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Cognitive therapy v. usual treatment for borderline personality disorder: prospective 6-year follow-up

  • Kate M. Davidson (a1), Peter Tyrer (a2), John Norrie (a3), Stephen J. Palmer (a4) and Helen Tyrer (a5)...

Abstract

Background

Longer-term follow-up of patients with borderline personality disorder have found favourable clinical outcomes, with long-term reduction in symptoms and diagnosis.

Aims

We examined the 6-year outcome of patients with borderline personality disorder who were randomised to 1 year of cognitive–behavioural therapy for personality disorders (CBT–PD) or treatment as usual (TAU) in the BOSCOT trial, in three centres across the UK (trial registration: ISRCTN86177428).

Method

In total, 106 participants met criteria for borderline personality disorder in the original trial. Patients were interviewed at follow-up by research assistants masked to the patient's original treatment group, CBT–PD or TAU, using the same measures as in the original randomised trial. Statistical analyses of data for the group as a whole are based on generalised linear models with repeated measures analysis of variance type models to examine group differences.

Results

Follow-up data were obtained for 82% of patients at 6 years. Over half the patients meeting criteria for borderline personality disorder at entry into the study no longer did so 6 years later. The gains of CBT–PD over TAU in reduction of suicidal behaviour seen after 1-year follow-up were maintained. Length of hospitalisation and cost of services were lower in the CBT–PD group compared with the TAU group.

Conclusions

Although the use of CBT–PD did not demonstrate a statistically significant cost-effective advantage, the findings indicate the potential for continued long-term cost-offsets that accrue following the initial provision of 1 year of CBT–PD. However, the quality of life and affective disturbance remained poor.

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Copyright

Corresponding author

Kate M. Davidson, Mental Health and Wellbeing, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, UK. Email: kate.davidson@glasgow.ac.uk

Footnotes

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Declaration of interest

P.T. is Editor of the British Journal of Psychiatry but had no part in the evaluation of this paper for publication.

Footnotes

References

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Cognitive therapy v. usual treatment for borderline personality disorder: prospective 6-year follow-up

  • Kate M. Davidson (a1), Peter Tyrer (a2), John Norrie (a3), Stephen J. Palmer (a4) and Helen Tyrer (a5)...

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Cognitive therapy v. usual treatment for borderline personality disorder: prospective 6-year follow-up

  • Kate M. Davidson (a1), Peter Tyrer (a2), John Norrie (a3), Stephen J. Palmer (a4) and Helen Tyrer (a5)...
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eLetters

Do patients with borderline personality disorder need extended courses of psychotherapy?

Joel Paris, psychiatrist
17 December 2010

The article by Davidson et al (BJP, December, 2010) states that a follow-up of patients with borderline personality disorder treated with CBT supports the NICE recommendation that short-term therapy is not suitable for this population. In my view, this conclusion is not quite warranted.

The results of this study, as the authors note, are not as positive as some prospective follow-ups, but still show that most patients improved, and that improvement was maintained 6 years later. This is not atrivial result in a severely disabled clinical group. The intervention, consisting of 30 sessions, somewhat shorter due to absences (Davidson et al, 2007), could be completed in 6-8 months. There are other reports in the literature of effective treatment within that time frame (Stanley et al, 2007). We need not conclude that all BPD patients require long coursesof therapy, but can reserve extended treatment for severe and chronic cases.

References:Davidson, K., Norrie, J., Tyrer, P., Gumley, A., Tata, P., Murray, H., et al. (2006). The effectiveness of cognitive behavior therapy for borderlinepersonality disorder: results from the borderline personality disorder study of cognitive therapy (BOSCOT) trial. Journal of Personality Disorders, 20, 450-465Stanley, B, Brodsky, B, Nelson, J, Dulit, R (2007): Brief dialectical behavior therapy for suicidality and self-injurious behaviors. Archives ofSuicide Research, 11:337-341
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Conflict of interest: None Declared

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