Cognitive therapy v. usual treatment for borderline personality disorder: prospective 6-year follow-up

• Published in: British journal of psychiatry 2010-12, Vol.197 (6), p.456-462
• Main Authors: Davidson, Kate M., Tyrer, Peter, Norrie, John, Palmer, Stephen J., Tyrer, Helen
• Format: Article
• Language: English
• Subjects: Adult; Anxiety; Assistants; Behavior modification; Borderline personality disorder; Borderline Personality Disorder - economics; Borderline Personality Disorder - psychology; Borderline Personality Disorder - therapy; Clinical outcomes; Cognition & reasoning; Cognitive ability; Cognitive behavioral therapy; Cognitive Therapy; Cognitive-behavioral factors; Cost analysis; Cost effectiveness; Cost-Benefit Analysis; Emergency Service, Hospital - economics; Emergency Service, Hospital - utilization; Emotional disorders; Female; Follow-Up Studies; Health Care Costs - statistics & numerical data; Hospitalization; Hospitalization - economics; Hospitalization - statistics & numerical data; Humans; Linear analysis; Linear models; Long term symptoms; Male; Medical diagnosis; Mental health; Outcome Assessment (Health Care); Patients; Personality; Personality disorders; Psychiatric Status Rating Scales; Psychiatry; Psychologists; Psychotherapy; Quality of Life; Self destructive behavior; Self-Injurious Behavior - epidemiology; State Medicine; Statistical analysis; Suicide; Suicide, Attempted - statistics & numerical data; Suicides & suicide attempts; United Kingdom
• ISSN: 0007-1250; 1472-1465
• DOI: 10.1192/bjp.bp.109.074286

Longer-term follow-up of patients with borderline personality disorder have found favourable clinical outcomes, with long-term reduction in symptoms and diagnosis. We examined the 6-year outcome of patients with borderline personality disorder who were randomised to 1 year of cognitive-behavioural therapy for personality disorders (CBT-PD) or treatment as usual (TAU) in the BOSCOT trial, in three centres across the UK (trial registration: ISRCTN86177428). In total, 106 participants met criteria for borderline personality disorder in the original trial. Patients were interviewed at follow-up by research assistants masked to the patient's original treatment group, CBT-PD or TAU, using the same measures as in the original randomised trial. Statistical analyses of data for the group as a whole are based on generalised linear models with repeated measures analysis of variance type models to examine group differences. Follow-up data were obtained for 82% of patients at 6 years. Over half the patients meeting criteria for borderline personality disorder at entry into the study no longer did so 6 years later. The gains of CBT-PD over TAU in reduction of suicidal behaviour seen after 1-year follow-up were maintained. Length of hospitalisation and cost of services were lower in the CBT-PD group compared with the TAU group. Although the use of CBT-PD did not demonstrate a statistically significant cost-effective advantage, the findings indicate the potential for continued long-term cost-offsets that accrue following the initial provision of 1 year of CBT-PD. However, the quality of life and affective disturbance remained poor.