Schema Therapy vs DBT for Borderline

Two leading treatments for borderline personality disorder produce nearly identical outcomes

STUDY: Wibbelink CJM et al, JAMA Psychiatry 2026

STUDY TYPE: Randomized clinical trial

FUNDING: CZ Fonds, Stichting Achmea Gezondheidszorg, Stichting Volksbond Rotterdam

Background

For borderline personality disorder, dialectical behavior therapy (DBT) and schema therapy dominate the evidence base:

• DBT uses behavioral and mindfulness-based skills to regulate emotion and reduce self-destructive behavior.
• Schema therapy helps people break out of early patterns of thinking and behaving, like the Vulnerable Child, Angry Child, Punitive Parent, and Detached Protector.

This trial compared them head-to-head.

The Study

204 outpatients with borderline personality disorder were randomized to DBT or schema therapy across nine Dutch clinics and followed for three years — two years of active treatment plus one year of follow-up. Both therapies included individual and group sessions in similar amounts (roughly 167 hours total).

Both groups improved substantially. Mean borderline (BPDSI-5) scores dropped from roughly 30 at baseline to below 10 at three years in both conditions, a large effect. The between-group difference was negligible (Cohen d = 0.15), and no secondary outcome favored either treatment.

Dropout was high in both groups: about 34% by year one in DBT and 29% in schema therapy, rising to 52% and 46% by year two.

Practice Implications

1. DBT may be more commonly used than schema therapy, but both work equally well. Here’s the guide to schema.