DIAGNOSIS: Borderline Personality Disorder
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.
Strength of Research Support
- 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
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
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
- 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.
- 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.
- 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
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)
- 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)