Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-10T15:45:28.817Z Has data issue: false hasContentIssue false
  • English
  • Français

A Service Evaluation of a 1-Year Dialectical Behaviour Therapy Programme for Women with Borderline Personality Disorder in a Low Secure Unit

Published online by Cambridge University Press:  13 February 2014

Emily Fox ,
Kirsten Krawczyk ,
Jessica Staniford  and
Geoffrey L. Dickens
Emily Fox*
Affiliation:
St Andrew's Healthcare, Northampton, UK
Kirsten Krawczyk
Affiliation:
St Andrew's Healthcare, Northampton, UK
Jessica Staniford
Affiliation:
St Andrew's Healthcare, Northampton, UK
Geoffrey L. Dickens
Affiliation:
St Andrew's Academic Centre, King's College London, Northampton, UK
*
Reprint requests to Emily Fox, St Andrew's Healthcare, Women's Service Psychology, Billing Road, Northampton NN1 5DG, UK. E-mail: efox@standrew.co.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Previous studies about the effectiveness of Dialectical Behaviour Therapy for the treatment of Borderline Personality Disorder have had promising results. However, no previous studies have examined its effectiveness when delivered in low secure inpatient services for women. Aims: To evaluate clinical outcomes during and after a 1-year period of admission within a low secure unit for women offering a Dialectical Behaviour Therapy programme. Method: A naturalistic, within subjects study of clinical data collected as part of routine practice was conducted. Participants were18 consecutively admitted women who met the diagnostic criteria for Borderline Personality Disorder and had completed at least 1 year of treatment. Measures covered: risk behaviours; self-reported symptoms of Borderline Personality Disorder, and current mood and symptom experience; staff reports of clinical problems, needs and social functioning. Scores were compared between admission and at 6 months and 1 year. Results: There was a statistically significant improvement on all 13 measures over the year's treatment. Most improvement was demonstrated between admission and 6 months. Conclusions: Engagement in1-year's treatment was associated with significant reduction in risk behaviours and both staff-rated and self-rated outcome measures. Some significant questions remain about which elements of the programme are most effective but the results are encouraging.

