Mikusky David, Sanhüter Niklas, Bauer Julia, Macchia Ana, Nickel Sandra, Abler Birgit
Center for Psychiatry Reichenau, Teaching Hospital of the Konstanz University, Reichenau, Germany.
University Clinic for Psychiatry and Psychotherapy III, Ulm, Germany.
J Psychiatr Pract. 2025 Jul 1;31(4):184-191. doi: 10.1097/PRA.0000000000000864.
This study investigates the medium-term effects of an intensified inpatient dialectical behavior therapy (DBT) program on psychosocial outcomes and predictors of response in patients with borderline personality disorder (BPD). While the effectiveness of DBT is well established, insights into psychosocial outcomes after inpatient treatment remain limited.
All 115 patients with BPD who participated in an 8-week inpatient DBT program at a university hospital in southern Germany in 2021 and 2022 were evaluated. Psychopathological changes were assessed using the short version of the Borderline Symptom List (BSL-23). Sociodemographic data and data on psychosocial functioning were collected using questions from the Indications of Rehabilitation Status Score (IRES-3) questionnaire before treatment, as well as at a 6-month follow-up. BSL-23 data were also assessed after treatment. To examine predictors of response to therapy, categorical pre-post comparisons as suggested by Jacobson and colleagues were applied to the BSL-23.
Eighty percent of the patients (n=92) completed the therapy. The patients who completed therapy were older than the dropouts. Significant reductions in BPD symptoms (BSL-23) were observed posttreatment (n=83) and at the 6-month follow-up (n=35). Effect sizes were large posttherapy (Cohen's d=0.837) and remained moderate after 6 months (d=0.460). With regard to psychosocial functioning, patients reported increased social support, fewer concerns about social relationships, and higher life and job satisfaction 6 months after therapy. Higher educational attainment was a significant predictor of treatment response.
The intensified inpatient DBT program described in this article led to significant and sustained reductions in symptoms and improvements in psychosocial outcomes in patients with BPD. Educational levels and age at treatment onset may be critical factors for successful treatment.
本研究调查强化住院辩证行为疗法（DBT）项目对边缘型人格障碍（BPD）患者心理社会结局及治疗反应预测因素的中期影响。虽然DBT的有效性已得到充分证实，但对住院治疗后心理社会结局的了解仍然有限。
对2021年和2022年在德国南部一家大学医院参加为期8周住院DBT项目的所有115例BPD患者进行评估。使用边缘症状清单简版（BSL-23）评估心理病理变化。在治疗前以及6个月随访时，使用康复状态评分指征（IRES-3）问卷中的问题收集社会人口统计学数据和心理社会功能数据。治疗后也评估BSL-23数据。为了检查治疗反应的预测因素，将雅各布森及其同事建议的分类前后比较应用于BSL-23。
80%的患者（n=92）完成了治疗。完成治疗的患者比退出治疗的患者年龄更大。治疗后（n=83）和6个月随访时（n=35）观察到BPD症状（BSL-23）显著减轻。治疗后效应量较大（科恩d=0.837），6个月后仍保持中等水平（d=0.460）。在心理社会功能方面，患者报告治疗6个月后社会支持增加、对社会关系的担忧减少、生活和工作满意度提高。较高的教育程度是治疗反应的显著预测因素。
本文所述的强化住院DBT项目使BPD患者的症状显著且持续减轻，心理社会结局得到改善。教育水平和治疗开始时的年龄可能是成功治疗的关键因素。
