***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND A r and omized clinical trial was conducted to evaluate whether the superior performance of dialectical behavior therapy ( DBT ) , a psychosocial treatment for borderline personality disorder , compared with treatment-as-usual in the community , is maintained during a 1-year posttreatment follow-up . METHODS We analyzed 39 women who met criteria for borderline personality disorder , defined by Gunderson 's Diagnostic Interview for Borderline Personality Disorder and DSM-III-R criteria , and who had a history of parasuicidal behavior . Subjects were r and omly assigned either to 1 year of DBT , a cognitive behavioral therapy that combines individual psychotherapy with group behavioral skills training , or to treatment-as-usual , which may or may not have included individual psychotherapy .  Efficacy was measured on parasuicidal behavior ( Parasuicide History Interview ) , psychiatric inpatient days ( Treatment History Interview ) , anger ( State-Trait Anger Scale ) , global functioning ( Global Assessment Scale ) , and social adjustment ( Social Adjustment Scale -- Interview and Social Adjustment Scale -- Self-Report ) . Subjects were assessed at 6 and 12 months into the follow-up year . RESULTS Comparison of the two conditions revealed that throughout the follow-up year , DBT subjects had significantly higher Global Assessment Scale scores . During the initial 6 months of the follow-up , DBT subjects had significantly less parasuicidal behavior , less anger , and better self-reported social adjustment . During the final 6 months , DBT subjects had significantly fewer psychiatric inpatient days and better interviewer-rated social adjustment . CONCLUSION In general , the superiority of DBT over treatment-as-usual , found in previous studies at the completion of 1 year of treatment , was retained during a 1-year follow-up Dialectical behaviour therapy ( DBT ) has proven to be an effective treatment in borderline personality disorder ( BPD ) . However , the effectiveness in BPD of DBT skills training ( DBT-ST ) alone is not known . This study aim ed at comparing the efficacy of DBT-ST and st and ard group therapy ( SGT ) for out patients with BPD . Sixty patients meeting the DSM-IV diagnostic criteria for BPD , as assessed by two semi-structured diagnostic interviews , were included in a 3-month , single-blind r and omised controlled trial . A total of 13 weekly group psychotherapy sessions of 120 min of either SGT or DBT-ST were conducted . Assessment s were carried out every 2 weeks by two blinded evaluators . Observer-rater , self-report scales and behavioural reports were used as outcome measures . DBT-ST was associated with lower dropout rates , 34.5 % compared to 63.4 % with SGT . It was superior to SGT in improving several mood and emotion areas , such as : depression , anxiety , irritability , anger and affect instability . A reduction in general psychiatric symptoms was also observed . Three-months weekly DBT-ST proved useful . This therapy was associated with greater clinical improvements and lower dropout rates than SGT . DBT-ST seems to play a role in the overall improvement of BPD seen with st and ard DBT intervention . It allows straightforward implementation in a wide range of mental health setting s and provides the additional advantage that it is cost effective OBJECTIVE The aim of this article is to examine whether st and ard Dialectical Behavior Therapy ( DBT ) ( 1 ) can be successfully implemented in a mixed population of borderline patients with or without comorbid substance abuse ( SA ) , ( 2 ) is equally efficacious in reducing borderline symptomatology among those with and those without comorbid SA , and ( 3 ) is efficacious in reducing the severity of the substance use problems . METHOD The implementation of DBT is examined qualitatively . The impact of comorbid SA on its efficacy , as well as on its efficacy in terms of reducing SA , is investigated in a r and omized clinical trial comparing DBT with treatment-as-usual ( TAU ) in 58 female borderline patients with ( n = 31 ) and without ( n = 27 ) SA . RESULTS St and ard DBT can be applied in a group of borderline patients with and without comorbid SA . Major implementation problems did not occur . DBT result ed in greater reductions of severe borderline symptoms than TAU , and this effect was not modified by the presence of comorbid SA . St and ard DBT , as it was delivered in our study , however , had no effect on SA problems . CONCLUSIONS St and ard DBT can be effectively applied with borderline patients with comorbid SA problems , as well as those without . St and ard DBT , however , is not more efficacious than TAU in reducing substance use problems . We propose that , rather than developing separate treatment programs for dual diagnosis patients , DBT should be " multitargeted . " This means that therapists ought to be trained in addressing a range of severe manifestations of personality pathology in the impulse control spectrum , including suicidal and self-damaging behaviors , binge eating , and SA This study tests the effectiveness of adding an eight-month , thirty-session schema-focused therapy ( SFT ) group to treatment-as-usual ( TAU ) individual psychotherapy for borderline personality disorder ( BPD ) . Patients ( N=32 ) were r and omly assigned to  SFT-TAU and TAU alone . Dropout was 0 % SFT , 25 % TAU . Significant reductions in BPD symptoms and global severity of psychiatric symptoms , and improved global functioning with large treatment effect sizes were found in the SFT-TAU group . At the end of treatment , 94 % of SFT-TAU compared to 16 % of TAU no longer met BPD diagnosis criteria ( p<.001 ) . This study supports group SFT as an effective treatment for BPD that leads to recovery and improved overall functioning Motive-oriented therapeutic relationship ( MOTR , also called complementary therapeutic relationship ) was postulated to be a particularly helpful therapeutic ingredient in the early-phase treatment of patients with personality disorders , in particular borderline personality disorder ( BPD ) . The present pilot study of r and omized controlled trial using an add-on design aims to investigate the effects of MOTR in early-phase treatment ( up to session 10 ) , with BPD patients on therapeutic alliance , session impact , and outcome . In total , N = 25 patients participated in the study . BPD patients were r and omly allocated to a manual-based investigation process in 10 sessions or to the same investigation process infused with MOTR .  Adherence ratings were performed and yielded satisfactory results . The results suggested a specific effectiveness of  MOTR  on the interpersonal problem area , on the quality of the therapeutic alliance and the quality of the therapeutic relationship , as rated by the patient . These results may have important clinical implication s for the early-phase treatment of patients presenting with BPD OBJECTIVE This study aim ed to evaluate the success of implementing outpatient schema focused therapy ( ST ) for borderline patients in regular mental healthcare and to determine the added value of therapist telephone availability outside office hours in case of crisis ( TTA ) . METHODS To enhance the implementation , the following adaptations regarding the original ST protocol were applied : a reduction in the frequency and duration of the therapy ; training therapists of eight regular healthcare centers in ST with a structured and piloted program supported by a set of films ( DVDs ) with examples of ST techniques ; training and supervision given by Dutch experts . Telephone availability outside office hours was r and omly allocated to 50 % of the therapists of each treatment center . Patient 's outcome measures were assessed with a semi-structured interview and self-report measures on BPD , quality of life , general psychopathology and an ST question naire , before , during and after treatment . RESULTS Data on 62 DSM-IV defined BPD patients were available . Intention-to-treat analyses showed that after 1.5 years of ST 42 % of the patients had recovered from BPD . No added value of therapist telephone availability ( TTA ) was found on the BPDSI score nor on any other measure after 1.5 years of ST . CONCLUSIONS ST for BPD can be successfully implemented in regular mental healthcare . Treatment results and dropout were comparable to a previous clinical trail . No additional effect of extra crisis support with TTA outside office hours ST was found BACKGROUND Transference-focused psychotherapy is a manualised treatment for borderline personality disorder . AIMS To compare transference-focused psychotherapy with treatment by experienced community psychotherapists . METHOD In a r and omised controlled trial ( NCT00714311 ) 104 female out- patients were treated for 1 year with either transference-focused psychotherapy or by an experienced community psychotherapist . RESULTS Significantly fewer participants dropped out of the transference-focused psychotherapy group ( 38.5 % v. 67.3 % ) and also significantly fewer attempted suicide ( d = 0.8 , P = 0.009 ) . Transference-focused psychotherapy was significantly superior in the domains of borderline symptomatology ( d = 1.6 , P = 0.001 ) , psychosocial functioning ( d = 1.0 , P = 0.002 ) , personality organisation ( d = 1.0 , P = 0.001 ) and psychiatric in-patient admissions ( d = 0.5 , P = 0.001 ) . Both groups improved significantly in the domains of depression and anxiety and the transference-focused psychotherapy group in general psychopathology , all without significant group differences ( d = 0.3 - 0.5 ) . Self-harming behaviour did not change in either group . CONCLUSIONS Transference-focused