Supplemental Materials for online Publication only

Supplemental Materials:

Excluded Studies (exclusion criterion)

1 = Studies that did not cover BPD; 2 = Studies not according to the DBT manual; 3 = Diagnosis not according to the DSM; 4 = Studies with less than 11 patients in the treatment group.

  1. Alper, G., & Peterson, S. J. (2001). Dialectical behavior therapy for patients with borderline personality disorder. Journal of Psychosocial Nursing and Mental Health Services, 39, 38–45.2
  2. Barley, W. D., Buie, S. E., Peterson, E. W., Hollingsworth, A. S., Griva, M., Hickerson, S. C., Lawson, J. E., & Bailey, B. J. (1993). The development of an inpatient cognitive behavioral treatment program for borderline personality disorder. Journal of Personality Disorders, 7, 232–240.2
  3. Ben-Porath, D. D., Wisniewski, L., & Warren, M. (2009). Differential treatment response for eating disordered patients with and without a comorbid borderline personality diagnosis using a dialectical behavior therapy (DBT)-informed approach. Eating Disorders, 17, 225–241.1
  4. Brassington, J., & Krawitz, R. (2006). Australasian dialectical behavior therapy pilot outcome study: effectiveness, utility and feasibility. Australasian Psychiatry, 14, 313–319.4
  5. Chen, E. Y., Matthews, L., Allen, C., Kuo, J. R., & Linehan, M. M. (2008). Dialectical behavior therapy for clients with binge-eating disorder or bulimia nervosa and borderline personality disorder. International Journal of Eating Disorders, 41, 505–512.1
  6. Dimeff, L. A., Koerner, K., Woodcock, E. A., Beadnell, B., Brown, M. Z., Skutch, J. M., Paves, A. P., Bazinet, A., & Harned, M. S. (2009). Which training method works best? A randomized controlled trial comparing three methods of training clinicians in dialectical behavior therapy skills. Behaviour Research and Therapy, 47, 921–930.2
  7. Evershed, S., Tennant, A., Boomer, D., Rees, A., Barkham, M., & Watsons, A. (2003). Practice-based outcomes of dialectical behaviour therapy (DBT) targeting anger and violence, with male forensic patients: a pragmatic and non-contemporaneous comparison. Criminal Behaviour and Mental Health, 13, 198–213.2
  8. Feldman, G., Harley, R., Kerrigan, M., Jacobo, M., & Fava, M. (2009). Change in emotional processing during a dialectical behavior therapy-based skills group for major depressive disorder. Behaviour research and therapy, 47, 316–321.1
  9. Fleischhaker, C., Munz, M., Böhme, R., Sixt, B., & Schulz, E. (2006). Dialectical behaviour therapy for adolescents (DBT-A). A pilot study on the therapy of suicidal, parasuicidal, and self-injurious behaviour in female patients with a borderline disorder. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 34, 15–25.2
  10. Goldstein, T. R., Axelson, D. A., Birmaher, B., & Brent, D. A. (2007). Dialectical behavior therapy for adolescents with bipolar disorder: a 1-year open trial. The Journal of the American Academy of Child and Adolescent Psychiatry, 46, 820–830.1
  11. Harley, R., Sprich, S., Safren, S., Jacobo, M., & Fava, M. (2008). Adaptation of dialectical behavior therapy skills training group for treatment-resistant depression. The Journal of Nervous and Mental Disease, 196, 136–143.1
  12. Hoffman, P. D., Fruzzetti, A. E., Buteau, E., Neiditch, E. R., Penney, D., Bruce, M. L., Hellman, F., & Struening, E. (2005). Family connections: a program for relatives of persons with borderline personality disorder. Family Process, 44, 217–225.2
  13. Huffman, J. C., Stern, T. A., Harley, R. M., & Lundy, N. A. (2003). The use of DBT skills in the treatment of difficult patients in the general hospital. Psychosomatics, 44, 421–429.2
  14. Katz, L. Y., Cox, B. J., Gunasekara, S., & Miller, A. L. (2004). Feasibility of dialectical behavior therapy for suicidal adolescent inpatients. The Journal of the American Academy of Child and Adolescent Psychiatry, 43, 276–282.1
