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Naturalistic Follow-up of a Behavioral Treatment for Chronically Parasuicidal Borderline Patients

Marsha M. Linehan, PhD; Heidi L. Heard; Hubert E. Armstrong, PhD
Arch Gen Psychiatry. 1993;50(12):971-974. doi:10.1001/archpsyc.1993.01820240055007.
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Background:  A randomized clinical trial was conducted to evaluate whether the superior performance of dialectical behavior therapy (DBT), a psychosocial treatment for borderline personality disorder, compared with treatment-as-usual in the community, is maintained during a 1-year posttreatment follow-up.

Methods:  We analyzed 39 women who met criteria for borderline personality disorder, defined by Gunderson's Diagnostic Interview for Borderline Personality Disorder and DSM-III-R criteria, and who had a history of parasuicidal behavior. Subjects were randomly assigned either to 1 year of DBT, a cognitive behavioral therapy that combines individual psychotherapy with group behavioral skills training, or to treatment-as-usual, which may or may not have included individual psychotherapy. Efficacy was measured on parasuicidal behavior (Parasuicide History Interview), psychiatric inpatient days (Treatment History Interview), anger (State-Trait Anger Scale), global functioning (Global Assessment Scale), and social adjustment (Social Adjustment Scale—Interview and Social Adjustment Scale—Self-Report). Subjects were assessed at 6 and 12 months into the follow-up year.

Results:  Comparison of the two conditions revealed that throughout the follow-up year, DBT subjects had significantly higher Global Assessment Scale scores. During the initial 6 months of the follow-up, DBT subjects had significantly less parasuicidal behavior, less anger, and better self-reported social adjustment. During the final 6 months, DBT subjects had significantly fewer psychiatric inpatient days and better interviewer-rated social adjustment. Conclusion: In general, the superiority of DBT over treatmentas-usual, found in previous studies at the completion of 1 year of treatment, was retained during a 1-year follow-up.

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