Influence of therapist competence and quantity of cognitive behavioural therapy on suicidal behaviour and inpatient hospitalisation in a randomised controlled trial in borderline personality disorder: further analyses of treatment effects in the BOSCOT study.
Bottom Line: A total of 101 participants provided full outcome data at 2 years post randomization.The previously reported intention-to-treat (ITT) results showed on average a reduction of 0.91 (95% confidence interval 0.15-1.67) suicidal acts over 2 years for those randomized to CBT.By incorporating the influence of quantity of therapy and therapist competence, we show that this estimate of the effect of CBTpd could be approximately two to three times greater for those receiving the right amount of therapy from a competent therapist.
Affiliation: Centre for Healthcare Randomised Trials, Health Services Research Unit, Aberdeen University, UK.Show MeSH
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Mentions: Figure 4 shows the mean number of suicidal acts (in the previous 6-month period) by treatment group across 12 months of treatment and 12 months of follow-up. Figure 5 relates suicidal acts over the 12-month period of therapy to the quantity of CBTpd and likewise Figure 6 shows quality of CBTpd (ranking therapists by their average CTRS score). From Figure 5, although the baseline rate is higher than the treated rate across the board, there is no indication of an obvious, simple relationship between treatment received and treatment effect. Indeed, the lowest rate of suicidal acts post randomization (0.1/year) is among those with fewest CBTpd sessions, and the highest among those who received the most. However, in our design, participants were not randomized to therapists and it might be the case that some therapists had easier, or more difficult patients, or that those who needed the least CBTpd actually took the least number of sessions of CBTpd, while those who needed most received the largest amount of therapy. We have therefore added the expected rate from the stepwise baseline predictive model (Table 2).
Affiliation: Centre for Healthcare Randomised Trials, Health Services Research Unit, Aberdeen University, UK.