  15. Low, G., Jones, D., Duggan, C., Power, M., & 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, 85–92.2
  16. Lynch, T. R., Morse, J. Q., Mendelson, T., & Robins, C. J. (2003). Dialectical behavior therapy for depressed older adults: a randomized pilot study. American Journal of Geriatric Psychiatry, 11, 33–45.1
  17. Lynch, T. R., Cheavens, J. S., Cukrowicz, K. C., Thorp, S. R., Bronner, L., & Beyer, J. (2007). Treatment of older adults with co-morbid personality disorder and depression: a dialectical behavior therapy approach. International Journal of Geriatric Psychiatry, 22, 131–143.1
  18. McCann, R. A., Ball, E. M., & Ivanhoff, A. (2000). DBT with an inpatient forensic population: The CMHIP model. Cognitive and Behavioral Practice, 7, 447–456.2
  19. McQuillan, A.,Nicastro, R., Guenot, F., Girard, M.,Lissner, C.,Ferrero, F. (2005). Intensive dialectical behavior therapy for outpatients with borderline personality disorder who are in crisis. Psychiatric Services, 56, 193–197.2
  20. Miller, A. L., Rathus, J. H., Linehan, M. M., Wetzler, S., & Leigh, E. (1997). Dialectical behavior therapy adapted for suicidal adolescents.Journal of Psychiatric Practice, 3,78–86.1
  21. Nee, C., & Farman, S. (2005). Female prisoners with borderline personality disorder: some promising treatment developments. Criminal Behaviour and Mental Health, 15, 2–16.2
  22. Nelson–Gray, R. O., Keane, S. P., Hurst, R. M., Mitchell, J. T., Warburton, J. B., Chok, J. T., & Cobb, A. R. (2006). A modified DBT skills training program for oppositional defiant adolescents: promising preliminary findings. Behaviour Research and Therapy, 44, 1811–1820.2
  23. Osborne, U. L., & McComish, J. F. (2006). Borderline personality disorder: nursing interventions using dialectical behavioral therapy. Journal of Psychosocial Nursing and Mental Health Services, 44, 40–47.2
  24. Palmer, R. L., Birchall, H., Damani, S., Gatward, N., McGrain, L., & Parker, L. (2003). A dialectical behavior therapy program for people with an eating disorder and borderline personality disorder— description and outcome. International Journal of Eating Disorders, 33, 281–286.1
  25. Perseius, K. I., Kåver, A., Ekdahl, S., Asberg, M., & Samuelsson, M. (2007). Stress and burnout in psychiatric professionals when starting to use dialectical behavioural therapy in the work with young self-harming women showing borderline personality symptoms. Journal of Psychiatric and Mental Health Nursing, 14, 635–643.3
  26. Rajalin, M., Wickholm-Pethrus, L., Hursti, T., & Jokinen, J. (2009). Dialectical behavior therapy-based skills training for family members of suicide attempters. Archives of Suicide Research, 13, 257–263.1
  27. Rathus, J. H., & Miller, A. L. (2002). Dialectical behavior therapy adapted for suicidal adolescents. Suicide and Life-Threatening Behavior, 32, 146–157.1
  28. Roth, B., & Pressé, L. (2003). Nursing interventions for parasuicidal behaviors in female offenders. Journal of Psychosocial Nursing and Mental Health Services, 41, 20–29.2
  29. Safer, D. L., Lively, T. J., Telch, C.F., & Agras, W. S. (2002). Predictors of relapse following successful dialectical behavior therapy for binge eating disorder. International Journal of Eating Disorders, 32, 155–163.1
  30. Safer, D. L., Telch, C. F., & Agras, W. S. (2001). Dialectical behavior therapy adapted for bulimia: a case report. International Journal of Eating Disorders, 30, 101–106.1
  31. Safer, D. L., Telch, C. F., & Agras, W. S. (2001). Dialectical behavior therapy for bulimia nervosa. The American Journal of Psychiatry, 158, 632–634.1
  32. Salbach, H., Klinkowski, N., Pfeiffer, E., Lehmkuhl, U., & Korte, A. (2007). Dialectical behavior therapy for adolescents with anorexia and bulimia nervosa (DBT-AN/ BN)— a pilot study. Praxis der Kinderpsychologie und Kinderpsychiatrie,56, 91–108.1
