Health Technology Assessment on Dialectical Behaviour Therapy (DBT) for Borderline Personality Disorder (BPD)

Condition Description – Borderline personality disorder (BPD) is a chronic mental condition that is characterized by emotional dysregulation, impulsive behaviors, chronic suicidal tendency, inner emptiness, and fear of abandonment. Adult BPD is characterized by predominantly affective, impulsive, and suicidal symptoms to maladaptive interpersonal relationships and functional impairments. Examples include unstable and intense interpersonal relationship problems that cause the patients to be estranged from family and friends, unable to hold a stable job, or unable to complete formal education. Patients might experience some periods with remission and frequent relapses throughout their adult life. BPD predicts a list of negative outcomes across the life of the patients including mood disorders, anxiety disorders, eating disorders, substance abuse, frequent utilization of health care, reduced quality of life, and shorter life expectancy. However, BDP can gradually get better over time.

Current treatment options – The only public-funded treatment option for BPD patients in BC is medication.

Description of the Assessed Technology(ies) - Dialectical Behavior Therapy (DBT) is a structured outpatient treatment based on cognitive-behavioral principles developed for the treatment of parasuicidal behavior in patients with BPD. DBT aims to address the symptoms of BPD by replacing maladaptive behaviors with healthier coping skills, such as mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. The key principles of treatment include moving flexibly between acceptance and validation and behavioral change strategies; this includes behavioral analysis, solution analysis and strategies, skills training, contingency management, exposure, cognitive modification, and psychoeducation.

Health Technology Assessment Committee’s Findings: 

After reviewing the available evidence, the Health Technology Assessment Committee found:

• Medication when effective can only manage mood and psychotic symptoms. Medication is not effective in treating important outcomes in BPD such as suicide and self-injury behavior, improved function, and quality of life.
• Dialectical behavior therapy (DBT) to be a clinically and cost-effective intervention, with substantial downstream cost-savings, for people with BPD.
• This program of care is expected to positively impact the patient experience, the health of marginalized populations, reduce service provider burnout, and reduce overall cost of care for this population.

There are considerable implementation considerations that vary with local mental health service delivery models and resources. It will be at the discretion of each health authority and/or relevant organization to assess the value of potential benefits in comparison to the additional implementation costs. If implemented, HTAC suggests a rigorous evaluation of outcomes to confirm efficacy in practice.