Dialectical Behavior Therapy

Abstract

Dialectical behavior therapy (DBT) is a principle-based third-wave cognitive-behavioral therapy. It is an empirically supported psychological intervention that is effective for a range of psychiatric diagnoses and clinical problems. In particular, DBT is helpful for patients who struggle with dysregulated emotions, behaviors, attention, and/or interpersonal relationships, such as those with personality disorders, self-injurious behaviors, chronic mood disorders, substance abuse, and histories of childhood abuse or neglect. DBT is a philosophically complex psychotherapy. It is founded on principles of behaviorism, enriched with the philosophy of dialectics, and it incorporates mindfulness-based practices adopted from Buddhist traditions. Adherent practitioners often receive years of training and consultation. This chapter first introduces the core elements of DBT for those who are not familiar with it. We then review evidence for DBT as an effective treatment for personality disorders. Finally, we conclude by summarizing limitations and future directions for research and practice of DBT. Throughout this chapter, we draw upon our clinical experiences and lessons learned as practitioners. We argue that DBT is among the most effective interventions for complex, multi-diagnostic patient groups when it is delivered in a comprehensive and adherent manner.

Borderline personality disorder (BPD) Compass is a promising complementary intervention to dialectical behavior therapy: Comment on Sauer-Zavala (2022).

“…Since its empirical debut in the early 1990s, dialectical behavior therapy (DBT) has amassed substantial support for treating individuals struggling with chronic suicidality, emotion dysregulation, impulsivity, and interpersonal distress (Crowell et al, 2021;Storebø et al, 2020). Today, it is known to be one of the most effective psychotherapies for complex mental health presentations, such as in borderline personality disorder (BPD; Crowell et al, 2021). DBT is a comprehensive and prolonged treatment that requires significant training from practitioners and thus can be time-intensive, costly, and inaccessible to many patients.…”

BPD Compass is an accessible alignment of dimensional assessment and treatment.

“…First, Crowell et al (2022) summarize the advantages BPD Compass may have over existing, longer term treatments. They mention its (relatively) brief duration and its use of well-known cognitive-behavioral therapy (CBT) skills as strengths that may increase BPD Compass' adoption in generalist settings, ultimately making high-quality care more accessible to patients.…”