Trial reportThe British journal of psychiatry : the journal of mental science2020
Refractory depression - mechanisms and efficacy of radically open dialectical behaviour therapy (RefraMED): findings of a randomised trial on benefits and harms.
Trial report in The British journal of psychiatry : the journal of mental science, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 2 of them syntheses that pooled 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.
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.
Who cites it
19 citing papers in PubMed, 2 syntheses or guidelines pooled it, 31 citations in OpenAlex.
- The Effectiveness of Dialectical Behavior Therapy in Reducing Self-Directed Violence and Suicidality in Usual Care Settings: A Meta-Analysis.Journal of clinical psychology · 2026Pooled it
- The utility of coping through emotional approach: A meta-analysis.Health psychology : official journal of the Division of Health Psychology, American Psychological Association · 2024Pooled it
- Obsessive-compulsive personality disorder in radically open dialectical behavior therapy for treatment-refractory depression.Personality disorders · 2026Trial
- Processes of change in a randomized clinical trial of radically open dialectical behavior therapy (RO DBT) for adults with treatment-refractory depression.Journal of consulting and clinical psychology · 2023Trial
- The Comparative Effectiveness of a Group Therapy for Overcontrol (Group Radical Openness) When Delivered In-Person vs. Remotely: Findings from a Retrospective Naturalistic Service Evaluation.Journal of clinical psychology · 2026Article
- Psychometric Evaluation of the FFOCI-SF and Other Clinical Outcome Measures in a Group Therapy for Overcontrol (Group Radical Openness).International journal of methods in psychiatric research · 2026Article
- The mediating role of social connectedness between inflexibility, the suppression of emotional expression, and symptoms of eating disorders and depression in adolescents with restrictive eating disorders referred for radically open dialectical behaviour therapy (RO DBT).Journal of eating disorders · 2025Article
- Using the alternative model of personality disorders for DSM-5 traits to identify personality types, and the relationship with disordered eating, depression, anxiety and stress.Journal of eating disorders · 2025Article
- Telehealth-Delivered Radically Open Dialectical Behavior Therapy for Adolescents (RO DBT-A): A Pilot Mixed-Methods Study.American journal of psychotherapy · 2024Article
- Article
- Engineering Virtuous health habits using Emotion and Neurocognition: Flexibility for Lifestyle Optimization and Weight management (EVEN FLOW).Frontiers in aging neuroscience · 2023Review
- Childhood behavioral inhibition and overcontrol: Relationships with cognitive functioning, error monitoring, anxiety and obsessive-compulsive symptoms.Research on child and adolescent psychopathology · 2022Article
- Adolescent experience of radically open dialectical behaviour therapy: a qualitative study.BMC psychiatry · 2022Article
- Clinical research challenges posed by difficult-to-treat depression.Psychological medicine · 2022Review
- Radically open dialectical behaviour therapy adapted for adolescents: a case series.BMC psychiatry · 2021Article
- Evaluation of radically open dialectical behaviour therapy in an adult community mental health team: effectiveness in people with autism spectrum disorders.BJPsych bulletin · 2021Article
- Sharing and connecting with others - patient experiences of radically open dialectical behavior therapy for anorexia nervosa and overcontrol: a qualitative study.Journal of eating disorders · 2021Article
- Radically Open Dialectical Behavior Therapy: Social Signaling, Transdiagnostic Utility and Current Evidence.Psychology research and behavior management · 2020Review
- Refractory depression - cost-effectiveness of radically open dialectical behaviour therapy: findings of economic evaluation of RefraMED trial.BJPsych open · 2019Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
16 authors at 9 institutions in 1 country.
Funding
Abstract
backgroundIndividuals with depression often do not respond to medication or psychotherapy. Radically open dialectical behaviour therapy (RO DBT) is a new treatment targeting overcontrolled personality, common in refractory depression.
aimsTo compare RO DBT plus treatment as usual (TAU) for refractory depression with TAU alone (trial registration: ISRCTN 85784627).
methodRO DBT comprised 29 therapy sessions and 27 skills classes over 6 months. Our completed randomised trial evaluated RO DBT for refractory depression over 18 months in three British secondary care centres. Of 250 adult participants, we randomised 162 (65%) to RO DBT. The primary outcome was the Hamilton Rating Scale for Depression (HRSD), assessed masked and analysed by treatment allocated.
resultsAfter 7 months, immediately following therapy, RO DBT had significantly reduced depressive symptoms by 5.40 points on the HRSD relative to TAU (95% CI 0.94-9.85). After 12 months (primary end-point), the difference of 2.15 points on the HRSD in favour of RO DBT was not significant (95% CI -2.28 to 6.59); nor was that of 1.69 points on the HRSD at 18 months (95% CI -2.84 to 6.22). Throughout RO DBT participants reported significantly better psychological flexibility and emotional coping than controls. However, they reported eight possible serious adverse reactions compared with none in the control group.
conclusionsThe RO DBT group reported significantly lower HRSD scores than the control group after 7 months, but not thereafter. The imbalance in serious adverse reactions was probably because of the controls' limited opportunities to report these.
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What OpenQuestion holds
Registered trials
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.