Risk management in dialectical behavior therapy: Treating life-threatening behaviors as problems to be solved.

Abstract

Dialectical behavior therapy (DBT) is an empirically supported behavioral treatment for individuals with borderline personality disorder who frequently exhibit life-threatening behavior, such as suicide attempts, nonsuicidal self-injury urges and actions, and suicidal ideation. We provide an overview of the theoretical framework by which DBT conceptualizes these life-threatening behaviors and the principles by which safety planning measures are implemented and maintained throughout treatment. The importance of orienting clients to treatment and obtaining their commitment to decrease life-threatening behavior is reviewed. Relevant strategies associated with risk management and assessment, such as the diary card, chain analysis, solution analysis, phone coaching, and consultation team, are described. The overview concludes with a case example to illustrate the application of these techniques with a DBT client with a long-standing history of engaging in life-threatening behaviors. Clinical Impact StatementQuestion: This article addresses how therapists engage clients in safety planning procedures for suicidal behavior in dialectical behavior therapy (DBT). Findings: Clinicians will learn about risk assessment and management strategies unique to DBT. Meaning: As a complex, evidence-and principle-based treatment, DBT is well-suited to reduce suicide attempts, self-injury, and suicidal ideation. Next Steps: Challenges to safety planning in DBT should be further explored in research and clinical practice.

Utilidad de la terapia dialéctica conductual abreviada para dificultades de regulación emocional en estudiantes mexicanos: Casos clínicos

“…Si bien el tratamiento de TDC se presenta de manera lineal y progresiva, las etapas del tratamiento con frecuencia se superponen y, a menudo, un paciente progresará en una etapa solo para retroceder nuevamente en otro momento (Koerner, 2012). Los estudios sobre los impactos de la TDC en población clínica se refieren principalmente a problemas de etapa 1 (Alba et al, 2022;Dunn et al, 2022;Hernández et al, 2022;Poon et al, 2022;Weinberg, 2022).…”

Introduction to the special section on suicide and crisis management in clinical practice: Theoretical and practical integration.

“…A second set of articles demonstrates the application of the Stanley and Brown Safety Planning Intervention in a juvenile detention setting (Rudd et al, 2021) and through alliance-focused training (Barzilay & Bloch-Elkouby, 2021). The final collection of articles shows the unique application of three theoretical models to enhance standardized methods of suicide and crisis assessment and management including dialectical behavior therapy (Alba et al, 2022), interpersonal reconstructive therapy (Critchfield et al, 2021), and motivational interviewing (Micol et al, 2021).…”