Dialectical Behavior Therapy (DBT) is a comprehensive, multimodal cognitive behavioral treatment originally developed for individuals who met criteria for borderline personality disorder (BPD) who displayed suicidal tendencies. DBT is based on behavioral theory but also includes principles of acceptance, mindfulness, and validation. Since its development, DBT has been adapted to various populations and has been successfully used in a wide array of settings. This article presents the approaches used in DBT with a particular emphasis on (a) the philosophy and assumptions on which the treatment is based, (b) the major theoretical constructs and the DBT conceptualization of the client, (c) the intervention and specific techniques used, (d) research supporting the theory and treatment, and (e) the integration of diversity, culture, and social justice.
AlperG.PetersonS. J. (2001). Dialectical Behavior Therapy for patients with borderline personality disorder. Journal of Psychosocial Nursing, 39(10), 38-45.
2.
American Psychological Association. (1998). Gold award: Integrating dialectical behavioral therapy into a community mental health program. Mental Health Center of Greater Manchester, NH. Psychiatric Services, 49, 1338-1340.
3.
BlennerhassettR.BamfordL.WhelanA.JamiesonS.Wilson O’RaghaillaighJ. (2009). Dialectical behaviour therapy in an Irish community mental health setting. Irish Journal of Psychological Medicine, 26(2), 59-63.
4.
BohusM.HaafB.SimmsT.LimbergerM. F.SchmahlC.UnckelC.. . .LinehanM. M. (2004). Effectiveness of inpatient dialectical behavioral therapy for borderline personality disorder: A controlled trial. Behaviour Research and Therapy, 42, 487-499.
5.
BohusM.HaafB.StiglmayrC.PohlU.BohmeR.LinehanM. (2000). Evaluation of inpatient dialectical-behavioral therapy for borderline personality disorder—A prospective study. Behaviour Research and Therapy, 38, 875-887.
6.
BrownK.RyanR. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84, 822-848.
7.
BrownM.ComtoisK. A.LinehanM. M. (2002). Reasons for suicide attempts and nonsuicidal self-injury in women with borderline personality disorder. Journal of Abnormal Psychology, 111, 198-202.
8.
ChapmanA. L.GratzK. L.BrownM. Z. (2006). Solving the puzzle of deliberate self-harm: The experiential avoidance model. Behaviour Research and Therapy, 44, 371-394.
9.
ComtoisK. A.ElwoodL.HoldcraftL. C.SimpsonT. L.SmithW. R. (2007). Effectiveness of Dialectical Behavior Therapy in a community mental health center. Cognitive and Behavioral Practice, 14, 406-414.
10.
ConklinC. Z.BradleyR.WestenD. (2006). Affect regulation in borderline personality disorder. Journal of Nervous and Mental Disease, 194, 69-77.
11.
ConklinC. Z.WestenD. (2005). Borderline personality disorder in clinical practice. American Journal of Psychiatry, 162, 867-875.
12.
CrowellS. E.BeauchaineT. P.LinehanM. M. (2009). A biosocial developmental model of borderline personality: Elaborating and extending Linehan’s theory. Psychological Bulletin, 135, 495-510.
13.
DavidsonR.Kabat-ZinnJ.SchumacherJ.RosenkranzM.MullerD.SantorelliS.. . .SheridanJ. F. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine, 65, 564-570.
14.
DimeffL. A.ComtoisK. A.LinehanM. M. (1998). In GrahamA. W.SchultzK. (Eds.), Principles of addiction medicine (pp. 1063-1079). Arlington, VA: American Society of Addiction Medicine.
15.
DimeffL.LinehanM. M. (2001). Dialectical Behavior Therapy in a nutshell. California Psychologist, 34, 10-13.
16.
DimeffL.RizviS. L.BrownM.LinehanM. M. (2000). Dialectical Behavior Therapy for substance abuse: A pilot application to methamphetamine-dependent women with borderline personality disorder. Cognitive and Behavioral Practice, 7, 457-468.
