Dialectical Behavioral Therapy: Benefits and Effectiveness

Dialectical behavioral therapy is a form of cognitive behavioral therapy created for use with individuals suffering with borderline personality disorder and ongoing suicidal ideation. In this type of therapy, mental health professionals accept their clients, but also acknowledge that change is necessary. In therapy, clients participate in training groups to learn behavioral skills, as well as in individual counseling to strengthen these skills and apply them to challenges they experience. Dialectical behavioral therapy also involves phone consultation with the therapist as well as professional consultation meetings. 1 Researchers have conducted experimental studies to evaluate the effectiveness of dialectical behavioral therapy, and the results have been positive.

Dialectical Behavioral Therapy in Treatment of Borderline Personality Disorder

Dialectical behavioral therapy was initially designed to meet the needs of individuals diagnosed with borderline personality disorder (BPD).Scientists have evaluated its effectiveness among people with BPD. In a 2006 study in JAMA Psychiatry, one group of patients with borderline personality disorder underwent one year of dialectical behavioral therapy, while a second group received usual psychiatric treatment. Study results showed that during the study period, 23 percent of patients in the dialectical behavioral therapy group attempted suicide compared to 46 percent in the standard treatment group.

Additionally, only 19.6 percent of patients undergoing dialectical behavioral therapy had to be admitted to the hospital after a year of the study, whereas nearly 49 percent of those receiving standard treatment experienced a psychiatric hospital admission. Finally, 43 percent of patients in the standard treatment group discontinued treatment, whereas only 19 percent of those receiving dialectical behavioral therapy stopped treatment. 1 The results of this study demonstrate that dialectical behavioral therapy is particularly useful for patients with borderline personality disorder who suffer from suicidal ideation, as evidenced by it being superior to standard treatment for reducing suicide attempts, preventing psychiatric hospital admissions, and maintaining patients in treatment.

The Four Modules of Dialectical Behavioral Therapy: What to Expect

Throughout treatment, DBT uses four main modules in skills training:

  • Mindfulness
  • Distress Tolerance
  • Interpersonal Effectiveness
  • Emotional Regulation
Each practice is designed to help with acceptance, communication and dealing with emotions. Mindfulness is the practice of being fully present in the moment. Often used in meditation, mindfulness helps to bring the mind into the present moment, rather than focusing on the past. Distress tolerance is about learning how to deal with difficult situations and not changing it. This helps with managing difficult emotions during hard situations in the present moment. Interpersonal effectiveness is about communicating what you need and learning how to say no while maintaining respect for yourself and others. Emotional regulation teaches how to change emotions, even during difficult moments. Although a variety of strategies may be used to customize DBT treatment to the individual, these four modules help guide dialectical behavioral therapy.

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Dialectical Behavioral Therapy Effectiveness

While dialectical behavioral therapy was designed with patients with borderline personality disorder in mind, it is effective even among patients without this diagnosis, according to recent research.

In 2013, scientists writing for the journal Psychotherapy and Psychosomatics assessed the effects of dialectical behavioral therapy on patients with a history of childhood sexual abuse and a diagnosis of post-traumatic stress disorder related to the abuse. Half of the patients in this study also had a diagnosis of borderline personality disorder. One group of patients completed an inpatient program that included dialectical behavioral therapy, whereas a second group received standard treatment. Study results indicated that patients receiving dialectical behavioral therapy improved more when compared to those undergoing standard treatment.

In this study, the benefits of dialectical behavioral therapy were independent of the borderline personality disorder diagnosis, suggesting that this form of treatment is effective for patients both with and without this condition. Furthermore, 39 percent of patients in the dialectical behavioral therapy group responded to treatment compared to 3 percent who received standard treatment. In addition, patients undergoing dialectical behavioral therapy demonstrated a 33-point decrease on an assessment of post-traumatic stress, compared to only a 2-point decrease, on average, among patients in the standard treatment group. 3

Based upon the results of this study, dialectical behavioral therapy is effective for patients experiencing post-traumatic stress associated with childhood abuse, regardless of whether they are also diagnosed with borderline personality disorder.

