Dialectical Behavior Therapy

Behavioral Health Update
BHSI Newsletter Vol. 1, No. 2

Dialectical Behavior Therapy
Karen Brinkman, MS, LP
Sheba Fernandez, Psy.D., L.P.

What is DBT?

Dialectical Behavior Therapy (DBT) is a popular new treatment program developed by Marsha M. Linehan, Ph.D. for patients diagnosed with Borderline Personality Disorder (BPD). DBT combines individual therapy, skills group training and psychiatric services. Skills group training is the unique component of the treatment. It focuses on teaching the client important life skills that are frequently lacking and lead to the repeat problems these clients suffer. The group provides skills training in the areas of interpersonal effectiveness, mindfulness, emotion regulation, and distress tolerance. Partly accounting for its considerable appeal, DBT incorporates well-accepted principles and techniques from current major therapy approaches (e.g., psychodynamic, client-centered). However, it is largely a cognitive behavioral approach utilizing strategies such as contingency management, behavioral analysis, and cognitive modification. The primary contribution of DBT involves the integration, systematic application, and empirical study of these strategies as applied to BPD.

Who would benefit from DBT?

As noted, DBT was developed for treating individuals diagnosed with BPD. BPD is viewed primarily as a dysfunction of the emotion regulation system and is a pervasive personality disorder. The common symptoms identified in this group are: (a) instability of mood including chronic emptiness and marked reactivity, (b) intense and unstable relationships often resulting in inadequate social support, (c) marked impulsivity as evidenced by alcohol abuse, illicit drug use, and sexual promiscuity, and (d) unstable self image. Generally these individuals have a history of suicide gestures, self harm behaviors, and multiple psychiatric hospitalizations. Empirical data suggest that 70% - 75% of BPD patients have a history of at least one self-injurious behavior.
Is DBT effective?

Empirical support for DBT is encouraging, but is greatly outpaced by the popularity of this treatment. Compared to other treatments provided in the community, DBT resulted in greater reductions in parasuicidal behavior, psychiatric hospitalizations, anger, and medication use. DBT also results in improved treatment compliance and completion. For other symptoms, DBT produced outcomes that were at least equivalent to community treatment. Studies that examine the long-term effectiveness of DBT and studies that dismantle or identify necessary components of DBT have yet to be conducted. Overall, the limited data on empirical validity has been greeted with excessive enthusiasm by clinicians because of the limited alternatives and significant risks involved in treating BPD (i.e., poor outcomes in traditional treatment, low treatment compliance, high hospitalization rates, serious suicide risk).

How do I choose a DBT program?

DBT programs have begun to proliferate and limited criteria exist to evaluate and compare programs. We recommend two criteria: treatment target and fidelity. Perhaps because of early success, DBT has become the antidote for many ailments. Anecdotal articles have started to appear describing the use of DBT for various problems of emotional or behavioral dyscontrol including domestic violence, binge eating, drug dependence and depression among others. However, research has been directed primarily at BPD and empirically supported programs likely screen for this diagnosis. A homogeneous group with regard to diagnosis allows skills training and theoretical concepts to focus on problem behaviors that are common to most individuals with BPD. Treatment fidelity, the extent to which the program follows the recommended model is more difficult to assess. Programs that follow the model are likely time-limited and include ongoing individual therapy and psychiatric services. ?
For additional information on or to refer individuals to the DBT skills training at BHSI please call 651-662-0800.