Fig. 1

CONSORT flowchart pragmatic RCT step-down versus outpatient DBT. ‘Received the allocated intervention’ = Number of participants that attended at least one skills training or at least one individual therapy session after they signed a therapist-client agreement (referred to as ‘starters’ in the text). ‘Lost to follow up’= Number of participants that received the allocated intervention but did not complete a 12 month assessment. ‘Discontinued intervention’ = Number of participants that received the allocated intervention but dropped out before it was completely finished. In DBT, ‘dropout’ means that a participant missed four individual therapy or four weekly skills training session in a row. ‘Analyzed’ = Number of participants whose data were used to estimate statistical models for primary outcome variables