Dialectical Behavior Therapy (DBT)

Developed by Marsha Linehan for borderline personality disorder, DBT now has strong evidence across eating disorders, PTSD, substance use, and adolescent self-harm. It blends radical acceptance with structured behavior change.

Conditions Treated

Borderline Personality DisorderPTSDEating DisordersSUDAdolescent Self-HarmTreatment-Resistant Depression
APA Practice Guideline
NICE Recommended
SAMHSA Evidence-Based
Suicide attempts reduced vs expert therapy
50%
Linehan 2006 RCT · PMID 16818865
Skill Modules
4
Program Length
~1 yr
Endorsed by
APA · NICE · SAMHSA
Developer
Linehan
Clinically Validated
Reviewed: April 2026

The Four DBT Skill Modules

  • Core Mindfulness

    Present-moment awareness. The foundation beneath every other DBT skill.

  • Distress Tolerance

    Survive crises without making them worse. Accept pain that cannot yet change.

  • Emotion Regulation

    Understand and shift emotional responses. Change emotions rather than just endure them.

  • Interpersonal Effectiveness

    Get needs met and maintain relationships without losing self-respect.

DBT Fidelity: What "Real DBT" Means

  • The term "DBT" is used loosely across clinical settings. RCT evidence applies to the full standard model. Partial delivery may still be helpful but carries a different evidence profile and should not be presented to patients as equivalent to the full program.

    FormatIndividualSkills GroupCoachingConsult TeamDurationRCT Evidence
    Standard DBT~1 yearStrong
    DBT-A16-24 wksStrong
    DBT-PE~1 yr + PEEmerging
    Skills-Only GroupVariesLimited
    DBT-InformedVariesNone

    Skills-only groups are a viable lower-intensity option in a stepped care model. They are not a validated substitute for full DBT in high-acuity presentations with active suicidality, chronic NSSI, or BPD. Patients referred as "in DBT" who are receiving skills-only treatment should be flagged for level-of-care review.

DBT Skill Acronyms Explained

  • DBT uses mnemonic acronyms to make skills memorable and usable in crisis. Each letter maps to a concrete action.

  • DEAR MANInterpersonal EffectivenessGetting what you need from others
    D
    DescribeState the facts clearly, without judgment.
    E
    ExpressShare your feelings and opinions.
    A
    AssertAsk for what you want, or say no directly.
    R
    ReinforceExplain why meeting your request benefits the other person.
    M
    MindfulStay focused on your goal; don't get sidetracked.
    A
    Appear ConfidentUse a confident tone, posture, and eye contact.
    N
    NegotiateBe willing to give to get; offer alternatives.
  • GIVEInterpersonal EffectivenessMaintaining relationships
    G
    GentleNo attacks, threats, or judging.
    I
    InterestedListen and show genuine interest.
    V
    ValidateAcknowledge the other person's feelings.
    E
    Easy MannerUse humor; be light-hearted when appropriate.
  • FASTInterpersonal EffectivenessKeeping self-respect
    F
    FairBe fair to yourself and others.
    A
    Apologies (few)Don't over-apologize for what you're not responsible for.
    S
    Stick to ValuesDon't compromise your values to please others.
    T
    TruthfulDon't lie, act helpless, or exaggerate.
  • TIPPDistress ToleranceRapidly reducing extreme emotional arousal
    T
    TemperatureCold water on face activates the dive reflex, slowing heart rate rapidly.
    I
    Intense ExerciseBrief high-intensity exercise burns off stress hormones.
    P
    Paced BreathingSlow, deep breathing activates the parasympathetic nervous system.
    P
    Paired Muscle RelaxationProgressive tension-release cycles reduce physical tension.
  • ACCEPTSDistress ToleranceTolerating crisis without making it worse
    A
    ActivitiesEngage in activities that occupy your mind.
    C
    ContributingDo something helpful for someone else.
    C
    ComparisonsCompare to others coping with difficulty, or to past times you managed.
    E
    Emotions (opposite)Do something that creates a different emotion.
    P
    Pushing AwayMentally set the situation aside; return when calmer.
    T
    ThoughtsReplace distressing thoughts with neutral ones.
    S
    SensationsUse intense physical sensations (cold, spice) as distraction.
  • PLEASEEmotion RegulationReducing vulnerability to emotional dysregulation
    PL
    Treat Physical IllnessSee a doctor; take medications as prescribed.
    E
    Eat BalancedDon't skip meals or eat in ways that affect mood.
    A
    Avoid Mood-Altering SubstancesAlcohol and drugs increase emotional vulnerability.
    S
    SleepMaintain a regular sleep schedule; treat sleep problems.
    E
    ExerciseRegular physical exercise builds emotional resilience.

