Queen Mary University of London, London, UK.
Psychother Psychosom. 2012;81(6):356-65. doi: 10.1159/000338897. Epub 2012 Sep 6.
A primary goal of dialectical behaviour therapy (DBT) is to reduce self-harm, but findings from empirical studies are inconclusive. The aim of this study was to assess the effectiveness and cost-effectiveness of DBT in reducing self-harm in patients with personality disorder.
Participants with a personality disorder and at least 5 days of self-harm in the previous year were randomised to receive 12 months of either DBT or treatment as usual (TAU). The primary outcome was the frequency of days with self-harm; secondary outcomes included borderline personality disorder symptoms, general psychiatric symptoms, subjective quality of life, and costs of care.
Forty patients each were randomised to DBT and TAU. In an intention-to-treat analysis, there was a statistically significant treatment by time interaction for self-harm (incidence rate ratio 0.91, 95% CI 0.89-0.92, p < 0.001). For every 2 months spent in DBT, the risk of self-harm decreased by 9% relative to TAU. There was no evidence of differences on any secondary outcomes. The economic analysis revealed a total cost of a mean of 5,685 GBP (6,786 EUR) in DBT compared to a mean of 3,754 GBP (4,481 EUR) in TAU, but the difference was not significant (95% CI -603 to 4,599 GBP). Forty-eight per cent of patients completed DBT. They had a greater reduction in self-harm compared to dropouts (incidence rate ratio 0.78, 95% CI 0.76-0.80, p < 0.001).
DBT can be effective in reducing self-harm in patients with personality disorder, possibly incurring higher total treatment costs. The effect is stronger in those who complete treatment. Future research should explore how to improve treatment adherence.
辩证行为疗法（DBT）的主要目标是减少自伤，但来自实证研究的结果尚无定论。本研究旨在评估 DBT 减少人格障碍患者自伤的有效性和成本效益。
至少在前一年中有 5 天以上自伤史的人格障碍患者被随机分为接受 12 个月的 DBT 或常规治疗（TAU）。主要结局是自伤天数的频率；次要结局包括边缘型人格障碍症状、一般精神病症状、主观生活质量和护理成本。
每组 40 名患者被随机分为 DBT 和 TAU。意向治疗分析显示，自伤的治疗与时间存在统计学显著的交互作用（发生率比 0.91，95%置信区间 0.89-0.92，p<0.001）。与 TAU 相比，每接受 2 个月的 DBT，自伤的风险降低 9%。在任何次要结局上均未发现差异。经济分析显示，DBT 的平均总成本为 5685 英镑（6786 欧元），而 TAU 的平均总成本为 3754 英镑（4481 欧元），但差异无统计学意义（95%置信区间 -603 至 4599 英镑）。48%的患者完成了 DBT。与脱落者相比，他们的自伤减少幅度更大（发生率比 0.78，95%置信区间 0.76-0.80，p<0.001）。
DBT 可有效减少人格障碍患者的自伤，可能会增加总治疗成本。在完成治疗的患者中效果更强。未来的研究应探讨如何提高治疗依从性。
