Dialectical Behavior Therapy (DBT)

Note: The Dialectical Behavior Therapy (DBT) program was not responsive to the CEBC's inquiry. The following information was obtained from publicly available sources.

About This Program

Target Population: Chronically suicidal youth with behaviors found in borderline personality disorder (BPD)

For organizations that serve children ages: 13 – 18

Program Overview

Dialectical Behavior Therapy (DBT) is a cognitive-behavioral treatment that was originally developed to treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD). The four skills modules include two sets of acceptance-oriented skills (mindfulness and distress tolerance) and two sets of change-oriented skills (emotion regulation and interpersonal effectiveness).

Components of DBT:

  • There are four components of comprehensive DBT: skills training group, individual treatment, DBT phone coaching, and consultation team.
  • 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.

Education and Training

Education and Training Resources

Publicly available information indicates there is a manual that describes how to deliver this program, and there is some training available for this program.
See contact info below.

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Child/Family Well-Being

Moran, L. R., Kaplan, C., Aguirre, B., Galen, G., Stewart, J. G., Tarlow, N., & Auerbach, R. P. (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. https://doi.org/10.1080/23794925.2018.1476075

Type of Study: One-group pretest-posttest
Number of Participants: 53

Population:

  • Age — 13-20 years
  • Race/Ethnicity — 77.36% White
  • Gender — 100% Female
  • Status — Participants were female adolescents in an intensive 1-month residential program, who met full criteria for borderline personality disorder.

Location/Institution: Unspecified residential DBT facility

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study tested the effectiveness of an intensive 1-month, residential Dialectical Behavior Therapy (DBT) treatment for adolescent girls. The impact of abuse on treatment outcomes was also assessed. Measures utilized include Zanarini Rating Scale for Borderline Personality Disorder, The Beck Depression Inventory–II, The Mood and Anxiety Symptoms Questionnaire, and The Childhood Trauma Questionnaire-Short Form. Results showed significant pretreatment to posttreatment reductions in both borderline personality disorder (BPD) and depression symptom severity with large effects. However, there were no significant changes in anxiety (distress or arousal) over time. Although experiencing multiple types of abuse was related to symptom severity, abuse did not moderate the effects of treatment. Collectively, results indicate that a 1-month residential DBT treatment with adolescents may result in reductions in BPD and depression severity but is less effective for anxiety. Moreover, while youth reporting abuse benefitted from treatment, they were less likely to achieve a clinically significant reduction in symptoms. Limitations include the relatively homogenous and small sample size; lack of treatment comparison or waitlist control groups; and lack of follow-up.

Length of postintervention follow-up: None.

McCauley, E., Berk, M. S., Asarnow, J. R., Adrian, M., Cohen, J., Korslund, K., Avina, C., Hughes, J., Harned, M., Gallop, R., & Linehan, M. M. (2018). Efficacy of Dialectical Behavior Therapy for adolescents at high risk for suicide: A randomized clinical trial. JAMA Psychiatry, 75(8), 777–785. https://doi.org/10.1001/jamapsychiatry.2018.1109

Type of Study: Randomized controlled trial
Number of Participants: 173

Population:

  • Age — 12–18 years
  • Race/Ethnicity — 56.39% White
  • Gender — 94.8% Female
  • Status — Participants were adolescents with suicidal ideation, history of suicide attempt, and meeting three or more criterions for borderline personality disorder.

Location/Institution: Behavior Research and Therapy Clinic, University of Washington, Seattle; Department of Psychiatry, Seattle Children’s Hospital, Seattle, Washington; Los Angeles Biomedical Research Institute at Harbor–University of California Los Angeles Medical Center, Los Angeles; and Ronald Reagan UCLA Medical Center, Los Angeles, California.

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study compared Dialectical Behavioral Therapy (DBT) to individual and group supportive therapy (IGST) on adolescents with high risk for suicide. Participants were randomly assigned to DBT (n=86) or IGST (n=87). Measures included the Suicide Attempt Self-Injury Interview. Results indicate that significant advantages were found for DBT on all primary outcomes after treatment. The rates of self-harm decreased through the 1-year follow-up. The advantage of DBT decreased, with no statistically significant between-group differences from 6 to 12 months. The results of this trial support the efficacy of DBT for reducing self-harm and suicide attempts in highly suicidal self-harming adolescents. Limitations include having a primarily female sample, as well as generalizability with routine practice conditions.

Length of postintervention follow-up: 1 year.

Adrian, M., McCauley, E., Berk, M. S., Asarnow, J. R., Korslund, K., Avina, C., Gallop, R., & Linehan, M. M. (2019). Predictors and moderators of recurring self-harm in adolescents participating in a comparative treatment trial of psychological interventions. Journal of Child Psychology and Psychiatry, 60(10), 1123–1132. https://doi.org/10.1111/jcpp.13099

Type of Study: Randomized controlled trial
Number of Participants: 173

Population:

  • Age — 12–18 years
  • Race/Ethnicity — 56.39% White
  • Gender — 94.8% Female
  • Status — Participants were adolescents with suicidal ideation, history of suicide attempt, and meeting three or more criterions for borderline personality disorder.

