20 Weeks DBT Group Skills Training Study
The aim of this study is to evaluate the effectiveness of a 20-week Dialectical Behaviour Therapy (DBT) skills training group for the treatment of chronic suicidal and non-suicidal self-injurious (NSSI) behaviours in individuals diagnosed with borderline personality disorder (BPD). Previous research has established the effectiveness of a one year comprehensive, combined individual and group DBT treatment. However, in practice, DBT is often offered in a skills only group format. This study will consist of a randomized, controlled trial designed to evaluate the effectiveness of DBT compared to a wait list control. 84 participants will be randomized to the 20-week DBT group or the wait-list and the following outcomes will be assessed:
- severity of suicidal and NSSI behaviours
- symptom distress
- treatment retention
- skill acquisition and
- social functioning
Assessments will occur at pre-treatment, 10 weeks, 20 weeks and 3 months post treatment. The following main hypotheses will be examined: (1) Patients in the DBT skills group condition will have superior outcomes to patients on the treatment as usual wait list control in areas targeted by the treatment: frequency of suicidal and NSSI behaviours, emergency room visits, psychiatric hospital admissions, impulsivity, and knowledge and use of behavioral skills, general symptoms. The group receiving DBT will have superior outcomes at post treatment and these outcomes will be maintained during the three month post-treatment follow-up.
|Study Design:||Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||Evaluating the Effectiveness of Dialectical Behaviour Skills Training for Suicidality in Borderline Personality Disorder|
- Deliberate Self-harm Inventory (DSHI; Gratz, 2001) [ Time Frame: baseline; 10 weeks; 20 weeks; 3 month follow up ] [ Designated as safety issue: Yes ]Self-report measure assessing self-harm and suicidal behaviour
- Treatment History Interview (THI-2; Linehan & Heard, 1987) [ Time Frame: baseline; 10 weeks; 20 weeks; 3 month follow up ] [ Designated as safety issue: No ]Assesses for emergency and psychiatric hospitalizations
- Barett Impulsiveness Scale (BIS-11; Patton et al., 1995) [ Time Frame: Baseline; 10 weeks; 20 weeks; 3 months follow up ] [ Designated as safety issue: No ]Self-report measure assessing for impulsive behaviour
- The State-trait Anger Expression Inventory (STAXI; Spielberger, Krasner & Solomon, 1988) [ Time Frame: Baseline; 10 weeks; 20 weeks; 3 months Follow up ] [ Designated as safety issue: No ]Self-report assessing for anger expressions
- The Borderline Evaluation of Severity over time Scale (BEST; Phfolm & Bloom, 1997) [ Time Frame: Baseline; 10 weeks; 20 weeks; 3 months Follow up ] [ Designated as safety issue: No ]self-report measure assessing for severity of BPD symptoms
- The Symptom Checklist 90 - Revised (SCL-90-R; Derogatis, 1983) [ Time Frame: Baseline; 10 weeks; 20 weeks; 3 months Follow up ] [ Designated as safety issue: No ]Self-report measure assessing for various psychiatric symptoms
|Study Start Date:||July 2010|
|Study Completion Date:||December 2012|
|Primary Completion Date:||December 2012 (Final data collection date for primary outcome measure)|
Experimental: 20 weeks skills group
Participants receive 20 weeks of Dialectical Behaviour Therapy Skills training, covering 5 modules: mindfulness, interpersonal effectiveness, emotional regulation, distress tolerance, dialectics.
Behavioral: Skills Training
20 weeks of Dialectical Behaviour Therapy Skills Training
No Intervention: Waitlist
Participants on the waitlist condition will be assessed at baseline and symptoms monitored at 10 weeks, 20 weeks and 8 months following baseline assessment. They will then be offered the active treatment.
The study will consist of a single-blind, two-arm randomized controlled trial designed to evaluate the effectiveness of DBT skills group offered as an adjunct to treatment as usual compared to a wait list control plus treatment as usual. The continuation of treatment as usual in both arms is permitted for two reasons. First, it would be unethical to assign suicidal patients to a wait list condition that prohibited involvement in ongoing treatment. Second, the proposed design enables us to address the question of the additive effect of the DBT skills group intervention. Subjects will be randomized to receive 20 weeks of DBT group skills training plus treatment as usual, or to a wait list control plus treatment as usual. Clinical effectiveness outcomes will be assessed at baseline, at 10 weeks, at 20 weeks and at 8 months follow-up. DBT skills training is a manualized intervention developed by Linehan (1993). Key skills from the modules described in Miller, Rathus, and Linehan (2006) will serve as the basis of the DBT skills group, delivered in a psychoeducational format over the course of weekly two-hour sessions. The skills group covers five modules: mindfulness, emotion regulation, distress tolerance, interpersonal effectiveness, and dialectics.
|Centre for Addiction and Mental Health|
|Toronto, Ontario, Canada, M5S 2S1|
|Principal Investigator:||Shelley McMain, PhD.||Centre for Addiction and Mental Health|