Dialectical Behavior Therapy for Borderline Personality Disorder

Evidence Supporting DBT

• The American Academy of Child and Adolescent Psychiatry recommends Dialectical Behavior Therapy (DBT) as the most effective psychiatric treatment for individuals with borderline personality disorder, as it reduces suicidality in this population 1
• DBT was specifically developed to treat patients with borderline personality disorder, a population at heightened risk for suicidal and non-suicidal self-directed violence, and combines elements of cognitive behavioral therapy, skills training, and mindfulness techniques to help patients develop skills in emotion regulation, interpersonal effectiveness, and distress tolerance 2
• Multiple systematic reviews have found that DBT reduces both suicidal and non-suicidal self-directed violence among patients with borderline personality disorder and recent self-harm behaviors, with moderate to large statistically significant effects over treatment as usual 2
• The Annals of Internal Medicine reports that DBT shows superiority over client-centered therapy for treating both core borderline personality pathology and associated symptoms, and has demonstrated efficacy in reducing anger, parasuicidal behavior, and improving mental health 2
• While cognitive behavioral therapy (CBT) has shown benefits for reducing suicidal ideation and behavior in general populations, DBT was specifically designed for the unique challenges of borderline personality disorder, according to the American Academy of Child and Adolescent Psychiatry and the Annals of Internal Medicine 1, 2

Special Considerations for Adolescents

• A modified version of DBT for adolescents (DBT-A) has been developed that includes participation of family members in skills training, and has shown promise in reducing rates of psychiatric hospitalization in adolescents diagnosed with borderline personality disorder, as reported by the Journal of the American Academy of Child and Adolescent Psychiatry 1
• In adolescents with bipolar spectrum disorders, DBT has demonstrated efficacy in reducing depressive symptoms and suicidal ideation, according to the Annual Review of Clinical Psychology 4, 5

Practical Implementation

• The Journal of the American Academy of Child and Adolescent Psychiatry recommends that DBT typically involves weekly individual therapy sessions combined with weekly group skills training over the course of one year 1
• For patients with acute suicidality, DBT incorporates specific crisis response planning and distress tolerance skills, as reported by the Annual Review of Clinical Psychology and the Journal of the American Academy of Child and Adolescent Psychiatry 1, 6