Keywords

Borderline Personality Disorderdialectical behaviour therapylow securewomen's serviceservice evaluation
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 43 , Issue 6 , November 2015 , pp. 676 - 691
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (4thedn) (DSM-IV). Washington, DC: American Psychiatric Association.Google Scholar
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (4thedn Text Rev.) (DSM-IV-TR). Washington, DC: American Psychiatric Association.Google Scholar
Bateman, A. and Fonagy, P. (1999). Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial. American Journal of Psychiatry, 156, 1563–1569.Google Scholar
Bohus, M., Haaf, B., Simms, T., Limberger, M. F., Schmahl, C., Unckel, C., et al. (2004). Effectiveness of inpatient dialectical behavioural therapy for borderline personality disorder: a controlled trial. Behaviour Research and Therapy, 42, 487–499.Google Scholar
Butler Committee (1975). Report of the Committee on Mentally Abnormal Offenders. London: The Stationary Office.Google Scholar
Cohen, J. (1988). Statistical Power Analysis for the Behavioural Sciences. Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
Coid, J., Kahtan, N., Gault, S. and Jarman, B. (2000). Women admitted to secure forensic services: comparison of women and men. Journal of Forensic Psychiatry, 11, 275–295.Google Scholar
Coid, J., Yang, M., Tyrer, P., Roberts, A. and Ullrich, S. (2006). Prevalence and correlates of personality disorder in Great Britain. British Journal of Psychiatry, 188, 423–431.CrossRefGoogle ScholarPubMed
Davidson, K. M. (2000). Cognitive Therapy for Personality Disorders: a guide for therapists. Oxford: Butterworth-Heinemann.Google Scholar
Department of Health (2003). The Personality Disorder Capability Framework. London: Department of Health.Google Scholar
Department of Health (2012). Low Secure Services: good practice commissioning guide, consultation draft. London: Department of Health.Google Scholar
Dickens, G., Sugarman, P. and Walker, L. (2007). HoNOS-secure: a reliable outcome measure for users of secure and forensic mental health services. Journal of Forensic Psychiatry and Psychology, 18, 507–514.Google Scholar
Doering, S., Horz, S., Rentrop, M., Fischer-Kern, M., Schuster, P., Benecke, C., et al. (2010). Transference-focused psychotherapy v. treatment by community psychotherapists for borderline personality disorder: randomised controlled trial. British Journal of Psychiatry, 196, 389–395.Google Scholar
Gunderson, J. G. (2011). Borderline personality disorder. New England Journal of Medicine, 364, 2037–2042.CrossRefGoogle ScholarPubMed
Guy, W. (1976). Clinical global impressions. In ECDEU Assessment Manual for Psychopharmacology (pp. 218–222). Revised DHEW Pub. (ADM). Rockville, MD: National Institute for Mental Health.Google Scholar
Hirsch, O., Keller, H., Albohn-Kühne, C., Krones, T. and Donner-Banzhoff, N. (2011). Pitfalls in the statistical examination and interpretation of the correspondence between physician and patient satisfaction ratings and their relevance for shared decision making research. BMC Medical Research Methodology, 11, 71. doi:10.1186/1471-2288-11-71Google Scholar
Kay, S. R., Wolkenfield, F. and Murrill, L. M. (1988). Profiles of aggression among psychiatric patients: II. Covariates and predictors. Journal of Nervous and Mental Disease, 176, 547–557.Google Scholar
Koons, C. R., Robins, C. J., Tweed, J. L., Lynch, T. R., Gonzalez, A. M. and Morse, J. Q. (2001). Efficacy of dialectical behaviour therapy in women veterans with borderline personality disorder. Behavior Therapy, 32, 371–390.Google Scholar
Lee, S. and Harris, M. (2010). The development of an effective occupational therapy assessment and treatment pathway, for women with a diagnosis of Borderline Personality Disorder (BPD) in an inpatient setting: implementing the Model of Human Occupation (MoHO). British Journal of Occupational Therapy, 73, 559–563.CrossRefGoogle Scholar
Leucht, S., Kane, J. M., Kissling, W., Hamann, J., Etschel, E. and Engel, R. (2005). Clinical implications of Brief Psychiatric Rating Scale scores. British Journal of Psychiatry, 187, 366–371.Google Scholar
Linehan, M. M. (1993a). Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York: The Guilford Press.Google Scholar
Linehan, M. M. (1993b). Skills Training Manual for Treating Borderline Personality Disorder. New York: The Guilford Press.Google Scholar
Linehan, M. M., Armstrong, H. E., Suarez, A., Allmon, D. and Heard, H. L. (1991). Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48, 1060–1064.Google Scholar
Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J. and Heard, H. L. (2006). Two-year randomised controlled trial and follow-up of dialectical behaviour therapy vs. therapy by experts for suicidal behaviours and borderline personality disorder. Archives of General Psychiatry, 63, 757–766.Google Scholar
