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Unit for Social and Community Psychiatry

DIALECT: dialectical therapy


Between 400,000 and 1 million people in the UK suffer from Borderline Personality Disorder (BPD). People with BPD have difficulty managing their emotions and frequently go to extremes to deal with them by cutting themselves or using drugs, or thinking about and attempting suicide. Many have substantial difficulties establishing or maintaining relationships with relatives and friends, and holding jobs. This can generate high costs to the NHS because of frequent use of Accident and Emergency Departments in hospitals and other services.

In this study we randomly allocated people who self-harmed and met the criteria for a personality disorder, typically BPD, into two groups. One group received Dialectical Behaviour Therapy (DBT) immediately, while the other group received DBT after a waiting period of six months. In both groups we assessed how often patients harmed themselves, tried to kill themselves or went to use other NHS services such as hospitals. Whilst there had been some previous studies which found that DBT may have been an effective treatment for self-harm in research settings, it was not yet clear whether these results would translate to an NHS setting where treatment services and provision are very different.

Research questions

  • Is a pragmatic randomised controlled trial of DBT in the NHS feasible?
  • IS DBT effective in reducing the amount participants self-harm over a 12-month period in comparison to a waitlist control?
  • Does DBT improve psychopathology, treatment satisfaction, the therapeutic relationship and reduce service use relative to a waitlist control group?
  • Is DBT a cost-effective treatment for the NHS?
  • Are any treatment effects of DBT present six months later?

Research activities

  • 80 participants were randomised to receive either 12 months of DBT immediately, or to go on a 12 months waiting list.
  • Participants were assessed before they started treatment, every two months during treatment, and then six months after treatment completion.


  • A significant reduction in self-harm was detected in the DBT group over time, in comparison to the waitlist control group.
  • The effect was stronger in those that completed treatment.
  • Upon treatment completion, further reductions in self-harm and the number of hospitalisations were found six months later.
  • Higher treatment costs were found to be associated with DBT.

Useful links


  • Mark Savill
  • Prof. Stefan Priebe

Associated papers

Priebe, Stefan, Nyla Bhatti, Kirsten Barnicot, Stephen Bremner, Amy Gaglia, Christina Katsakou, Iris Molosankwe, Paul McCrone, and Martin Zinkler. Effectiveness and cost-effectiveness of dialectical behaviour therapy for self-harming patients with personality disorder: a pragmatic randomised controlled trial. Psychotherapy and psychosomatics 81, no. 6 (2012): 356.

Barnicot K, Savill M, Bhatti N, Priebe S, 2014. A pragmatic randomised controlled trial of dialectical behaviour therapy: effects on hospitalisation and post-treatment follow-up. Psychother Psychosom, Vol: 83, Pages: 192-193.

Katsakou, Christina, Stamatina Marougka, Kirsten Barnicot, Mark Savill, Hayley White, Kate Lockwood, and Stefan Priebe. "Recovery in borderline personality disorder (BPD): a qualitative study of service users' perspectives."PloS one 7, no. 5 (2012).

Barnicot, Kirsten, Christina Katsakou, Nyla Bhatti, Mark Savill, Naomi Fearns, and Stefan Priebe. Factors predicting the outcome of psychotherapy for borderline personality disorder: a systematic review. Clinical Psychology Review 32, no. 5 (2012): 400-412.

Barnicot, K; Katsakou, C; Marougka, S; Priebe, S (2010). Treatment completion in psychotherapy for borderline personality disorder – a systematic review and meta-analysis. Acta Psychiatrica Scandinavica, 1-12.

Barnicot, Kirsten, and Stefan Priebe. "Post‐traumatic stress disorder and the outcome of dialectical behaviour therapy for borderline personality disorder."Personality and mental health 7, no. 3 (2013): 181-190.


National Institute for Health Research, Research for Patient Benefit Programme.

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