What Is Dialectical Behavior Therapy?

  • Dialectical Behavior Therapy (DBT) is a structured, evidence-based psychotherapy developed by Marsha M. Linehan at the University of Washington in the late 1980s. It was the first treatment to demonstrate RCT efficacy for borderline personality disorder and chronic suicidality, and has since built a substantial evidence base across emotional dysregulation disorders.1

History & Origins

  • DBT emerged from clinical failure and a decade of iterative trial. Understanding its origins illuminates why the therapy is structured the way it is.

  • Marsha Linehan, The Therapist Who Lived It

    In 2011, Linehan disclosed she had been hospitalized in the early 1960s, subjected to ECT, seclusion, and Thorazine, with symptoms now consistent with BPD. Her recovery came through radical acceptance: "I had to accept that I was not the person I wanted to be." DBT's central dialectic was not an academic construction, it was her own path out.

    Linehan MM. "Marsha Linehan Turns the Lens on Herself." New York Times. June 23, 2011.

  • 1980

    Standard CBT fails the population

    Standard CBT's change-focused stance feels invalidating to chronically suicidal patients, and leads to dropout. Linehan concludes that validation AND change are both required.

    Mid-1980s

    The dialectical synthesis

    Drawing on Zen philosophy and behavioural science, Linehan integrates radical acceptance into a behavioural framework. The skills group is added when individual therapy alone leaves gaps in skill acquisition between sessions.

    1991

    First randomized controlled trial published

    Linehan et al. publish in Archives of General Psychiatry: DBT outperforms treatment as usual on parasuicide, psychiatric hospitalization, and treatment retention. It is the first psychotherapy to demonstrate efficacy for BPD in an RCT.1

    1993

    Skills Training Manual published

    Linehan publishes the Skills Training Manual for Treating Borderline Personality Disorder (Guilford Press), making DBT replicable across sites. A second edition followed in 2015 with expanded modules.

    2006

    Two-year RCT confirms durability

    A 2-year RCT vs. expert therapy: DBT halves suicide attempts (HR 2.66, p=.005) and reduces psychiatric hospitalizations, cementing it as the standard of care for suicidality in BPD.2

    2010s–present

    Adapted protocols expand reach

    DBT-A, DBT-PTSD, DBT-SUD, and DBT for eating disorders each develop their own trial bases. NICE, NIMH, APA, and SAMHSA formally endorse DBT. WHO incorporates BPD with DBT as the primary recommended treatment (ICD-11 6B25).

Linehan's Biosocial Theory

  • DBT is grounded in a specific etiological model that directly informs treatment. Linehan's biosocial theory proposes that chronic emotional dysregulation - the core deficit in BPD - emerges from a transaction between two factors:

  • Biological Sensitivity

    High baseline emotional reactivity, faster, more intense emotional responses with slower return to baseline. A real neurobiological difference, not a character flaw.

  • Invalidating Environment

    Pervasive rejection, dismissal, or punishment of emotional responses. Fails to teach emotion labeling, regulation, or the validity of emotional experience.

  • Clinical implication: The biosocial model is explicitly non-blaming. It locates pathology in the transaction between biology and environment - not in the patient's character or the family alone. This framing reduces shame and supports the therapeutic alliance required in DBT.