psychotherapy is more efficacious than treatment by experienced community psychotherapists in the domains of borderline symptomatology , psychosocial functioning , and personality organisation . Moreover , there is preliminary evidence for a superiority in the reduction of suicidality and need for psychiatric in-patient treatment Background Structured psychotherapy is recommended as the preferred treatment of personality disorders . A substantial group of patients , however , has no access to these therapies or does not benefit . For those patients who have no ( longer ) access to psychotherapy  a Collaborative Care Program ( CCP ) is developed . Collaborative Care originated in somatic health care to increase shared decision making and to enhance self management skills of chronic patients . Nurses have a prominent position in CCP 's as they are responsible for optimal continuity and coordination of care . The aim of the CCP is to improve quality of life and self management skills , and reduce destructive behaviour and other manifestations of the personality disorder . Methods / design Quantitative and qualitative data are combined in a comparative multiple case study . This makes it possible to test the feasibility of the CCP , and also provides insight into the preliminary outcomes of CCP . Two treatment conditions will be compared , one in which the CCP is provided , the other in which Care as Usual is offered . In both conditions 16 patients will be included . The perspectives of patients , their informal carers and nurses are integrated in this study . Data ( question naires , documents , and interviews ) will be collected among these three groups of participants . The process of treatment and care within both research conditions is described with qualitative research methods . Additional quantitative data provide insight in the preliminary results of the CCP compared to CAU . With a stepped analysis plan the ' black box ' of the application of the program will be revealed in order to underst and which characteristics and influencing factors are indicative for positive or negative outcomes . Discussion The present study is , as to the best of our knowledge , the first to examine Collaborative Care for patients with severe personality disorders receiving outpatient mental health care . With the chosen design we want to examine how and which elements of the CC Program could contribute to a better quality of life for the patients .Trial registration Netherl and s Trial Register ( NTR ) : A r and omized controlled trial was conducted to determine whether a manual-based psychodynamic treatment , labeled dynamic deconstructive psychotherapy ( DDP ) , would be feasible and effective for individuals with co-occurring borderline personality disorder ( BPD ) and alcohol use disorder . Thirty participants were assessed every 3 months during a year of treatment with either DDP or treatment as usual ( TAU ) in the community . DDP participants showed statistically significant improvement in parasuicide behavior , alcohol misuse , institutional care , depression , dissociation , and core symptoms of BPD , and treatment retention was 67 % to 73 % . Although TAU participants received higher average treatment intensity , they showed only limited change during the same period . The results support the feasibility , tolerability , and efficacy of DDP for the co-occurring subgroup and highlight the need for further research . ( PsycINFO Data base Record ( c ) 2010 APA , all rights reserved ) BACKGROUND Longer-term follow-up of patients with borderline personality disorder have found favourable clinical outcomes , with long-term reduction in symptoms and diagnosis . AIMS We examined the 6-year outcome of patients with borderline personality disorder who were r and omised to 1 year of cognitive-behavioural therapy for personality disorders ( CBT-PD ) or treatment as usual ( TAU ) in the BOSCOT trial , in three centres across the UK ( trial registration : IS RCT N86177428 ) . METHOD In total , 106 participants met criteria for borderline personality disorder in the original trial . Patients were interviewed at follow-up by research assistants masked to the patient 's original treatment group , CBT-PD or TAU , using the same measures as in the original r and omised trial . Statistical analyses of data for the group as a whole are based on generalised linear models with repeated measures analysis of variance type models to examine group differences . RESULTS Follow-up data were obtained for 82 % of patients at 6 years . Over half the patients meeting criteria for borderline personality disorder at entry into the study no longer did so 6 years later . The gains of CBT-PD over TAU in reduction of suicidal behaviour seen after 1-year follow-up were maintained . L 
    Output:
    
The overall efficacy of specific therapies for BPD is promising .