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 7 gives a visual depiction of the interesting feature that there may be a qualitative interaction between quality and quantity of therapy, with the largest reductions coming from those who had the more competently delivered therapy, but in limited quantity. To investigate this, we combined these two variables to create the subgroup, which had more competently delivered therapy (a therapist with an average score on CTRS ≥ 60), but attended <15 sessions. The treatment estimate now changes to −3.35 suicidal acts averted every 2 years. We went one stage further and redefined the quantity as being between 3 and 20, so removing those who had so little therapy (including none) that it was difficult to see how benefit could have derived, and adding in some participants with a few more sessions (from 16 to 20). The CBTpd treatment estimate now rose to almost five suicidal acts averted.
Affiliation: Centre for Healthcare Randomised Trials, Health Services Research Unit, Aberdeen University, UK.