17.
DoughertyD. M.BjorkJ. M.HuckabeeC. G.MoellerF. G.SwannA. C. (1999). Laboratory measures of aggression and impulsivity in women with borderline personality disorder. Psychiatry Research, 85, 315-326.
18.
Ebner-PriemerU. W.BadeckS.BeckmannC.WagnerA.FeigeB.WeissI.. . .BohusM. (2005). Affective dysregulation and dissociative experience in female patients with borderline personality disorder: A startle response study. Journal of Psychiatric Research, 39, 85-92.
19.
Ebner-PriemerU. W.KuoJ.WelchS. S.ThielgenT.WitteS.BohusM.LinehanM. M. (2006). A valence-dependent group-specific recall bias of retrospective self-reports. Journal of Nervous and Mental Disease, 194, 774-779.
20.
EvansS.FerrandoS.FindlerM.StowellC.SmartC.HaglinD. (2008). Mindfulness-based cognitive therapy for generalized anxiety disorder. Journal of Anxiety Disorders, 22, 716-721.
21.
EvershedS.TennantA.BoomerD.ReesA.BarkhamM.WatsonA. (2003). Practice-based outcomes of Dialectical Behaviour Therapy (DBT) targeting anger and violence, with male forensic patients: A pragmatic and non-contemporaneous comparison. Criminal Behaviour and Mental Health, 13, 198-213.
22.
FoaE. B. (2000). Psychosocial treatment of posttraumatic stress disorder. Journal of Clinical Psychiatry, 61, 43-48.
23.
FruzzettiA. E.ShenkC.HoffmanP. D. (2005). Family interaction and the development of borderline personality disorder: A transactional model. Developmental Psychopathology, 17, 1007-1030.
24.
GratzK. L.RosenthalM. Z.TullM. T.LejuezC. W.GundersonJ. G. (2006). An experimental investigation of emotion dysregulation in borderline personality disorder. Journal of Abnormal Psychology, 115, 850-855.
25.
HarleyR. M.BaityM. R.BlaisM. A.JacoboM. C. (2007). Use of Dialectical Behavior Therapy skills training for borderline personality disorder in a naturalistic setting. Psychotherapy Research, 17, 362-370.
26.
HarleyR.SprichS.SafrenS.JacoboM.FavaM. (2008). Adaptation of Dialectical Behavior Therapy skills training group for treatment-resistant depression. Journal of Nervous and Mental Disease, 196, 136-143.
27.
HarnedM. S.SalsmanN. L.SecristC. D.ComtoisK. A.LinehanM. M. (2006, November). Historical factors as predictors of DBT treatment response. In Lynch (Chair)T. R., Client predictors of treatment response in Dialectical Behavior Therapy across multiple randomized controlled trials. Symposium conducted at the 40th annual convention of the Association for Behavioral and Cognitive Therapies, Chicago, IL.
28.
HimleM.FranklinM. (2009). The more you do it, the easier it gets: Exposure and response prevention for OCD. Cognitive and Behavioral Practice, 161, 29-39.
29.
HooleyJ. M.HoffmanP. D. (1999). Expressed emotion and clinical outcome in borderline personality disorder. American Journal of Psychiatry, 56, 1557-1562.
30.
IversonK. M.ShenkC.FruzzettiA. E. (2009). Dialectical Behavior Therapy for women victims of domestic abuse: A pilot study. Professional Psychology-Research and Practice, 40, 242-248.
31.
KoernerK.LinehanM. M. (1992). Integrative therapy for borderline personality disorder: dialectical behaviour therapy. In NorcrossJ. C. (Ed.), Handbook of psychotherapy integration (pp. 433-459). New York, NY: Basic Books.
32.
KoernerK.LinehanM. M. (1997). Case formulation in Dialectical Behavior Therapy for borderline personality disorder. In EellsT. (Ed.), Handbook of psychotherapy case formulation (pp. 340-367). New York, NY: Guilford.
33.
