Dialectical Behavior Therapy for Borderline Personality Disorder: A Meta-Analysis Using Mixed-Effects Modeling
Dialectical Behavior Therapy for Borderline Personality Disorder: A Meta-Analysis Using Mixed-Effects Modeling
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DOI：
10.1037/a0021015
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发表时间：
2010-12-01
影响因子：
5.9
通讯作者：
Kosfelder, Joachim
中科院分区：
文献类型：
--
作者：
Kliem, Soeren;Kroeger, Christoph;Kosfelder, Joachim
目的：目前，对边缘型人格障碍（BPD）的心理社会干预研究最多的是辩证行为疗法（DBT）。我们进行了一项荟萃分析，以检查DBT的疗效和长期有效性。方法：进行系统的书目研究，从在线数据库（PubMed，PsycINFO，PsychSpider，Medline）中查找相关文献。我们排除了以下研究：诊断为BPD以外的患者接受治疗，治疗不包括DBT手册或住院DBT计划建议中规定的所有成分，患者未能根据精神疾病诊断和统计手册进行诊断，干预组患者少于10例。使用混合效应分层建模方法，我们计算了自杀和自伤行为的总体效应量和效应量。结果：干预后总体效应量的计算基于16项研究。其中，8项为随机对照试验（RCT），8项既不随机也不对照（nRCT）。治疗前后脱落率为27.3%。当纳入针对特定治疗的边缘性RCT的调节剂时，发现自杀和自伤行为的中度总体效应和中度效应量。没有证据表明其他主持人的影响（例如，研究质量、环境、干预持续时间）。从治疗后到随访，仅包括5项RCT，显示了小的损害。结论：未来的研究应该将DBT与其他积极的边缘特异性治疗进行比较，这些治疗也已经使用几个长期随访评估点证明了其疗效。
Objective: At present, the most frequently investigated psychosocial intervention for borderline personality disorder (BPD) is dialectical behavior therapy (DBT). We conducted a meta-analysis to examine the efficacy and long-term effectiveness of DBT. Method: Systematic bibliographic research was undertaken to find relevant literature from online databases (PubMed, PsycINFO, PsychSpider, Medline). We excluded studies in which patients with diagnoses other than BPD were treated, the treatment did not comprise all components specified in the DBT manual or in the suggestions for inpatient DBT programs, patients failed to be diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, and the intervention group comprised fewer than 10 patients. Using a mixed-effect hierarchical modeling approach, we calculated global effect sizes and effect sizes for suicidal and self-injurious behaviors. Results: Calculations of postintervention global effect sizes were based on 16 studies. Of these, 8 were randomized controlled trials (RCTs), and 8 were neither randomized nor controlled (nRCT). The dropout rate was 27.3% pre- to posttreatment. A moderate global effect and a moderate effect size for suicidal and self-injurious behaviors were found, when including a moderator for RCTs with borderline-specific treatments. There was no evidence for the influence of other moderators (e.g., quality of studies, setting, duration of intervention). A small impairment was shown from posttreatment to follow-up, including 5 RCTs only. Conclusions: Future research should compare DBT with other active borderline-specific treatments that have also demonstrated their efficacy using several long-term follow-up assessment points.