INTRODUCTION In the treatment of borderline personality disorder (BPD), there is empirical support for both dialectical behavior therapy (DBT) and schema therapy (ST); these treatments have never been compared directly. This study examines whether either of them is more effective than the other in treating patients with BPD. METHODS In this randomized, parallel-group, rater-blind clinical trial, outpatients aged between 18 and 65 years with a primary diagnosis of BPD were recruited in a tertiary outpatient treatment center (Lübeck, Germany). Participants were randomized to DBT or ST with one individual and one group session per week over 1.5 years. The primary outcome was the BPD symptom severity assessed with the mean score of the Borderline Personality Disorder Severity Index at 1-year naturalistic follow-up. RESULTS Between November 26, 2014, and December 14, 2018, we enrolled 164 patients (mean age = 33.7 [SD = 10.61] years). Of these, 81 (49.4%) were treated with ST and 83 (50.6%) with DBT, overall, 130 (79.3%) were female. Intention-to-treat analysis with generalized linear mixed models did not show a significant difference at 1-year naturalistic follow-up between DBT and ST for the BPDSI total score (mean difference 3.32 [95% CI: -0.58-7.22], p = 0.094, d = -24 [-0.69; 0.20]) with lower scores for DBT. Pre-to-follow-up effect sizes were large in both groups (DBT: d = 2.45 [1.88-3.02], ST: d = 1.78 [1.26-2.29]). CONCLUSION Patients in both treatment groups showed substantial improvements indicating that even severely affected patients with BPD and various comorbid disorders can be treated successfully with DBT and ST. An additional non-inferiority trial is needed to show if both treatments are equally effective. The trial was retrospectively registered on the German Clinical Trials Register, DRKS00011534 without protocol changes.

中文翻译：

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辩证行为疗法与图式疗法相比对边缘性人格障碍的有效性：一项随机临床试验。


引言 在边缘型人格障碍（BPD）的治疗中，辩证行为疗法（DBT）和图式疗法（ST）都有实证支持；这些治疗方法从未被直接比较过。这项研究检验了它们中的任何一个在治疗 BPD 患者方面是否比另一个更有效。方法 在这项随机、平行组、评估者盲法临床试验中，在三级门诊治疗中心（德国吕贝克）招募了年龄在 18 岁至 65 岁之间、初步诊断为 BPD 的门诊患者。参与者在 1.5 年内被随机分配接受 DBT 或 ST，每周进行 1 次个人训练和 1 次小组训练。主要结果是在 1 年自然随访中用边缘性人格障碍严重程度指数的平均分评估 BPD 症状的严重程度。结果 2014年11月26日至2018年12月14日期间，我们招募了164名患者（平均年龄= 33.7 [SD = 10.61]岁）。其中，81 例（49.4%）接受 ST 治疗，83 例（50.6%）接受 DBT 治疗，总体而言，130 例（79.3%）为女性。使用广义线性混合模型进行的意向治疗分析并未显示 DBT 和 ST 的 BPDSI 总分在 1 年自然随访中存在显着差异（平均差 3.32 [95% CI：-0.58-7.22]，p = 0.094，d = -24 [-0.69；0.20]），DBT 得分较低。两组的随访前效果均较大（DBT：d = 2.45 [1.88-3.02]，ST：d = 1.78 [1.26-2.29]）。结论 两个治疗组的患者均表现出显着的改善，这表明即使患有 BPD 和各种共病的严重患者也可以通过 DBT 和 ST 成功治疗。需要进行额外的非劣效性试验来证明两种治疗是否同样有效。 该试验在德国临床试验登记册上进行了回顾性注册，DRKS00011534，没有修改方案。