Location/Institution: Behavior Research and Therapy Clinic, University of Washington, Seattle; Department of Psychiatry, Seattle Children’s Hospital, Seattle, Washington; Los Angeles Biomedical Research Institute at Harbor–University of California Los Angeles Medical Center, Los Angeles; and Ronald Reagan UCLA Medical Center, Los Angeles, California

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study utilizes the population from McCauley et al. (2018). This study examined predictors and moderators of treatment outcomes for suicidal adolescents who participated in Dialectical Behavioral Therapy (DBT) and individual and group supportive therapy (IGST). Participants were randomly assigned to DBT (n=86) or IGST (n=87). Measures utilized include the Child Behavior Checklist, Schedule for Affective Disorders and Schizophrenia for School-Aged Children, Drug Use Screening Inventory-Revised, UCLA PTSD Reaction Index for DSM-IV, Brief Symptom Inventory, Difficulties with Emotion Regulation Scale, and the Conflict Behavior Questionnaire-20. Results indicated that adolescents that have high levels of family conflict, externalizing problems, and increased level of severity markers demonstrated the most change in self-harm behaviors over the course of treatment and benefitted from both treatment interventions. Those with higher levels of emotion dysregulation and parent psychopathology may benefit more from the DBT. Limitations include lack of sufficient males, limitations of assessing externalizing problems, possibility of bias of clinicians and families, and lack of generalizability to adolescents with mild symptomology.

Length of postintervention follow-up: None.

Tebbett-Mock, A. A., Saito, E., McGee, M., Woloszyn, P., & Venuti, M. (2020). Efficacy of Dialectical Behavior Therapy versus treatment as usual for acute-care inpatient adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 59(1), 149–156. https://doi.org/10.1016/j.jaac.2019.01.020

Type of Study: Pretest-posttest with nonequivalent control group
Number of Participants: 425

Population:

  • Age — 12–17 years
  • Race/Ethnicity — Race - 41% White; Ethnicity - 74% Non-Hispanic/Latino
  • Gender — 66% Female
  • Status — Participants were adolescents hospitalized on acute-care inpatient unit within a private psychiatric hospital.

Location/Institution: Private psychiatric hospital in the Northeast United States.

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study evaluated Dialectical Behavior Therapy (DBT) versus treatment as usual (TAU) for adolescents on an acute-care psychiatric inpatient unit. A retrospective chart review for adolescents receiving inpatient DBT (n = 425) and for a historical control group (TAU, n = 376) treated on the same unit before DBT was completed. Patients who received DBT had significantly fewer constant observation (CO) hours for self-injury; incidents of suicide attempts and self-injury; restraints; and days hospitalized compared to patients who received TAU. Statistically significant differences were not found between DBT and TAU groups for number of CO hours for aggression, incidents of aggression toward patients or staff, seclusions, or readmissions. A cost analysis determined that $251,609 less was spent on staff time for CO hours with DBT compared to TAU. Limitations of this study include the nonrandomized nature of the sample, as well as inability to examine other variables due to data being retrieved from an electronic medical record. There was no follow-up data, and it was not possible to capture potential re-admission of participants to other inpatient units at other hospitals. Lastly, there were no assessments of staff-related variables, which could have impacted outcomes.

Length of postintervention follow-up: None.

The following studies were not included in rating Dialectical Behavior Therapy (DBT) on the Scientific Rating Scale...

Burckhardt, R., Manicavasagar, V., Shaw, F., Fogarty, A., Batterham, P. J., Dobinson, K., & Karpin, I. (2018). Preventing mental health symptoms in adolescents using Dialectical Behaviour Therapy skills group: A feasibility study. International Journal of Adolescence and Youth, 23(1), 70–85. https://doi.org/10.1080/02673843.2017.1292927

The study is a feasibility trial that evaluates a prevention program, Dialectical Behavior Therapy (DBT), that teaches cognitive reappraisal, acceptance, and problem-solving strategies to adolescent females. Participants (n=96) were randomly allocated to either DBT skills group or control condition. Measures included Difficulties in Emotion Regulation Scale, Centre for Epidemiologic Studies—Depression Scale Eight Item Version, PROMIS-Anxiety Short Form, and PROMIS-Anger Short Form. Results indicated there were no statistical differences between the conditions although effect sizes suggested a small advantage favoring the control condition. On the qualitative evaluation, however, most participants reported important benefits in relation to improved emotion regulation abilities. Limitations included generalizability due to participants identifying as female, only a selected portion of DBT skills group material was used in this feasibility study, and a potential for bias due to a qualitative question emphasizing the benefits of the program. Note: This study was not used in the rating of Dialectical Behavior Therapy (DBT) in this topic area due to only part of the group material being used.

Additional References

No reference materials are currently available for Dialectical Behavior Therapy (DBT).

Contact Information

Marsha M. Linehan, PhD, ABPP
Email:
Phone: (206) 543-9886

Date Research Evidence Last Reviewed by CEBC: September 2019

Date Program Content Last Reviewed by Program Staff: June 2020

Date Program Originally Loaded onto CEBC: June 2020