Standard DBT Program Components

  • Linehan's validated full-protocol DBT includes four distinct components. Programs delivering only part of the model - sometimes called "DBT-informed" - may produce different outcomes from those measured in RCTs.

  • Individual Therapy (Weekly)

    50–60 min sessions working the diary card, conducting chain analyses of target behaviors, and troubleshooting skill application. Session agenda follows the strict target hierarchy.

  • Skills Training Group (Weekly)

    2–2.5 hour classroom-style group (not process therapy). Covers all four modules in ~6 months. Focus is skill acquisition, not interpersonal processing.

  • Phone Coaching

    Brief between-session calls (5–15 min) for in-the-moment skill coaching during crises. Skills coaching only, not therapy. A key differentiator for high-acuity presentations.

  • Therapist Consultation Team

    Weekly 60-minute clinician meeting, DBT applied to the therapist. Work with high-acuity patients causes burnout and dialectical drift. The consultation team keeps clinicians regulated, adherent, and effective. Skipping this is the most common fidelity failure in community DBT programs – without it, therapists drift toward validation-only or change-only stances within months.

What a DBT Week Looks Like

  • Standard DBT is a substantial commitment, roughly 3-4 hours of structured treatment per week for the patient, plus protected consultation team time for the clinician. Understanding the weekly rhythm clarifies why the model produces the outcomes it does, and what to account for when building or referring into a program.

  • Skills Group

    120 min

    weekly

  • Individual

    50–60 min

    weekly

  • Phone Coaching

    5–15 min

    as needed

  • Consult Team

    60 min

    weekly

  • Patient time commitment: roughly 3-4 hours per week across individual therapy, skills group, and coaching calls, sustained for approximately one year. The evidence base reflects this full commitment.

DBT Individual Session Structure

  • DBT sessions follow a strict agenda driven by the diary card. A fixed target hierarchy, not collaborative agenda-setting, determines what gets addressed first. This structure is what makes DBT safe for high-acuity presentations.

  • DBT Target Hierarchy (applied to diary card)

    1. 1
      Life-threatening behaviors
      Suicidal ideation/acts, NSSI, behaviors that endanger others. Always addressed first.
    2. 2
      Therapy-interfering behaviors
      Non-attendance, non-compliance, therapist burnout behaviors. Second priority.
    3. 3
      Quality-of-life behaviors
      Substance use, relationship crises, housing instability. Third priority.
    4. 4
      Increasing behavioural skills
      Skills practice and generalization. Present when higher priorities are absent.

The DBT Diary Card

  • The diary card is the engine of DBT individual therapy. Completed daily, it generates the session agenda, nothing else does.

  • What it tracks (daily)

    • Urge intensity – suicidal ideation, NSSI urges, and substance urges rated 0–5 for each day
    • Target behaviors – NSSI acts, suicide attempts, self-harm, substance use (yes/no per day)
    • Misery level – overall emotional suffering, 0–5 scale, each day of the week
    • Skill use – which DBT skills were used each day, and whether they helped (effectiveness rating)
    • Medications taken – adherence column; clinician can correlate symptom days with missed doses

  • How it drives the session

    The therapist opens every session by reviewing the diary card. Whatever sits highest on the target hierarchy, suicidality, then therapy-interfering behavior, then quality-of-life, becomes the first agenda item. The diary card removes guesswork from prioritization.

    Sessions where the patient arrives without a completed diary card begin with the non-completion itself, which is treated as a therapy-interfering behavior (Target Level 2) and addressed via chain analysis before anything else.

    Digital diary cards are increasingly common. App-based versions send push reminders, auto-graph urge trends, and let clinicians review data before the session, turning the diary card into a real-time measurement tool.

Chain Analysis in DBT

  • Chain analysis (also called behavioural chain analysis) is the primary tool DBT therapists use to understand why a target behavior occurred and where in the sequence to intervene. It is conducted in individual therapy every time a high-priority target behavior appears on the diary card.

