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  3. Dialectical Behavior Therapy Vs Schema Therapy For Patients With Borderline Personality Disorder: The Boots Multicenter Randomized Clinical Trial.
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  3. Dialectical Behavior Therapy Vs Schema Therapy For Patients With Borderline Personality Disorder: The Boots Multicenter Randomized Clinical Trial.

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

Carlijn J M Wibbelink1, Jan H Kamphuis1, Roland Sinnaeve2

  • 1Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands.

JAMA Psychiatry
|April 22, 2026

View abstract on PubMed

Summary
This summary is machine-generated.

Dialectical behavior therapy (DBT) and schema therapy (ST) showed similar effectiveness in reducing borderline personality disorder (BPD) severity. Both evidence-based treatments led to significant improvements in patients with BPD.

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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.