KoonsC. R.ChapmanA. L.BettsB. B.O’RourkeB.MorseN.RobinsC. J. (2006). DBT adapted for the vocational rehabilitation of significantly disabled mentally ill adults. Cognitive and Behavioral Practice, 13, 146-156.
34.
KoonsC. R.RobinsC. J.TweedJ. L.LynchT. R.GonzalezA. M.MorseJ. Q.. . .BastianL. A. (2001). Efficacy of Dialectical Behavior Therapy in women veterans with borderline personality disorder. Behavior Therapy, 32, 371-390.
35.
KringA. M.WernerK. H. (2004). Emotion regulation and psychopathology. In PhilippotP.FeldmanR. S. (Eds.), The regulation of emotion (pp. 359-385). Mahwah, NJ: Lawrence Erlbaum.
36.
LevineD.MarzialiE.HoodJ. (1997). Emotion processing in borderline personality disorders. Chicago Journal of Nervous and Mental Disease, 185, 240-246.
37.
LinehanM. M. (1987). Dialectical behavioral therapy in groups: treating borderline personality disorders and suicidal behavior. In BrodyC. M. (Ed.), Women’s therapy groups: Paradigms of feminist treatment (pp. 145-162). New York, NY: Springer.
38.
LinehanM. M. (1989). Cognitive and behavior therapy for borderline personality disorder. In TasmanA.HalesR. E.FrancesA. J. (Eds.), Review of psychiatry (Vol. 8, pp. 84-102). Washington D.C.: American Psychiatric Press
39.
LinehanM. M. (1993a). Cognitive-behavioral treatment of borderline personality disorder. New York, NY: Guilford.
40.
LinehanM. M. (1993b). Skills training manual for treating borderline personality disorder. New York, NY: Guilford.
41.
LinehanM. M. (1997). Validation and psychotherapy. In BohartA.GreenbergL. (Eds.), Empathy reconsidered: New directions in psychotherapy (pp. 353-392). Washington, DC: American Psychological Association.
42.
LinehanM. M.ArmstrongH. E.SuarezA.AllmonD.HeardH. L. (1991). Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48, 1060-1064.
43.
LinehanM. M.BohusM.LynchT. (2007). Dialectical Behavior Therapy for pervasive emotion dysregulation: Theoretical and practical underpinnings. In GrossJ. (Ed.), Handbook of emotion regulation (pp.581-605). New York, NY: Guilford.
44.
LinehanM. M.ComtoisK. A.MurrayA. M.BrownM. Z.GallopR. J.HeardH. L.. . .LindenboimN. (2006). Two-year randomized controlled trial and follow-up of Dialectical Behavior Therapy vs. therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63, 757-766.
45.
LinehanM. M.Dexter-MazzaE. (2008). Dialectical Behavior Therapy for borderline personality disorder. In BarlowD. H. (Ed.), Clinical handbook of psychological disorders (pp. 365-420). New York, NY: Guilford.
46.
LinehanM. M.DimeffL. A.ReynoldsS. K.ComtoisK. A.WelchS. S.HeagertyP.KivlahanD. R. (2002). Dialectical Behavior Therapy versus Comprehensive Validation Therapy plus 12-step for the treatment of opioid dependent women meeting criteria for borderline personality disorder. Drug and Alcohol Dependence, 67, 13-26.
47.
LinehanM. M.HeardH. L.ArmstrongH. E. (1993). Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patients. Archives of General Psychiatry, 50, 971-974.
48.
LinehanM. M.McDavidJ. D.BrownM. Z.SayrsJ. H. R.GallopR. J. (2008). Olanzapine plus Dialectical Behavior Therapy for women with high irritability who meet criteria for borderline personality disorder: A double-blind, placebo-controlled study. Journal of Clinical Psychiatry, 69, 999-1005.
49.
LinehanM. M.SchmidtH.IIIDimeffL. A.CraftJ. C.KanterJ.ComtoisK. A. (1999). Dialectical Behavior Therapy for patients with borderline personality disorder and drug-dependence. American Journal on Addictions, 8, 279-292.