DBT for Adolescents (DBT-A)

  • 21studiesA 2021 meta-analysis (5 RCTs) found significant reductions in self-harm (g = −0.44) and suicidal ideation (g = −0.31) vs control groups.4

    DBT-A is a developmentally adapted version of standard DBT for adolescents presenting with self-harm, suicidality, or significant emotional dysregulation. It was developed by Alec Miller, Jill Rathus, and Marsha Linehan and runs 16–24 weeks, roughly a quarter of the time of adult DBT.

  • Shorter Duration

    Standard DBT-A runs 16-24 weeks vs approximately 1 year for adult DBT. Skills training covers all four modules but at a faster pace.

  • Family Component

    DBT-A includes a multi-family skills group where parents and caregivers learn the same DBT skills as their adolescent - reducing invalidating environments at home.

  • "Walking the Middle Path"

    A fifth skill module unique to DBT-A addressing the dialectical tensions specific to adolescence: dependence vs. independence, validation vs. change within the family system.

  • DBT-A vs. DBT-informed: Programs that use DBT skills training alone without individual therapy and phone coaching are "DBT-informed," not DBT-A. RCT evidence applies specifically to the full DBT-A model.

DBT-PE: Treating Trauma in DBT

  • Standard DBT does not directly target PTSD. DBT-PE adds a validated Prolonged Exposure protocol once the patient has sufficient DBT skills to tolerate it.

    Developed by Melanie Harned at the University of Washington, DBT-PE (DBT + Prolonged Exposure) addresses a gap Linehan originally acknowledged: standard DBT stabilizes, but doesn't directly process trauma. Because BPD and PTSD co-occur in 30–70% of clinical presentations, and trauma is often the developmental root of emotion dysregulation, many patients plateau without it.

  • Two-Stage Sequencing

    DBT-PE begins only after the patient demonstrates sufficient DBT skills, typically 3+ months into standard DBT. Stage 1 stabilizes life-threatening behaviors; Stage 2 introduces PE targeting.

  • Who It's For

    Indicated for BPD + PTSD, complex trauma, and childhood abuse histories. The target is PTSD symptoms that standard DBT has not resolved, particularly shame, avoidance, and intrusive re-experiencing.

  • Evidence Base

    A 2021 RCT (Harned et al.) found DBT-PE produced significantly greater PTSD remission and suicidal/NSSI reduction vs. standard DBT alone, with no increase in dropout or adverse events.10

  • DBT-PE requires specific training beyond standard DBT certification. Clinicians should not attempt to integrate PE techniques without the full DBT-PE protocol training, the two-stage sequencing and safety monitoring protocols are what make it safe for this population.

DBT via Telehealth

  • Post-2020 research supports telehealth delivery of DBT without clinically meaningful outcome differences versus in-person. Phone coaching was always part of the model; video skills groups are a natural extension.

  • What the evidence shows

    • Video-delivered skills groups show equivalent skill acquisition and dropout rates vs. in-person across multiple 2021–2024 studies11
    • Individual DBT via video is well-tolerated; therapeutic alliance measures are comparable to in-person formats
    • Phone coaching, already embedded in the standard DBT model, is structurally identical in telehealth; no adaptation required
    • Active suicidality and crisis management require written safety plans, clear escalation pathways, and jurisdiction-specific rules for emergency breach of confidentiality before starting telehealth DBT

  • Key adaptations for telehealth

    • Digital diary card with push reminders, removing the paper handoff that breaks down in asynchronous care
    • Breakout room facilitation for paired skills practice in group settings
    • Explicit location verification at session start for clients with active suicidal ideation (know where they are for emergency dispatch)
    • Consultation team continuity is unchanged, video consultation functions identically to in-person

Conditions Treated with DBT

  • DBT's core transdiagnostic mechanism - emotion dysregulation - makes it applicable across a range of presentations. Evidence is strongest where dysregulation is a primary driver.