  33. Schnell, K., & Herpertz, S. C. (2007). Effects of dialectic-behavioral-therapy on the neural correlates of affective hyperarousal in borderline personality disorder. Journal of Psychiatric Research, 41, 837–847.4
  34. Sharma, B., Dunlop, B. W., Ninan, P. T., & Bradley, R. (2007). Use of dialectical behavior therapy in borderline personality disorder: a view from residency. Academic Psychiatry, 31, 218–224.4
  35. Simpson, E. B., Pistorello, J., Begin, A., Costello, E., Levinson, J., Mulberry, S., Pearlstein, T., Rosen, K., & Stevens, M. (1998). Use of dialectical behavior therapy in a partial hospital program for women with borderline personality disorder. Psychiatric Services, 49, 669–673.2
  36. Soler, J., Pascual, J. C., Campins, J., Barrachina, J., Puigdemont, D., Alvarez, E., & Pérez, V. (2005). Double-blind, placebo-controlled study of dialectical behavior therapy plus olanzapine for borderline personality disorder. The American Journal of Psychiatry, 162, 1221–1224.2
  37. Soler, J., Pascual, J. C., Tiana, T., Cebrià, A., Barrachina, J., Campins, M. J., Gich, I., Alvarez, E., & Pérez, V. (2009). Dialectical behaviour therapy skills training compared to standard group therapy in borderline personality disorder: a 3-month randomised controlled clinical trial. Behaviour Research and Therapy, 47, 353–358.2
  38. Soler, J., Trujols, J., Pascual, J. C., Portella, M. J., Barrachina, J., Campins, J., Tejedor, R., Alvarez, E., & Pérez, V. (2008). Stages of change in dialectical behavior therapy for borderline personality disorder. British Journal of Clinical Psychology, 47, 417–426.2
  39. Spoont, M. R., Sayer, N. A., Thuras, P., Erbes, C., & Winston,E. (2003). Adaptation of dialectical behavior therapy by a VA medical center. Psychiatric Services, 54, 627–629.2
  40. Stanley, B., Brodsky, B., Nelson, J. D., & Dulit, R. (2007). Brief dialectical behavior therapy (DBT-B) for suicidal behavior and non-suicidal self injury. Archives of Suicide Research, 11, 337–341.2
  41. Stepp, S. D., Epler, A. J., Jahns, S., & Trull, T. J. (2008). The effect of dialectical behavior therapy skills use on borderline personality disorder features. Journal of Personality Disorders, 22, 549–563.3
  42. Stippel, A. E., Krischer, M. K., & Lehmkuhl, G. (2008). Treatment of an 11-year-old child with elements of the dialectical behavioral therapy for adolescents. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 36, 353–356.4
  43. Telch, C. F., Agras, W. S., & Linehan, M. M. (2001). Dialectical behavior therapy for binge eating disorder. Journal of Consulting and Clinical Psychology, 69, 1061–1065.1
  44. Telch, C. F., Argas, W. S., & Linehan, M. M. (2000). Group dialectical behavior therapy for binge eating disorder. A preliminary uncontrolled trial.Behavior Therapy, 31, 569–582.1
  45. Trupin, E. W., Stewart, D. G., Beach, B., & Boesky, L. (2002). Effectiveness of a dialectical behavior therapy program for incarcerated female juvenile offenders. Child and adolescent mental health, 7, 121–127.2
  46. Turner, R. M. (2000). Naturalistic evaluation of dialectical behavioral therapy-oriented treatment for borderline personality disorder. Cognitive and Behavioral Practice, 7, 413–419.2
  47. Wagner, A. W., Rizvi, S. L., & Harned, M. S. (2007). Applications of dialectical behavior therapy to the treatment of complex trauma-related problems: when one case formulation does not fit all. Journal of Traumatic Stress, 20, 391–400.1
  48. Yen, S., Johnson, J., Costello, E., & Simpson, E. B. (2009). A 5-day dialectical behavior therapy partial hospital program for women with borderline personality disorder: predictors of outcome from a 3-month follow-up study. Journal of Psychiatric Practice,15, 173–182.2