50.
LivesleyJ. W.JangK. L.VernonP. A. (1998). Phenotypic and genetic structure of traits delineating personality disorder. Archives of General Psychiatry, 55, 941-948.
51.
LynchT. R.CheavensJ. S.CukrowiczK. C.ThorpS. R.BronnerL.BeyerJ. (2007). Treatment of older adults with co-morbid personality disorder and depression: A Dialectical Behavior Therapy approach. International Journal of Geriatric Psychiatry, 22, 131-143.
52.
LynchT. R.MorseJ. Q.MendelsonT.RobinsC. J. (2003). Dialectical Behavior Therapy for depressed older adults: A randomized pilot study. American Journal of Geriatric Psychiatry, 11, 33-45.
53.
MartinB. (2006). Could Dialectical Behavior Therapy (DBT) form the basis for a truly multicultural therapy? Introduction to Dialectical Behavior Therapy. One-day workshop, University of Washington, Seattle.
54.
McMainS.KormanL. M.DimeffL. A. (2001). Dialectical Behavior Therapy and the treatment of emotion dysregulation. Journal of Clinical Psychology, 57, 183-196.
55.
McMainS. F.LinksP. S.GnamW. H.GuimondT.CardishR. J.KormanL.. . .StreinerD. L. (2009). A randomized trial of Dialectical Behavior Therapy versus general psychiatric management for borderline personality disorder. American Journal of Psychiatry, 166, 1365-1374.
56.
MillerA. L.RathusJ. H.LinehanM. M. (2007). Dialectical Behavior Therapy with suicidal adolescents. New York, NY: Guilford.
57.
MyersL. J. (2003). Understanding an Afrocentric world view: Introduction to an optimal psychology (2nd ed.). Dubuque, IA: Kendall/Hunt.
58.
Nelson-GrayR. O.KeaneS. P.HurstR. M.MitchellJ. T.WarburtonJ. B.ChokJ. T.CobbA. R. (2006). A modified DBT skills training program for oppositional defiant adolescents: Promising preliminary findings. Behaviour Research and Therapy, 44, 1811-1820.
59.
PutnamK. M.SilkK. R. (2005). Emotion dysregulation and the development of borderline personality disorder. Development and Psychopathology, 17, 899-925.
60.
QuinnA.SheraW. (2009). Evidence-based practice in group work with incarcerated youth. International Journal of Law and Psychiatry, 325, 288-293.
61.
RajalinM.Wickholm-PethrusL.HurstiT.JokinenJ. (2009). Dialectical Behavior Therapy-based skills training for family members of suicide attempters. Archives of Suicide Research, 13, 257-263.
62.
RathusJ. H.MillerA. L. (2002). Dialectical Behavior Therapy adapted for suicidal adolescents. Suicide and Life-Threatening Behavior, 32, 146-157.
63.
RobinsC. J.SchmidtH.LinehanM. M. (2004). Dialectical Behavior Therapy: Synthesizing radical acceptance with skillful means. In HayesS. C.FolletteV. M.LinehanM. M. (Eds.), Mindfulness and acceptance: Expanding the cognitive-behavioral tradition (pp. 30-44). New York, NY: Guilford.
64.
RogersC. R. (1961). On becoming a person. Boston, MA: Houghton Mifflin.
65.
RosenfeldB.GaliettaM.IvanoffA.Garcia-MansillaA.MartinezR.FavaJ.. . .GreenD. (2007). Dialectical Behavior Therapy for the treatment of stalking offenders. International Journal of Forensic Mental Health, 6, 95-103.
66.
RosenthalM. Z.GratzK. L.KossonD. S.CheavensJ. S.LejuezC. W.LynchT. R. (2008). Borderline personality disorder and emotional responding: A review of the research literature. Clinical Psychology Review, 28, 75-91.
67.
SaferD. L.TelchC. F.AgrasW. S. (2001). Dialectical Behavior Therapy for bulimia nervosa. American Journal of Psychiatry, 158, 632-634.
