Dialectical Behavior Therapy

Intended Outcomes:

• DBT skills training group is focused on enhancing clients’ capabilities by teaching them behavioral skills. The group is run like a class where the group leader teaches the skills and assigns homework for clients to practice using the skills in their everyday lives. Groups meet on a weekly basis for approximately 2.5 hours and it takes 24 weeks to get through the full skills curriculum, which is often repeated to create a 1-year program. Briefer schedules that teach only a subset of the skills have also been developed for specific populations and settings.
• DBT skills training group is focused on enhancing clients’ capabilities by teaching them behavioral skills. The group is run like a class where the group leader teaches the skills and assigns homework for clients to practice using the skills in their everyday lives. Groups meet on a weekly basis for approximately 2.5 hours and it takes 24 weeks to get through the full skills curriculum, which is often repeated to create a 1-year program. Briefer schedules that teach only a subset of the skills have also been developed for specific populations and settings.
• DBT individual therapy is focused on enhancing client motivation and helping clients to apply the skills to specific challenges and events in their lives. In the standard DBT model, individual therapy takes place once a week for approximately 60 minutes and runs concurrently with skills groups.
• DBT phone coaching is focused on providing clients with in-the-moment coaching on how to use skills to effectively cope with difficult situations that arise in their everyday lives. Clients can call their individual therapist between sessions to receive coaching at the times when they need help the most.
• DBT therapist consultation team is intended to be therapy for the therapists and to support DBT providers in their work with people who often have severe, complex, difficult-to-treat disorders. The consultation team is designed to help therapists stay motivated and competent so they can provide the best treatment possible. Teams typically meet weekly and are composed of individual therapists and group leaders who share responsibility for each client’s care.

• Mindfulness: the practice of being fully aware and present in this one moment
• Distress Tolerance: how to tolerate pain in difficult situations, not change it
• Interpersonal Effectiveness: how to ask for what you want and say no while maintaining self-respect and relationships with others
• Emotion Regulation: how to decrease vulnerability to painful emotions and change emotions that you want to change

Continuum of Care:
Treatment

Topic Areas:
Behavioral Health/Mental Health, Disruptive Behaviors, Eating Disorders, Substance Use, Suicide, Trauma

Ages:
Adult (25+), Teen/Adolescent (13-18), Young Adult (19-24)

Geographic Locations:
Rural, Urban

Delivery Settings:
Community-Based, Virtual

Cultural Considerations:
Limited research found involving diverse populations

Audience:
DBT was originally intended to treat borderline personality disorder (BPD), but it has been adapted to treat other mental health conditions. It can help people who have difficulty with emotional regulation or are exhibiting self-destructive behaviors (such as eating disorders and substance use disorders).

Credentials:
Licensed clinician. Certification is required.

Manuals:
Yes

Is Training Required?
Yes, see developer info

Who can provide the required training?
Various agencies provide DBT training. Program costs vary. Click here to view one source for training information.

Program Costs (materials, training, etc.):
Yes, refer to program website

Program/Practice Website:
https://dialecticalbehaviortherapy.com/

Relevant Published, Peer-Reviewed Research:

Pistorello, J., Fruzzetti, A.E., MacLane, C., Iverson, K.M., & Gallop, R. (2012). Dialectical behavior therapy (DBT) applied to college students: a randomized clinical trial. Journal of Consulting and Clinical Psychology, 80, (6), 982-994. Type of research

Warlick, C.A., Poquiz, J., Huffman, J.M., DeLong, L., Moffitt-Carney, K., Leonard, J., Schellenger, B., & Nelson, J. (2022). Effectiveness of a Brief Dialectical Behavior Therapy Intensive-Outpatient Community Health Program. American Psychological Association 59 (1). 125-132

Lyndsey R. Moran, Cynthia Kaplan, Blaise Aguirre, Gillian Galen, Jeremy G. Stewart, Naomi Tarlow & Randy P. Auerbach (2018) Treatment Effects Following Residential Dialectical Behavior Therapy for Adolescents with Borderline Personality Disorder, Evidence-Based Practice in Child and Adolescent Mental Health, 3:2, 117-128, DOI: 10.1080/23794925.2018.1476075

Atara D. Hiller & Christopher D. Hughes (2022) Dialectical Behavior Therapy for Adolescents: Treatment Outcomes in an Outpatient Community Setting, Evidence-Based Practice in Child and Adolescent Mental Health, DOI: 10.1080/23794925.2022.2056929

McCauley E, Berk MS, Asarnow JR, et al. Efficacy of Dialectical Behavior Therapy for Adolescents at High Risk for Suicide: A Randomized Clinical Trial. JAMA Psychiatry. 2018;75(8):777–785. doi:10.1001/jamapsychiatry.2018.1109

Tebbett-Mock, A.A., Saito, E., McGee, M., Woloszyn, P., & Venuti, M. (2020) Efficacy of dialectical behavioral therapy versus treatment as usual for acute-care inpatient adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 59 (1) 149-156.

