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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
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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 Kinderund 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
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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
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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
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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
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(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 Kinderund 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
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Table I
DBT-components in included studies
Studie
Individual
Skills group per
sessions per week week
phone coaching / Weekly
pages
staff coaching
Consultation team
Bohus et al., 2004 2h
2h
As needed
Yes
pp. 490-491
Clarkin et al.,
2007
2.5h
As needed
Yes
p. 923
1.5h (twice a
week)
As needed
Yes
p. 408
Friedrich, Gunia, 1h
& Huppertz, 2003
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 As needed
week)
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
1h
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
al, 1 h
2h
As needed
Yes
p.3
& 1-1.5h
2.5h
In the clinic hours Yes
pp. 27-28, 30
2h
As needed
Yes
p.381
2-2.5h
As needed
Yes
p. 1233
Comtois
2007
McMain
2009
et
et
Prendergast
McCausland,
2007
Simpson
2004
et
1h
al., 1h
al., 1h
van den Bosch et 1h
al., 2005
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Table II
The coefficients of the moderators in a meta-analysis of dialectical behavior therapy (DBT) for
borderline personality disorder (BPD)
Fixed Effect for
Global effect size
Regression
Standard
T
Approx.
P
Coefficient
Error
0.47
0.03
14.15
7
< 0.001
-0.39
0.13
-.3.0
7
0.021
0.02
0.09
0.22
7
0.830
0.04
0.06
0.72
7
0.494
0.003
0.004
0.74
7
0.486
< 0.001
< 0.001
0.7
7
0.507
-.38
0.34
-1.13
7
0.298
-0.02
0.03
-0.71
7
0.498
0.56
0.02
19.79
4
<0.001
-0.38
0.08
-4.82
4
0.006
DF
pre-post (n = 15)
borderline-specific control condition
dummy variable
0 = No
1 = Yes
RCT
dummy variable
0 = No
1 = Yes
Setting
dummy variable
0 = Inpatient
1 = Outpatient
Duration
Grand mean centered
Mean (40.0 weeks)
Respectively: Duration**2
Grand mean centered
Mean (1873.7)
Drop-Out
Grand mean centered
Mean (25.8%)
Method quality
Grand mean centered
Mean (22.0)
Suicidal and self-injurious behaviors
pre-post (n = 13)
borderline-specific control condition
dummy variable
0 = No
1 = Yes
(continued)
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Table 2 (continued)
Duration
0.002
0.001
1.41
4
0.230
<0.001
<0.001
1.45
4
0.221
Grand mean centered
Mean (41.2 weeks)
Respectively: Duration ** 2
Grand mean centered
Mean (1907)
Fixed Effect for
Regression Coefficient Standard Errort
Approx. DF p
Drop-Out
-0.71
0.40
-1.81
4
0.142
0.005
0.01
-0.51
4
0.637
0.023
-0.29
4
0.785
-0.18
0.05
-3.85
2
0.184
-0.003
0.003
-0.98
2
0.431
-0.0001
<0.001
-0.70
2
0.555
0.01
0.02
0.56
2
0.629
Grand mean centered
Mean (27.1%)
Method quality
Grand mean centered
Mean (22.6)
Studies that examine samples with high rates of-0.007
self-injurious behaviors
Dummy variable
0 = no
1 = yes
Global effect size
post-FU (n = 5)
Duration
Grand mean centered
Mean (32.4 weeks)
Duration ** 2
Grand mean centered
Mean (1319.2)
Method quality
Grand mean centered
Mean (23.8)
Note. post = post-intervention; FU = follow-up.