ReachMDDialectical Behavior Therapy vs Schema Therapy for Borderline Personality Disorder

🧠 Mental Health / Behavioral Sensitivity

The BOOTS trial randomized 204 adults with borderline personality disorder across nine outpatient centers in the Netherlands. Participants received either dialectical behavior therapy (DBT) or schema therapy (ST) over two years, with follow-up extending to three years after baseline.

Clinical Considerations

• Borderline personality disorder severity improved substantially over three years in both treatment groups.
• No statistically significant difference was observed between DBT and schema therapy on the primary outcome measure.
• Secondary outcomes, including functioning, quality of life, sleep, and general symptom severity, similarly showed no between-group differences.
• Treatment attrition was common in both groups, exceeding 45% by year two regardless of treatment assignment.

Practice Applications

• Interpret findings as evidence supporting either DBT or schema therapy.
• Recognize meaningful improvement occurred across both psychotherapy models.
• Consider patient preference, therapist expertise, and program availability when selecting treatment.
• Avoid assuming one modality is superior based on current evidence.