Substance Abuse and Dialectical Behavioral Therapy

Dialectical behavioral therapy is also a viable option for patients experiencing substance use disorders. Researchers from Yale University School of Medicine analyzed the effects of dialectical behavioral therapy in a group of women in outpatient treatment who were diagnosed with borderline personality disorder and substance use disorder.

Women in the study received 20 weeks of treatment with dialectical behavioral therapy, and the study results, published in a 2011 issue of The American Journal of Drug and Alcohol Abuse, showed that the women experienced improvements in mood and emotional regulation as well as decreases in drug use. Study results also indicated that the improvement in emotional regulation abilities was responsible for the decrease in drug use among the women.

At the start of the study, 39 percent of the women reported using drugs on a weekly basis, whereas a month prior to the end of the study, about 9 percent indicated they were using drugs weekly.4 The results of this study provide evidence that dialectical behavioral therapy can be effective for reducing substance abuse among patients with borderline personality disorder.

Dialectical Behavioral Therapy in Cases of Heroin Addiction

Dialectical behavioral therapy has demonstrated effectiveness in women who are dependent upon drugs and has also been found useful in treating addiction to heroin. A 2002 study in the journal Drug and Alcohol Dependence compared the effectiveness of a treatment involving the 12-step program to that of dialectical behavioral therapy for women who had a diagnosis of borderline personality disorder and were also addicted to heroin. Women in the study took opiate agonist medications in addition to participating in treatment.

Study results showed that women who received dialectical behavioral therapy decreased their opiate use and maintained this decrease throughout the course of the 12-month study, whereas women in the 12-step group increased their use during the final four months of the study. In addition, patients undergoing dialectical behavioral therapy were more forthcoming about their opiate use, whereas women in both groups experienced reductions in psychopathology as a result of the treatment. 5 The use of dialectical behavioral therapy is appropriate for clients undergoing treatment for opiate addition, including medication-assisted treatment, and can be used even among patients with co-occurring heroin addiction and borderline personality disorder.

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Bipolar Disorder Treatment with Dialectical Behavioral Therapy

Though developed for use with patients with borderline personality disorder, the benefits of dialectical behavioral therapy extend to those with bipolar disorder. In 2007, researchers writing for the Journal of the American Academy of Child & Adolescent Psychiatry assessed the usefulness of dialectical behavioral therapy in adolescents with a bipolar disorder diagnosis. Adolescents in this study participated in one year of treatment, which began with weekly sessions for 6 months followed by an additional 6 months during which the frequency of sessions decreased.

At the end of the study, 90 percent of the adolescents had successfully completed treatment, and they showed decreases in suicide ideation and self-injurious behaviors. They also demonstrated improvements in depression and emotional regulation. Study results showed that the average score on an assessment of suicide ideation reduced from 6.7 at the start of treatment to 2.2 after 6 months of treatment. It is noted that this treatment also involved training for family members, and patients were receiving medications in conjunction with the therapy.

Based upon the results of the study, the researchers, who were affiliated with the University of Pittsburgh Medical Center, concluded that dialectical behavioral therapy is appropriate for adolescents with a diagnosis of bipolar disorder 6 This finding demonstrates that dialectical behavioral therapy can be beneficial for individuals who have co-occurring diagnoses, such as bipolar disorder, along with addiction and borderline personality disorder.

Dialectical Behavioral Therapy Can Help with Long-Term Recovery

Dialectical behavioral therapy, though intended for use with patients demonstrating symptoms of borderline personality disorder, has also proven itself effective for the treatment of bipolar disorder. The research has also shown that this form of therapy can result in positive outcomes for patients diagnosed with substance use disorders and post-traumatic stress. More specifically, dialectical behavioral therapy is useful for treating patients who are addicted to heroin and receiving medication- assisted treatment, as it can reduce both heroin use and psychopathology.

It is encouraging that dialectical behavioral therapy is effective for its intended purpose of treating borderline personality disorder, as evidenced by research showing that this form of treatment is more effective than standard psychiatric treatment for patients with borderline personality disorder. As demonstrated by the research, it seems reasonable to conclude that dialectical behavioral therapy is effective for those both with and without borderline personality disorder, and it is therefore a useful, evidence-based treatment tool for a range of psychiatric conditions.