Objectives: Employment and recovery can be difficult goals to reach for individuals with severe borderline personality disorder, even for those who have successfully completed dialectical behavior therapy (DBT) and are no longer in crisis. This study examined the feasibility of DBT-Accepting the Challenges of Exiting the System (DBT-ACES), a follow-up to standard DBT (SDBT).
Methods: A pre-post evaluation was conducted of the outcomes for 30 clients with borderline personality disorder who entered DBT-ACES during the study period (April 2000 to June 2005). Outcomes included employment, exit from the public mental health system, and quality of life, as well as self-inflicted injury and emergency and inpatient admissions.
Results: From the end of SDBT to the end of DBT-ACES, the study found a significant improvement in participants' odds of being employed or in school (odds ratio [OR]=3.34, p<.05), working at least 20 hours per week (OR=4.93, p=.01), and subjective quality of life (B=.49, p=.03) and a decrease in the number of inpatient admissions (RR=.07, p<.05). Comparing the end of SDBT to a year after DBT-ACES, the latter two outcomes were mostly retained, but the findings were not significant. One year after leaving DBT-ACES, only 36% of DBT-ACES clients were still receiving public mental health services. Emergency room admissions, inpatient psychiatry admissions, and medically treated self-inflicted injuries all decreased during SDBT and remained low during and following DBT-ACES.
Conclusions: This study demonstrated the feasibility of meaningful recovery from severe borderline personality disorder with a combination of SDBT and DBT-ACES, but controlled research is needed.