Linehan, M. M., Heard, H. L. and Armstrong, H. E. (1993). Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patients. Archives of General Psychiatry, 50, 971–974.Google Scholar
Long, C. G., Fulton, B. and Hollin, C. R. (2008). The development of a “best practice” service for women in a medium-secure psychiatric setting: treatment components and evaluation. Clinical Psychology and Psychotherapy, 15, 304–319.Google Scholar
Long, C. G., Webster, P., Waine, J., Motala, J. and Hollin, C. R. (2008). Usefulness of the CANFOR-S for measuring needs among mentally disordered offenders resident in medium or low secure hospital services in the UK: a pilot evaluation. Criminal Behaviour and Mental Health, 18, 39–48.Google Scholar
Low, G., Jones, D., Duggan, C., Power, M. and MacLeod, A. (2001). The treatment of deliberate self-harm in borderline personality disorder using dialectical behaviour therapy: a pilot study in a high security hospital. Behavioural and Cognitive Psychotherapy, 29, 85–92.Google Scholar
Mental Health Act (1983 amended 2007). c12. London: The Stationery Office.Google Scholar
Ministry of Justice (2011). Working with Personality Disordered Offenders: a practitioner's guide. London: Crown copyright.Google Scholar
National Collaborating Centre for Mental Health (2009). Borderline Personality Disorder: treatment and management (National Clinical Practice Guideline Number 78). London: The British Psychological Society and The Royal College of Psychiatrists.Google Scholar
National Institute for Mental Health in England (2003a). Breaking the Cycle of Rejection: the personality disorder capabilities framework. London: Department of Health.Google Scholar
National Institute for Mental Health in England (2003b). Personality Disorder: no longer a diagnosis of exclusion. Policy implementation guidance for the development of services for people with personality disorder, Gateway reference 1055. London: NIMH(E).Google Scholar
Palmer, R. L. (2002). Dialectical Behaviour Therapy for borderline personality disorder. Advances in Psychological Treatment, 8, 10–16.CrossRefGoogle Scholar
Paris, J. and Zweig-Frank, H. (2001). A 27-year follow-up of patients with borderline personality disorder. Comprehensive Psychiatry, 42, 482–487.Google Scholar
Royal College of Psychiatrists Centre for Quality Improvement (2010). Standards for Low Secure Services. London: Royal College of Psychiatrists.Google Scholar
Ryle, A. (1997). Cognitive Analytic Therapy of Borderline Personality Disorder: the model and the method. New York: John Wiley and Sons.Google Scholar
Snowden, P. and Kane, E. (2003). Personality disorder: no longer a diagnosis of exclusion. The Psychiatrist, 27, 401–403.Google Scholar
Sugarman, P. and Walker, L. (2007). Health of the Nation Outcome Scales for Users of Secure and Forensic Services (HoNOS-Secure). Royal College of Psychiatrists website http://www.rcpsych.ac.uk/training/honos/secure.aspx.Google Scholar
Swenson, C. R., Sanderson, C., Dulit, R. A. and Linehan, M. M. (2001). The application of dialectical behaviour therapy for patients with borderline personality disorder on inpatient units. Psychiatric Quarterly, 72, 307–324.Google Scholar
Thomas, S., Harty, M-A., Parrott, J., McCrone, P., Slade, G. and Thornicroft, G. (2003). CANFOR: Camberwell Assessment of Need - Forensic Version. London: Gaskell.Google Scholar
van Asselt, A. D. I., Dirksen, C. D., Arntz, A. and Severens, J. L. (2007). The cost of borderline personality disorder: societal cost of illness in BPD-patients. European Psychiatry, 22, 354–361.Google Scholar
Ventura, M. A., Green, M. F., Shaner, A. and Liberman, R. P. (1993). Training and quality assurance with the brief psychiatric rating scale: “the drift buster” International Journal of Methods in Psychiatric Research, 3, 221–244.Google Scholar
Verheul, R., Van Den Bosch, L. M., Koeter, M. W., De Ridder, M. A., Stijnen, T. and Van Den Brink, W. (2003). Dialectical behaviour therapy for women with borderline personality disorder: 12 month, randomised clinical trials in The Netherlands. British Journal of Psychiatry, 182, 135–140.CrossRefGoogle ScholarPubMed
Wing, J. K., Beevor, A. S., Curtis, R. H., Park, S. B., Hadden, S. and Burns, A. (1998). Health of the Nation Outcome Scales (HoNOS): research and development. British Journal of Psychiatry, 172, 11–18.Google Scholar
World Health Organization (1992). Tenth Revision of the International Classification of Diseases and Related Health Problems (ICD-10). Geneva: WHO.Google Scholar
Yudofsky, S. C., Silver, J. M., Jackson, W., Endicott, J. and Williams, D. (1986). The Overt Aggression Scale for the objective rating of verbal and physical aggression. American Journal of Psychiatry, 143, 35–39.Google Scholar
Zanarini, M. C. (2003). Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD): a continuous measure of DSM-IV borderline psychopathology. Journal of Personality Disorders, 17, 233–242.Google Scholar
Submit a response

Comments

No Comments have been published for this article.