Dialectical Behavior Therapy

Dialectical Behavior Therapy (DBT) is the application of a broad array of cognitive and behavior therapy strategies to the problems of Borderline Personality Disorder (BPD), including suicidal behaviors.

Dialectical Behavior Therapy also has a number of distinctive defining characteristics. As its name suggests, its overriding characteristic is an emphasis on "dialectics" - that is, the reconciliation of opposites in a continual process of synthesis. The most fundamental dialectic is the necessity of accepting patients just as they are within a context of trying to teach them to change. This emphasis on acceptance as a balance to change flows directly from the integration of a perspective drawn from Eastern (Zen) practice with Western psychological practice.

Stylistically, Dialectical Behavior Therapy blends a matter-of-fact, somewhat irreverent, and at times outrageous attitude about current and previous parasuicidal and other dysfunctional behaviors with therapist warmth, flexibility, responsiveness to the patient, and strategic self-disclosure.

Emotion regulation, interpersonal effectiveness, distress tolerance, core mindfulness, and self-management skills are actively taught. In all modes of treatment, the application of these skills is encouraged and coached. The tendency of borderline patients to actively avoid threatening situations is a continuing focus of Dialectical Behavior Therapy.

The focus on validating requires that the Dialectical Behavior Therapy therapist search for the grain of wisdom or truth inherent in each of the patient's responses and communicate that wisdom to the patient. Validation also involves frequent, sympathetic acknowledgement of the patient's sense of emotional desperation. Throughout treatment, the emphasis is on building and maintaining a positive, interpersonal, collaborative relationship between patient and therapist. A major characteristic of the therapeutic relationship is that the primary role of the therapist is as consultant to the patient, not as consultant to other individuals.

From Dr. Marsha M. Linehan's book, Cognitive-Behavioral Treatment of Borderline Personality Disorder (1993).

Interpersonal outcome of cognitive behavioral treatment for chronically suicidal borderline patients.

Linehan MM, Tutek DA, Heard HL, Armstrong HE

Department of Psychology, University of Washington, Seattle 98195.

OBJECTIVE: This study reports the efficacy of a cognitive behavioral outpatient treatment on interpersonal outcome variables for patients diagnosed with borderline personality disorder. METHOD: In a 1-year clinical trial, 26 female patients with borderline personality disorder were randomly assigned to either dialectical behavior therapy or a treatment-as-usual comparison condition. All subjects met criteria of DSM-III-R and Diagnostic Interview for Borderline Patients for borderline personality disorder and were chronically suicidal. RESULTS: In both the intent-to-treat and treatment completion groups, dialectical behavior therapy subjects had significantly better scores on measures of anger, interviewer-rated global social adjustment, and the Global Assessment Scale and tended to rate themselves better on overall social adjustment than treatment-as-usual subjects. CONCLUSIONS: These results suggest that dialectical behavior therapy is a promising psychosocial intervention for improving interpersonal functioning among severely dysfunctional patients with borderline personality disorder.

Publication Types:

PMID: 7977884, UI: 95068524

Use of dialectical behavior therapy in a partial hospital program for women with borderline personality disorder.

Simpson EB, Pistorello J, Begin A, Costello E, Levinson J, Mulberry S, Pearlstein T, Rosen K, Stevens M

Women's Partial Hospital Program at Butler Hospital, Providence, Rhode Island, USA. elizabeth_simpson@postoffice.brown.edu

Dialectical behavior therapy, an outpatient psychosocial treatment for chronically suicidal women with borderline personality disorder, has been adapted for use in a partial hospital program for women. Patients attend the program for a minimum of five days of individual and group therapy, and full census is 12 women. About 65 percent of participants meet at least three criteria for borderline personality disorder, and most have suicidal and self-injurious behavior. Their comorbid diagnoses include trauma-related diagnoses and anxiety disorders, severe eating disorders, substance abuse, and depression. The partial hospital program is linked to an aftercare program offering six months of outpatient skills training based on dialectical behavior therapy. Both programs focus on teaching patients four skills: mindfulness (attention to one's experience), interpersonal effectiveness, emotional regulation, and distress tolerance. Two years of operation of the women's partial hospital program provides promising anecdotal evidence that dialectical behavioral therapy, an outpatient approach, can be effectively modified for partial hospital settings and a more diverse population.

PMID: 9603574, UI: 98264737


1. Cognitive-Behavioral Treatment of Borderline Personality Disorder [Book Link]

2. Skills Training Manual for Treating Borderline Personality Disorder [Book Link]