68.
ScheelK. R. (2000). The empirical basis of Dialectical Behavior Therapy: Summary, critique, and implications. Clinical Psychology: Science and Practice, 7, 68-86.
69.
SchotteD. E.ClumG. A. (1987). Problem-solving skills in suicidal psychiatric patients. Journal of Consulting and Clinical Psychology, 55, 49-54.
70.
SelbyE. A.JoinerT. E. (2009). Cascades of emotion: The emergence of borderline personality disorder from emotional and behavioral dysregulation. Review of General Psychology, 133, 219-229.
71.
SheltonD.SamplS.KestenK. L.ZhangW. L.TrestmanR. L. (2009). Treatment of impulsive aggression in correctional settings. Behavioral Sciences & the Law, 27, 787-800.
72.
ShneidmanE. (1985). Definition of suicide. New York, NY: John Wiley.
73.
SimpsonE. B.YenS.CostelloE.RosenK.BeginA.PistorelloJ.PearlsteinT. (2004). Combined Dialectical Behavior Therapy and fluoxetine in the treatment of borderline personality disorder. Journal of Clinical Psychiatry, 65, 379-385.
74.
SkodolA. E.GundersonJ. G.PfohlB.WidigerT. A.LivesleyW. J.SieverL. J. (2002). The borderline diagnosis I: Psychopathology, comorbidity, and personality structure. Biological Psychiatry, 51, 936-950.
75.
SolerJ.PascualJ. C.TianaT.CebriaA.BarrachinaJ.CampinsM. J.. . .PerezV. (2009). Dialectical behaviour therapy skills training compared to standard group therapy in borderline personality disorder: A 3-month randomised controlled clinical trial. Behaviour Research and Therapy, 47, 353-358.
76.
StanleyB.BrodskyB.NelsonJ. D.DulitR. (2007). Brief Dialectical Behavior Therapy (DBT-B) for suicidal behavior and non-suicidal self injury. Archives of Suicide Research, 11, 337-341.
77.
SteinK. F. (1996). Affect instability in adults with a borderline personality disorder. Archives of Psychiatric Nursing, 10, 32-40.
78.
TelchC. F.AgrasW. S.LinehanM. M. (2001). Dialectical Behavior Therapy for binge eating disorder: A promising new treatment. Journal of Consulting and Clinical Psychology, 69, 1061-1065.
79.
TurnerR. M. (2000). Naturalistic evaluation of Dialectical Behavior Therapy-oriented treatment for borderline personality disorder. Cognitive and Behavioral Practice, 7, 413-419.
80.
TurnerR. M.BarnettB. E.KorslundK. E. (1998). The application of Dialectical Behavior Therapy to adolescent borderline clients. In Session: Psychotherapy in Practice, 4(2), 45-66.
81.
Van den BoschL. M. C.LouisaM.KoeterM.StijnenT.VerheulR.Van den BrinkW. (2005). Sustained efficacy of Dialectical Behaviour Therapy for borderline personality disorder. Behavior Research and Therapy, 439, 1231-1241.
82.
VerheulR.Van den BoschL. M. C.KoeterM. W. J.de RidderM. A. J.StijnenT.Van den BrinkW. (2003). Dialectical behaviour therapy for women with borderline personality disorder: 12-month, randomized clinical trial in the Netherlands. British Journal of Psychiatry, 182, 135-140.
83.
WagnerA. W.LinehanM. M. (1999). Facial expression recognition ability among women with borderline personality disorder: Implications for emotion regulation?Journal of Personality Disorders, 13, 329-344.
84.
WestenD. (2000). The efficacy of Dialectical Behavior Therapy for borderline personality disorder. Clinical Psychology: Science and Practice, 71, 92-94.
85.
YenS.ZlotnickC.CostelloE. (2002). Affect regulation in women with borderline personality disorder traits. Journal of Nervous and Mental Disease, 190, 693-696.
