Evidence map›Paper›PMID 23420622›Full record

Trial reportPsychology and psychotherapy2013

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.

John Norrie, Kate Davidson, Philip Tata, Andrew Gumley

Open access · bronzeAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Psychology and psychotherapy, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 4 pooled it
2.1field-weighted citation impact, top 13% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 4 syntheses or guidelines pooled it, 23 citations in OpenAlex.

  1. Pooled it
  2. Psychosocial interventions for self-harm in adults.The Cochrane database of systematic reviews · 2021
    Pooled it
  3. Psychological therapies for people with borderline personality disorder.The Cochrane database of systematic reviews · 2020
    Pooled it
  4. Psychosocial interventions for self-harm in adults.The Cochrane database of systematic reviews · 2016
    Pooled it
  5. Trial
  6. Trial
  7. Review
  8. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors at 4 institutions in 1 country.

John NorrieCentre for Healthcare Randomised Trials, Health Services Research Unit, Aberdeen University, UK.
Kate Davidson
Philip Tata
Andrew Gumley
Central and North West London NHS Foundation Trust · GBGartnavel General Hospital · GBUniversity of Aberdeen · GBUniversity of Ulster · GB

Funding

Chief Scientist Office CZH/4/435Wellcome Trust 064027/Z/01/Z
6 · The paper itself

Abstract

objectivesWe investigated the treatment effects reported from a high-quality randomized controlled trial of cognitive behavioural therapy (CBT) for 106 people with borderline personality disorder attending community-based clinics in the UK National Health Service - the BOSCOT trial. Specifically, we examined whether the amount of therapy and therapist competence had an impact on our primary outcome, the number of suicidal acts, using instrumental variables regression modelling.

designRandomized controlled trial. Participants from across three sites (London, Glasgow, and Ayrshire/Arran) were randomized equally to CBT for personality disorders (CBTpd) plus Treatment as Usual or to Treatment as Usual. Treatment as Usual varied between sites and individuals, but was consistent with routine treatment in the UK National Health Service at the time. CBTpd comprised an average 16 sessions (range 0-35) over 12 months.

methodWe used instrumental variable regression modelling to estimate the impact of quantity and quality of therapy received (recording activities and behaviours that took place after randomization) on number of suicidal acts and inpatient psychiatric hospitalization.

resultsA 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.

conclusionsTrials should routinely control for and collect data on both quantity of therapy and therapist competence, which can be used, via instrumental variable regression modelling, to estimate treatment effects for optimal delivery of therapy. Such estimates complement rather than replace the ITT results, which are properly the principal analysis results from such trials.

Indexed as

Age of OnsetBorderline Personality DisorderClinical CompetenceCognitive Behavioral TherapyFemaleFollow-Up StudiesHospitalizationHumansIntention to Treat AnalysisKaplan-Meier EstimateOutcome Assessment, Health CareRegression AnalysisState MedicineStatistics, NonparametricSuicide, AttemptedTime Factors

Identifiers

PMID23420622
PMCPMC4491320
OpenAlexW2113913717

What OpenQuestion holds

Textmetadata
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.