    ConditionEvidenceNotes
    Borderline Personality Disorder (BPD)StrongestOriginal indication; most RCT evidence. Reduces self-harm, suicide attempts, psychiatric hospitalizations. PMID 21114345
    Chronic suicidality / NSSIStrongLinehan 2006 RCT: DBT halved suicide attempts vs expert therapy over 2 years. PMID 16818865
    Adolescent self-harm (DBT-A)StrongSystematic review of 21 studies (5 RCTs); DBT-A showed significant reduction in self-harm (g = -0.44) and suicidal ideation (g = -0.31) vs control groups. PMID 33875025
    Eating disorders (BED, Bulimia)ModerateEmotion regulation targets binge-purge cycles. Evidence is promising but fewer large RCTs vs BPD. PMID 34575707
    PTSD / Complex PTSD (DBT-PTSD)EmergingDBT-PTSD RCT (Bohus 2020): small but significant superiority over CPT for C-PTSD in childhood abuse survivors (d = 0.33). PMID 32697288
    Substance use disorders (DBT-SUD)ModerateDistress tolerance and urge surfing reduce relapse. Evidence base is smaller (Linehan 2002, n=23). PMID 12062776
    Depression with high emotional reactivityModerateEmotion regulation module and behavioural activation; particularly useful for treatment-resistant presentations.

Common Comorbidities

  • The table above covers what DBT is designed for. This covers what walks in the door alongside it. Clinicians rarely treat a single condition, emotional dysregulation drives a cluster of co-occurring presentations that all respond to DBT skills.

  • Major Depression

    High co-occurrence with BPD and emotional dysregulation. Emotion regulation module directly addresses mood lability.

  • PTSD

    Trauma history is very common in DBT populations. DBT-PTSD is a dedicated protocol with RCT evidence for C-PTSD in childhood abuse survivors (Bohus 2020).

  • Anxiety Disorders

    GAD, social anxiety, and panic are frequent comorbidities. Mindfulness and distress tolerance skills generalize effectively.

  • Eating Disorders

    Emotional eating and binge-purge cycles linked to dysregulation. DBT targeting emotion regulation shows moderate evidence.

  • Substance Use Disorders

    Self-medication of emotional pain is common. DBT-SUD combines standard DBT with urge surfing and contingency management.

  • Complex PTSD (ICD-11 6B41)

    C-PTSD's core features (dysregulation, negative self-concept, interpersonal disruption) map directly onto DBT targets. DBT-PTSD sequences stabilization before trauma processing.

  • ADHD

    Impulsivity overlap with BPD; rejection-sensitive dysphoria responds to DBT distress tolerance and interpersonal effectiveness skills.

Outcome Measurement in DBT

  • DBT uses two complementary measurement approaches: idiographic tracking via diary cards and nomothetic assessment via validated rating scales.

  • Diary Card, Formal Measurement Tool

    The diary card is DBT's primary within-treatment outcome measure. Daily 0–5 ratings of urge intensity, misery level, and skill use generate a session-by-session dataset that surfaces response and non-response before the therapist would otherwise detect it.

    0–5
    Urge intensity scale
    Daily
    Completion cadence
    Weekly
    Clinician review

  • BSL-23 (Borderline Symptom List)

    The BSL-23 is the criterion standard BPD symptom measure in DBT research. A mean score ≥1.05 indicates clinically significant BPD pathology; scores below this threshold represent reliable clinical improvement. Administer at intake, every 4–6 weeks, and discharge.

    Clinical cutoff: mean score ≥ 1.05 indicates clinically significant BPD symptoms. Movement across this threshold is the clearest signal of meaningful change in high-acuity DBT populations.

  • DERS (Difficulties in Emotion Regulation Scale)

    DBT's primary mechanistic outcome target. Six subscales track distinct components of dysregulation, making DERS useful for identifying which specific deficits are driving a patient's presentation rather than just a total score.

