Exploring Dialectical Behaviour Therapy vs Conversational Model in the treatment of Borderline Personality Disorder: A randomised clinical trial

INTERVENTION: Intervention A: Dialectical Behaviour Therapy (DBT) The participants will take part in a manualised treatment that combines treatment strategies from behavioural, cognitive and supportive psychotherapies. It will include weekly individual therapy for two months, followed by concurrent weekly individual and group therapy for 12 months. The individual DBT therapy session will be for approximately one hour per week and apply directive, problem‐orientated techniques (including behavioural skill training, contingency management, and cognitive modification) balanced with supportive techniques such as reflection, and acceptance. The emphasis is on teaching participants how to manage emotional experiences. The group therapy will meet once each week for two and a half hours and follow a psycho‐educational format. Behavioural skills in three main areas will be taught in three modules as follows: interpersonal effectiveness, distress tolerance, and emotion regulation skills. Each module will be preceded by a two‐week focus on Mindfulness, which is the core skill taught over the entire group. The group will include the teaching and application of skills, and the practice of them between classes. Intervention B: Conversational Model (CM) The participants will have twice weekly individual therapy for fourteen months. The individual therapy will be for approximately one hour per session and will be nondirective. The focus will be on understanding the patient’s emotional experience and actively describing that back to the patient. The therapist actively looks for subtle signs of emotionally misunderstanding the patient, leading to mutual self‐reflection and repair of the moment of disconnection in the therapeutic relationship. High value is placed on the patient’s real experience (as against socially acceptable experience) and the development of an authentic personal narrative. The patient is encouraged to find links between the maladaptive relationship patterns they have developed in their current social world and the relationship pattern they have with the therapist (and possibly, but not necessarily, the links with their childhood relationships). CONDITION: Borderline Personality Disorder PRIMARY OUTCOME: Primary Outcome 1: Parasuicidal behaviour (including suicide attempts and non‐suicidal self‐injury) as measured by information from the following measures: ; a. Suicide Attempt Self‐Injury Interview Count (SASII) ; b. Borderline Personality Disorder Severity Index (BPDSI) ; c. Structured Clinical Interview for Axis II Disorders (SCID‐II) Primary Outcome 2: Depression scores as measured by Beck Depression Inventory II (BDI‐II) SECONDARY OUTCOME: Secondary Outcome 1: Number and severity of BPD symptoms as measured by Borderline Personality Disorder Severity Index (BPDSI) Secondary Outcome 2: Interpersonal problems as measured by the Inventory of Interpersonal Problems (IIP) Secondary Outcome 3: Mindfulness skills as measured by the Kentucky Inventory of Mindfulness Scale (KIMS) Secondary Outcome 4: Dissociation as measured by the Dissociative Experiences Scale (DES) Secondary Outcome 5: Emotion regulation as measured by the Difficulties in Emotion Regulation Scale (DERS) Secondary Outcome 6: Sense of self as measured by the Sense of Self Inventory (SSI) INCLUSION CRITERIA: Meet the diagnostic criteria for BPD as measured by SCID‐II interview Minimum of three episodes of parasuicidal behaviour in the past 12 months Between 18‐65 years of age Fluent in English Live within an hour’s drive of the treatment centre