Dialectical Behavior Therapy vs Schema Therapy for Patients With Borderline Personality Disorder: The BOOTS...

Area of Science:

• Psychiatry and Psychology
• Clinical Trials
• Mental Health Treatment

Background:

• Head-to-head comparisons of evidence-based treatments for borderline personality disorder (BPD), such as dialectical behavior therapy (DBT) and schema therapy (ST), are scarce.
• DBT and ST are recognized as relevant treatments for BPD.

Purpose of the Study:

• To compare the effectiveness of DBT and ST in a multicenter trial among outpatients with BPD.

Main Methods:

• A 3-year multicenter superiority randomized clinical trial (RCT) involving 204 outpatients with BPD aged 18-65 years.
• Participants were randomized to 2 years of either DBT or ST, delivered in a combined group-individual format.
• The primary outcome was the change in BPD severity assessed by the Borderline Personality Disorder Severity Index, fifth version (BPDSI-5) from baseline to 1-year posttreatment follow-up.

Main Results:

• No significant difference was found between DBT and ST in reducing BPD severity (P=.27).
• Both treatments demonstrated large improvements in BPD severity and secondary outcomes, including general symptom severity, functioning, and quality of life.
• Dropout rates did not significantly differ between the two treatment groups.

Conclusions:

• This multicenter RCT found no significant differences in effectiveness between DBT and ST for outpatients with BPD.
• Both treatments led to substantial improvements across various outcomes.
• Further research is needed to assess treatment equivalence and identify which treatment is most effective for specific patient subgroups.