therapist talks to patient representing dbt therapy
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Summary: No, dialectical behavior therapy is not better than schema therapy for borderline personality disorder, according to the first head-to-head study to compare the two treatment approaches.

Key Points:

  • Borderline personality disorder (BPD) is a serious mental illness that can cause severe disruption in every area of life.
  • For years, mental health professionals considered BPD untreatable, leaving many patients with BPD with no treatment, inadequate treatment, or inappropriate treatment.
  • In the late 1980s and early 1990s, the development of dialectical behavior therapy (DBT) offered an effective option for patients with BPD.
  • New research compares the effectiveness of schema therapy, also developed in the 1990s, with the effectiveness of dialectical behavior therapy (DBT) for patients with BPD.

About BPD: The Facts and Figures

Mental health experts define BPD as follows:

“A mental health condition that characterized by a pervasive pattern of instability in relationships, self-image, moods, and behavior and hypersensitivity to possible rejection and abandonment. These symptoms often result in impulsive actions and problems in relationships. People with BPD may experience intense episodes of anger, depression, and anxiety that can last from a few hours to days.”

The symptoms of BPD include, but are not limited to:

  • Extreme fear of abandonment
  • Volatile relationships with friends, family, and peers
  • Unstable identity
  • Rapidly shifting concept of self
  • Risky behavior
  • Impulsivity
  • Suicidality
  • Non-suicidal self-injury (NSSI)
  • Severe/extreme mood swings
  • Anger/rage that appears suddenly and is difficult to control
  • Dissociation
  • Paranoia

When we review those symptoms, it’s clear why people with BPD need professional support. The emotional volatility, the extreme fear of abandonment, and the unstable sense of self, combined with impulsivity, anger, and risk-taking, can make daily life extremely challenging for individuals with BPD and the people close to them.

The latest data on the prevalence of BPD shows the following:

  • Past-year diagnosis of BPD: 1.6%
  • Lifetime (ever diagnosed) BPD: 5.9%

That means that in the U.S. in the past year, just over four million people had a clinical diagnosis of BPD. For those patients, finding effective treatment is essential. Consider the consequences of untreated BPD:

  • Impaired educational achievement
  • Difficulty finding and keeping gainful employment
  • Difficulty forming and maintaining meaningful relationships
  • Medical problems associated with lack of self-care
  • Legal issues associated with anger and impulsivity
  • Increased risk of alcohol and drug addiction
  • Social isolation
  • Increased risk of co-occurring mental health disorders
  • Elevated risk of suicide and/or self-harm (NSSI)

When we think about the consequences of untreated BPD, and understand the symptoms of BPD, the need for continued research into BPD treatment becomes obvious: the disruption caused by BPD is substantial and severe.

That’s why it’s important to review new research on the topic, like the recent publication we mention in the introduction to this article, which we’ll discuss below.

BPD Treatment: Dialectical Behavior Therapy or Schema Therapy?

In April 2026, a group of researchers published a paper called “Dialectical Behavior Therapy vs Schema Therapy for Patients With Borderline Personality Disorder” that explored this research question:

“What is the comparative effectiveness of dialectical behavior therapy (DBT) vs schema therapy (ST) for individuals with borderline personality disorder (BPD)?”

To find an answer, the research team designed an experiment involving 204 people with BPD from nine (9) outpatient mental health treatment centers in Holland. They divided the participants into two groups:

  • DBT Group: 95 patients received a combination of individual and group DBT for two years
  • ST Group: 109 patients received a combination of individual and group ST for two years

The research team administered the Borderline Personality Disorder Severity Index, Fifth Edition (BPDSI-5) to both groups at the following seven (7) time points: baseline, 6 months, one year, 18 months, two years, 30 months, and three years post treatment. The duration of the therapeutic interventions lasted a total of 25 months, with the post-intervention assessments performed to determine the durability and long-term effectiveness of the interventions.

The primary outcome the researchers identified was any change in score on the BDSI-5 over the course of the comparison for the two psychotherapies, DBT and ST, and any difference in those changes indicating greater effectiveness for one over the other. Secondary outcomes included any change in score on the BDSI-5 subscales, which measure the core components of the disorder, and any difference in those changes between the two therapeutic approaches.

For a review of the current psychotherapies most often used for BPD treatment, please read this article on our blog:

Is Psychotherapy Good Treatment for Borderline Personality Disorder?

Now let’s look at what the researchers found when comparing dialectical behavior therapy and schema therapy for BPD.

Dialectical Behavior Therapy vs. Schema Therapy for DBT: The Results

First, let’s look at the primary outcome: change in BDSI-5 over three years.

BPDSI-5 total score

Baseline:

  • DBT: 30.56
  • ST: 29.70

Three years:

  • DBT: 7.99
  • ST: 9.08

Those outcomes may surprise mental health professionals. Despite significant differences in the treatment approaches, researchers observed no significant difference in the outcomes. The two psychotherapeutic approaches were equally effective in reducing overall scores on the BDSI-5, with improvements remaining stable up to one year post treatment.

Next, let’s go one step deeper, and look at the results on the BPD subscales. These measure the severity of each category of BPD symptoms. In this study, researchers focused on core aspects of the disorder, including fear of abandonment, instability in relationships, and identity disruption.

BPDSI-5 Subscales: DBT vs. ST Outcomes Over Three Years

Abandonment:

  • DBT: 19-point decrease
  • ST: 16-point decrease

Interpersonal relationships:

  • DBT: 18-point decrease
  • ST: 18-point decrease

Identity:

  • DBT: 12-point decrease
  • ST: 11-point decrease

Here’s how the study authors characterize the primary and secondary outcomes in this head-to-head study of DBT vs. ST:

“No significant differences between DBT and ST in the rates of change were observed for any of the outcome measures. The high similarity in outcome trajectories over time is remarkable given the differences between the therapeutic techniques, despite their shared cognitive-behavioral roots.”

Let’s put this research in perspective.

Before DBT, people with BPD were at risk of ostracization and isolation, not only from friends and family, but also from effective treatment. In short, very little helped people with BPD. Even the most skilled therapists didn’t understand how to offer people with BPD the support they needed to manage their severe, distressing, and disruptive symptoms.

Now, close to three decades after the development of DBT, we have another psychotherapeutic approach that works. That’s real progress. And that’s good news for people with BPD and their friends, families, and loved ones.