Table I

DBT-components in included studies

Studie / Individual sessions per week / Skills group per week / phone coaching /
staff coaching / Weekly Consultation team / pages
Bohus et al., 2004 / 2h / 2h / As needed / Yes / pp. 490-491
Clarkin et al., 2007 / 1h / 2.5h / As needed / Yes / p. 923
Comtois et al., 2007 / 1h / 1.5h (twice a week) / As needed / Yes / p. 408
Friedrich, Gunia, & Huppertz, 2003 / 1h / 1.5h / 8-9 und 16-23 Uhr / Yes / p. 293
Höschel, 2006 / 2h / 3h / as needed within the staff member limits to ensure
generalization / Yes / pp. 18-19
Kröger et al., 2006 / 1h / 1.8h (three times a week) / As needed / Yes / p. 1213
Koons et al., 2001 / 1h / 1.5h / As needed / Yes / pp. 376, 382
Linehan et al., 1991 / 1h / 2.5h / As needed / Yes / p. 1061
Linihan et al., 1999 / 1h / 2.25h / As needed / Yes / pp. 281-282
Linihan et al., 2002 / 0.6 – 1.5 h / 2.5h / As needed / Yes / p. 16
Linehan et al., 2006 / 1 h / 2.5h / as needed within the therapist’s limits to ensure
generalization / Yes / p. 759
Linehan et al., 2008 / 0.6 – 1.5 h / 2.5h / As needed / Yes / p. 1000
McMain et al, 2009 / 1 h / 2h / As needed / Yes / p.3
Prendergast & McCausland, 2007 / 1-1.5h / 2.5h / In the clinic hours / Yes / pp. 27-28, 30
Simpson et al., 2004 / 1h / 2h / As needed / Yes / p.381
van den Bosch et al., 2005 / 1h / 2-2.5h / As needed / Yes / p. 1233

Table II

The coefficients of the moderators in a meta-analysis of dialectical behavior therapy (DBT) for borderline personality disorder (BPD)

Fixed Effect for / Regression Coefficient / Standard Error / T / Approx. DF / P
Global effect size
pre-post (n = 15) / 0.47 / 0.03 / 14.15 / 7 / < 0.001
borderline-specific control condition
dummy variable
0 = No
1 = Yes / -0.39 / 0.13 / -.3.0 / 7 / 0.021
RCT
dummy variable
0 = No
1 = Yes / 0.02 / 0.09 / 0.22 / 7 / 0.830
Setting
dummy variable
0 = Inpatient
1 = Outpatient / 0.04 / 0.06 / 0.72 / 7 / 0.494
Duration
Grand mean centered
Mean (40.0 weeks) / 0.003 / 0.004 / 0.74 / 7 / 0.486
Respectively: Duration**2
Grand mean centered
Mean (1873.7) / < 0.001 / < 0.001 / 0.7 / 7 / 0.507
Drop-Out
Grand mean centered
Mean (25.8%) / -.38 / 0.34 / -1.13 / 7 / 0.298
Method quality
Grand mean centered
Mean (22.0) / -0.02 / 0.03 / -0.71 / 7 / 0.498
Suicidal and self-injurious behaviors
pre-post (n = 13) / 0.56 / 0.02 / 19.79 / 4 / <0.001
borderline-specific control condition
dummy variable
0 = No
1 = Yes / -0.38 / 0.08 / -4.82 / 4 / 0.006

(continued)

Table 2 (continued)

Duration
Grand mean centered
Mean (41.2 weeks) / 0.002 / 0.001 / 1.41 / 4 / 0.230
Respectively: Duration ** 2
Grand mean centered
Mean (1907) / <0.001 / <0.001 / 1.45 / 4 / 0.221
Fixed Effect for / Regression Coefficient / Standard Error / t / Approx. DF / p
Drop-Out
Grand mean centered
Mean (27.1%) / -0.71 / 0.40 / -1.81 / 4 / 0.142
Method quality
Grand mean centered
Mean (22.6) / 0.005 / 0.01 / -0.51 / 4 / 0.637
Studies that examine samples with high rates of self-injurious behaviors
Dummy variable
0 = no
1 = yes / -0.007 / 0.023 / -0.29 / 4 / 0.785
Global effect size
post-FU (n = 5) / -0.18 / 0.05 / -3.85 / 2 / 0.184
Duration
Grand mean centered
Mean (32.4 weeks) / -0.003 / 0.003 / -0.98 / 2 / 0.431
Duration ** 2
Grand mean centered
Mean (1319.2) / -0.0001 / <0.001 / -0.70 / 2 / 0.555
Method quality
Grand mean centered
Mean (23.8) / 0.01 / 0.02 / 0.56 / 2 / 0.629

Note. post = post-intervention; FU = follow-up.