2015 EST Status: Treatment pending re-evaluation Very strong: High-quality evidence that treatment improves symptoms and functional outcomes at post-treatment and follow-up; little risk of harm; requires reasonable amount of resources; effective in non-research settings

Strong: Moderate- to high-quality evidence that treatment improves symptoms OR functional outcomes; not a high risk of harm; reasonable use of resources

Weak: Low or very low-quality evidence that treatment produces clinically meaningful effects on symptoms or functional outcomes; Gains from the treatment may not warrant resources involved

Insufficient Evidence: No meta-analytic study could be identified

Insufficient Evidence: Existing meta-analyses are not of sufficient quality

Treatment pending re-evaluation

1998 EST Status: Strong Research Support Strong: Support from two well-designed studies conducted by independent investigators.

Modest: Support from one well-designed study or several adequately designed studies.

Controversial: Conflicting results, or claims regarding mechanisms are unsupported.

Brief Summary

• Basic premise: A subset of individuals experience emotions more intensely than others. In order to regulate heightened emotions, they tend to react in a more extreme and impulsive manner (e.g., self-harm, suicide attempts). It is thought that a lack of awareness and acceptance of these emotional experiences interferes with developing more effective coping strategies for distress.
• Essence of therapy: Dialectical behavior therapy teaches clients behavioral skills in mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation.
• Length:Varies, but usually lasts 1-1.5 years including both individual therapy and skills groups
  

Treatment Resources

Editors: David Albert, PhD; Stephanie Goldstein, BS

Note: The resources provided below are intended to supplement not replace foundational training in mental health treatment and evidence-based practice

Treatment Manuals / Outlines

Treatment Manuals

Books Available for Purchase Through External Sites

• DBT® Skills Training Manual (Linehan)
• Cognitive-Behavioral Treatment of Borderline Personality Disorder (Linehan)
• Skills Training Manual for Treating Borderline Personality Disorder (Linehan)
• Doing Dialectical Behavior Therapy: A Practical Guide (Koerner)
• The Expanded DBT Skills Training Manual: Practical DBT for Self-Help, and Individual & Group Treatment Settings (Pederson & Pederson)

Training Materials and Workshops

• DBT®-Linehan Board of Certification
• Behavioral Tech: Training Options for Individuals and Teams (including workshops, online training, training for teams, and consultation)

Measures, Handouts and Worksheets

• DBT® Skills Training Handouts and Worksheets (Linehan)

Self-help Books

• The Dialectical Behavior Therapy Skills Workbook: Practical DBT Exercises (McKay, Wood, & Brantley)
• Loving Someone with Borderline Personality Disorder: How to Keep Out-of-Control Emotions from Destroying Your Relationship (Manning)
• The High-Conflict Couple: A Dialectical Behavior Therapy Guide to Finding Peace, Intimacy, and Validation (Fruzzetti)

Important Note: The books listed above are based on empirically-supported in-person treatments. They have not necessarily been evaluated empirically either by themselves or in conjunction with in-person treatment. We list them as a resource for clinicians who assign them as an adjunct to conducting in-person treatment.

Smartphone Apps

• DBT Diary Card and Skills Coach (Durham DBT, Inc.)
• DBT Self-Help (Cognitus Psykoterapi & Utveckling)

Important Note: The apps listed above are based on empirically-supported in-person treatments. They have not necessarily been evaluated empirically either by themselves or in conjunction with in-person treatment. We list them as a resource for clinicians who assign them as an adjunct to conducting in-person treatment.

Video Demonstrations

• Sitting in on Therapy with MML (Linehan & Koerner): Part 1

• Sitting in on Therapy with MML (Linehan & Koerner): Part 2

• Sitting in on Therapy with MML (Linehan & Koerner): Part 3

• Sitting in on Therapy with MML (Linehan & Koerner): Part 4

• Dialectical behavior therapy with Marsha Linehan (clip). See full video here.

• Dialectical behavior therapy with Alan Fruzzetti

Videos Available for Purchase Through External Sites

• Sitting in on Therapy with Marsha M. Linehan, PhD, ABPP – Series 1: Getting a New Client Connected to DBT
• Sitting in on Therapy with Marsha M. Linehan, PhD, ABPP – Series 2: Assessing and Treating Suicidal Behaviors

Video Descriptions

• Dialectical Behavior Therapy (BPD Resource Center)

• Dialectical Behavior Therapy: Theory, Treatment, & Research (Fruzzetti)

• Rethinking BPD: A Clinician’s View (Linehan)

Videos Available for Purchase Through External Sites

• Opposite Action: Changing Emotions You Want to Change (Linehan, Behavioral Tech)
• DBT at a Glance: An Introduction to Dialectical Behavior Therapy (Manning & DuBose, Behavioral Tech)
• House of DBT (Linehan, Behavioral Tech; directed towards clients)
• Core Components of Dialectical Behaviour Therapy: Volume 1: Conducting a Comprehensive Behavioural and Solution Analysis (Swales & Dunkley, Behavioral Tech)
• Core Components of Dialectical Behaviour Therapy: Volume 2: Pre-Treatment (Swales & Dunkley, Behavioral Tech)

Clinical Trials

• Two-year randomized controlled trial and follow-up of DBT vs therapy by experts for suicidal behaviors and BPD (Linehan et al., 2006)
• Dialectical behavior therapy of borderline patients with and without substance use problems: Implementation and long-term effects (van den Bosch, Verheul, Schippers, & van den Brink, 2002)
• Effectiveness of inpatient dialectical behavior therapy for borderline personality disorder: A controlled trial (Bohus et al., 2004)
• Impact of DBT versus community treatment by experts on emotional experience, expression, and acceptance in borderline personality disorder (Neacsiu, Lungu, Harned, Rizvi, & Linehan, 2014)
• Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder (Neacsiu, Rizvi, & Linehan, 2010)
• DBT skills training compared to standard group therapy in borderline personality disorder: A 3-month randomised controlled clinical trial (Soler et al., 2009)

Meta-analyses and Systematic Reviews

• Psychological therapies for borderline personality disorder (Stoffers et al., 2012)
• Research on dialectical behavior therapy for borderline personality disorder (Koerner & Linehan, 2000)
• Dialectical behavior therapy: Current status, recent developments, and future directions (Robins & Chapman, 2004)
• Dialectical behavior therapy for borderline personality disorder: A meta-analysis using mixed effects modeling (Kliem, Kroger, & Kosfelder, 2010)

Other Treatment Resources

• Dialectical behavior therapy for borderline personality disorder: Theory and method (Linehan, 1987)
• Financial cost-effectiveness of dialectical behavior therapy (abridged by Miga, Karlson, & DuBose from Krawitz)
• Mechanisms of change in dialectical behavior therapy: Theoretical and empirical observations (Lynch, Chapman, Rosenthal, Kuo, & Linehan, 2006)
• The application of dialectical behavior therapy for patients with borderline personality disorder on inpatient units (Swenson, Sanderson, Dulit, & Linehan, 2001)
• How does DBT facilitate treatment retention among individuals with comorbid borderline personality disorder and substance use disorders? (Bornovalova & Daughters, 2007)