Delaquis, C. P., Joyce, K. M., Zalewski, M., Katz, L. Y., Sulymka, J., Agostinho, T., & Roos, L. E. (2022). Dialectical behaviour therapy skills training groups for common mental health disorders: A systematic review and meta-analysis. Journal of Affective Disorders, 300, 305–313

Emotion Regulation Outcomes and Preliminary Feasibility Evidence from a Mindfulness Intervention for Adolescent Substance Use

Charles, N. E., Floyd, P. N., Bulla, B. A., Barry, C. T., & Anestis, J. C. (2021). PAI-A Predictors of Treatment Response in a DBT-A-Informed Intervention for Adolescent Boys. Journal of Psychopathology and Behavioral Assessment, 43(4), 840-853

Zapolski, T., Whitener, M., Khazvand, S., Crichlow, Q., Revilla, R., Salgado, E., … & Wu, W. (2021). Implementation of Dialectical Behavioral Therapy for Adolescents (DBT-A) Skills Group in High Schools for At-Risk Youth: Going 4 Goals Protocol.

Berk, M. S. (2020). Dialectical behavior therapy with parents of youth at risk for suicide.

Charles, N. E., Floyd, P. N., Bulla, B. A., Barry, C. T., & Anestis, J. C. (2021).
PAI-A Predictors of Treatment Response in a DBT-A-Informed Intervention for Adolescent Boys. Journal of Psychopathology and Behavioral Assessment, 43(4), 840-853.

Simon, G. E., Shortreed, S. M., Rossom, R. C., Beck, A., Clarke, G. N., Whiteside, U., Richards, J.E., Penfold, R. B., Boggs, J. M., & Smith, J. (2022). Effect of offering care management or online dialectical behavior therapy skills training vs usual care on self-harm among adult outpatients with suicidal ideation: A randomized clinical trial. JAMA: Journal of the American Medical Association, 327(7), 630-638. https://doi.org/10.1001/jama.2022.0423

Herres, J., James, K. M., Bounoua, N., Krauthamer Ewing, E. S., Kobak, R., & Diamond, G. S. (2021). Anxiety-related difficulties in goal-directed behavior predict worse treatment outcome among adolescents treated for suicidal ideation and depressive symptoms. Psychotherapy, 58(4), 523-532. https://doi.org/10.1037/pst0000391

Wibbelink, C. J. M., Arntz, A., Grasman, R. P. P. P., Sinnaeve, R., Boog, M., Bremer, O. M. C., Dek, E. C. P., Alkan, S. G., James, C., Koppeschaar, A. M., Kramer, L., Ploegmakers, M., Schaling, A., Smits, F. I., & Kamphuis, J. H. (2022). Towards optimal treatment selection for borderline personality disorder patients (BOOTS): A study protocol for a multicenter randomized clinical trial comparing schema therapy and dialectical behavior therapy. BMC Psychiatry, 22, 28. https://doi.org/10.1186/s12888-021-03670-9

Southward, M. W., Eberle, J. W., & Neacsiu, A. D. (2022). Multilevel associations of daily skill use and effectiveness with anxiety, depression, and stress in a transdiagnostic sample undergoing dialectical behavior therapy skills training. Cognitive Behaviour Therapy, 51(2), 114-129. https://doi.org/10.1080/16506073.2021.1907614

Additional Sources:

https://depts.washington.edu/uwbrtc/about-us/dialectical-behavior-therapy/

WV Rating:
Promising
»WV Ratings Info

Rationale for Rating:

Need more research on long term effects/outcomes. Most of the studies looked at lacked follow up or had zero clinical outcomes past 6 months. There was also a very high percentage of females in the studies, although in a variety of settings (acute psych, intensive outpatient, etc.). The best outcomes were found for Borderline Personality Disorder, NSSI (non suicide, self injurious behavior), suicidality, depression and eating disorders.