Linehan M M, Heard H L, Armstrong H E
Department of Psychology, University of Washington, Seattle.
Arch Gen Psychiatry. 1993 Dec;50(12):971-4. doi: 10.1001/archpsyc.1993.01820240055007.
A randomized clinical trial was conducted to evaluate whether the superior performance of dialectical behavior therapy (DBT), a psychosocial treatment for borderline personality disorder, compared with treatment-as-usual in the community, is maintained during a 1-year posttreatment follow-up.
We analyzed 39 women who met criteria for borderline personality disorder, defined by Gunderson's Diagnostic Interview for Borderline Personality Disorder and DSM-III-R criteria, and who had a history of parasuicidal behavior. Subjects were randomly assigned either to 1 year of DBT, a cognitive behavioral therapy that combines individual psychotherapy with group behavioral skills training, or to treatment-as-usual, which may or may not have included individual psychotherapy. Efficacy was measured on parasuicidal behavior (Parasuicide History Interview), psychiatric inpatient days (Treatment History Interview), anger (State-Trait Anger Scale), global functioning (Global Assessment Scale), and social adjustment (Social Adjustment Scale--Interview and Social Adjustment Scale--Self-Report). Subjects were assessed at 6 and 12 months into the follow-up year.
Comparison of the two conditions revealed that throughout the follow-up year, DBT subjects had significantly higher Global Assessment Scale scores. During the initial 6 months of the follow-up, DBT subjects had significantly less parasuicidal behavior, less anger, and better self-reported social adjustment. During the final 6 months, DBT subjects had significantly fewer psychiatric inpatient days and better interviewer-rated social adjustment.
In general, the superiority of DBT over treatment-as-usual, found in previous studies at the completion of 1 year of treatment, was retained during a 1-year follow-up.
开展了一项随机临床试验，以评估辩证行为疗法（DBT）（一种用于治疗边缘型人格障碍的心理社会治疗方法）与社区常规治疗相比，在治疗后1年的随访期间其卓越疗效是否得以维持。
我们分析了39名符合边缘型人格障碍标准的女性，这些标准由冈德森的《边缘型人格障碍诊断访谈》和《精神疾病诊断与统计手册第三版修订本》（DSM-III-R）标准界定，且她们有过准自杀行为史。受试者被随机分配接受为期1年的DBT治疗（一种将个体心理治疗与团体行为技能训练相结合的认知行为疗法）或常规治疗（常规治疗可能包含也可能不包含个体心理治疗）。通过准自杀行为（《准自杀史访谈》）、精神科住院天数（《治疗史访谈》）、愤怒情绪（状态-特质愤怒量表）、整体功能（整体评估量表）和社会适应（社会适应量表——访谈版和社会适应量表——自我报告版）来衡量疗效。在随访年的第6个月和第12个月对受试者进行评估。
两种治疗情况的比较显示，在整个随访年中，接受DBT治疗的受试者整体评估量表得分显著更高。在随访的最初6个月里，接受DBT治疗的受试者准自杀行为显著减少，愤怒情绪减轻，自我报告的社会适应情况更好。在最后6个月里，接受DBT治疗的受试者精神科住院天数显著减少，访谈者评定的社会适应情况更好。
总体而言，在先前研究中发现的DBT相对于常规治疗在治疗1年结束时所具有的优势在1年随访期间得以保持。
