hazell P, Taylor Salisbury TL, Townsend E, et al. Interventions for self‐harm in children and adolescents. Cochrane Database Syst Rev. 2021(3).
3. Lee NK, Cameron J, Jenner L. A systematic review of interventions for co-occurring substance use and borderline personality disorders. Drug and alcohol review. 2015;34(6):663-72.
4. Brazier J, Tumur I, Holmes M, Ferriter M, Parry G, Dent-Brown K, et al. Psychological therapies including dialectical behaviour therapy for borderline personality disorder: A systematic review and preliminary economic evaluation. Health Technol Assess. 2006;10(35):1-61.
5. Duarte R, Lloyd A, Kotas E, Andronis L, White R. Are acceptance and mindfulness-based interventions 'value for money'? Evidence from a systematic literature review. Br J Clin Psychol. 2019;58(2):187-210.