Medium-term Effects of Intensified Inpatient Dialectical Behavior Therapy on Psychosocial Outcomes

This study investigates the medium-term effects of an intensified inpatient dialectical behavior therapy (DBT) program on psychosocial outcomes and predictors of response in patients with borderline personality disorder (BPD). While the effectiveness of DBT is well established, insights into psychosocial outcomes after inpatient treatment remain limited.

All 115 patients with BPD who participated in an 8-week inpatient DBT program at a university hospital in southern Germany in 2021 and 2022 were evaluated. Psychopathological changes were assessed using the short version of the Borderline Symptom List (BSL-23). Sociodemographic data and data on psychosocial functioning were collected using questions from the Indications of Rehabilitation Status Score (IRES-3) questionnaire before treatment, as well as at a 6-month follow-up. BSL-23 data were also assessed after treatment. To examine predictors of response to therapy, categorical pre-post comparisons as suggested by Jacobson and colleagues were applied to the BSL-23.

Eighty percent of the patients (n=92) completed the therapy. The patients who completed therapy were older than the dropouts. Significant reductions in BPD symptoms (BSL-23) were observed posttreatment (n=83) and at the 6-month follow-up (n=35). Effect sizes were large posttherapy (Cohen's d=0.837) and remained moderate after 6 months (d=0.460). With regard to psychosocial functioning, patients reported increased social support, fewer concerns about social relationships, and higher life and job satisfaction 6 months after therapy. Higher educational attainment was a significant predictor of treatment response.

The intensified inpatient DBT program described in this article led to significant and sustained reductions in symptoms and improvements in psychosocial outcomes in patients with BPD. Educational levels and age at treatment onset may be critical factors for successful treatment.