Psychiatry

Psychopathology

Internal medicine

Psychology

Randomized controlled trial

Physical therapy

Dialectical behavior therapy

Borderline personality disorder

Group psychotherapy

Psychotherapist

Clinical psychology

Medicine

Psychotherapy and Psychosomatics

&lt;b&gt;&lt;i&gt;Introduction:&lt;/i&gt;&lt;/b&gt; Evidence-based psychotherapies for borderline personality disorder (BPD) are lengthy, posing a barrier to their access. Brief psychotherapy may achieve comparable outcomes to long-term psychotherapy for BPD. Evidence is needed regarding the comparative effectiveness of short- versus long-term psychotherapy for BPD. &lt;b&gt;&lt;i&gt;Objective:&lt;/i&gt;&lt;/b&gt; The aim was to determine if 6 months of Dialectical Behavior Therapy (DBT) is noninferior to 12 months of DBT in terms of clinical effectiveness. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; This two-arm, single-blinded, randomized controlled noninferiority trial with suicidal or self-harming patients with BPD was conducted at two sites in Canada. Participants (&lt;i&gt;N&lt;/i&gt; = 240, &lt;i&gt;M&lt;/i&gt; (SD)&lt;sub&gt;age&lt;/sub&gt; = 28.27 (8.62), 79% females) were randomized to receive either 6 (DBT-6) or 12 months (DBT-12) of comprehensive DBT. Masked assessors obtained measures of clinical effectiveness at baseline and every 3 months, ending at month 24. DBT-6 and DBT-12 were outpatient treatments consisting of weekly individual therapy sessions, weekly DBT skills training group sessions, telephone consultation as needed, and weekly therapist consultation team meetings. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; The noninferiority hypothesis was supported for the primary outcome, total self-harm (6 months: margin = −1.94, &lt;i&gt;M&lt;/i&gt;&lt;sub&gt;diff&lt;/sub&gt; [95% CI] = 0.16 [−0.14, 0.46]; 12 months: margin = −1.47, &lt;i&gt;M&lt;/i&gt;&lt;sub&gt;diff&lt;/sub&gt; [95% CI] = 0.04 [−0.17, 0.23]; 24 months: margin = −1.25, &lt;i&gt;M&lt;/i&gt;&lt;sub&gt;diff&lt;/sub&gt; [95% CI] = 0.12 [−0.02, 0.36]). Results also supported noninferiority of DBT-6 for general psychopathology and coping skills at 24 months. Furthermore, DBT-6 participants showed more rapid reductions in BPD symptoms and general psychopathology. There were no between-group differences in dropout rates. &lt;b&gt;&lt;i&gt;Conclusions:&lt;/i&gt;&lt;/b&gt; The noninferiority of a briefer yet comprehensive treatment for BPD has potential to reduce barriers to treatment access.

The Effectiveness of 6 versus 12 Months of Dialectical Behavior Therapy for Borderline Personality Disorder: A Noninferiority Randomized Clinical Trial