    Non-acceptance:Negative reactions to one's own emotions
    Goals:Difficulty focusing when distressed
    Impulse:Impulse control when distressed
    Strategies:Access to regulation strategies
    Awareness:Attending to and acknowledging emotions
    Clarity:Knowing what emotion is being felt

  • C-SSRS (Columbia Suicide Severity Rating Scale)

    Standard of care for suicidality monitoring in DBT. Administer at every session for patients with active ideation or NSSI history, not just at intake and discharge. The diary card captures urge intensity; C-SSRS captures severity and behavior.

    C-SSRS should not be administered only at admission and discharge in DBT programs. High-acuity presentations require session-level tracking to catch deterioration between weekly individual appointments.

  • PHQ-9 / GAD-7 for Comorbidities

    Session-by-session PHQ-9 and GAD-7 data enables early detection of non-response and supports measurement-based care alongside the diary card. The combination, diary card for DBT-specific targets, standardized scales for comorbidities, is the current best-practice measurement stack for DBT programs.

DBT vs CBT: Key Differences

  • FactorDBTCBT
    Core philosophyAcceptance AND change (dialectical)Change-focused (thought/behavior modification)
    Primary targetEmotional dysregulation, self-destructive behaviorSpecific cognitions and behaviors maintaining distress
    FormatIndividual + skills group + phone coachingIndividual therapy only (typically)
    Duration~1 year (standard full-protocol program)12–20 sessions (time-limited)
    Best forBPD, self-harm, suicidality, high emotional intensityDepression, anxiety, OCD, specific phobias, insomnia
    Validation emphasisExplicit validation is a core therapeutic strategyCollaborative but less explicit validation emphasis
    MindfulnessCore module; foundation of all other skillsIncorporated in third-wave CBT variants (ACT, MBCT)

Related

  • DBT programs typically monitor emotion regulation, depression, anxiety, PTSD symptoms, and target behaviors like self-harm frequency and urge intensity.

  • Assessments Used in DBT Programs

    • GAD-7Anxiety severity
    • PHQ-9Depression severity - administered every session
    • PCL-5PTSD symptoms
    • PSS-10Stress levels
    • CSSRSSuicidality tracking
    • RSD TestRejection sensitivity
    • DERSEmotion dysregulation - DBT's primary outcome target

    Dot size shows how strongly each scale's condition is linked to the conditions this therapy treats, in HiBoop's co-occurrence map.

Billing codes

  • Dialectical Behaviour Therapy (DBT) sessions are reimbursed under standard psychotherapy CPT codes. Validated outcome scales (e.g. PHQ-9, GAD-7) add CPT 96127 per scale per session.

  • 90791Initial diagnostic evaluation
  • 90834Psychotherapy, 45 min
  • 90837Psychotherapy, 60 min

Track DBT outcomes with validated scales

Frequently Asked Questions

  • What are the four modules of DBT?

    DBT is organized into four skill modules: (1) Core Mindfulness, the foundation of all DBT skills, teaching awareness of the present moment; (2) Distress Tolerance, for surviving crises without making them worse; (3) Emotion Regulation, for understanding and changing emotional responses; and (4) Interpersonal Effectiveness, for navigating relationships while maintaining self-respect.

  • What is the 24-hour rule in DBT?

    The 24-hour rule in DBT states that a client who has engaged in self-harm or suicidal behavior may not call the therapist for coaching in the 24 hours immediately following the behavior. The rule is a contingency designed to avoid inadvertently reinforcing crisis behavior with therapist attention. Clients may still contact the therapist for other reasons during that window; the restriction applies specifically to phone coaching calls.

  • Who is DBT not recommended for?

    DBT may not be appropriate as a standalone treatment for active psychosis, severe intellectual disability, primary antisocial personality disorder without emotional dysregulation, or when a client is unable to commit to the full program. It is also contraindicated when a client cannot reliably attend both individual therapy and skills group. For straightforward PTSD without comorbid emotional dysregulation, DBT is not a first-line choice.

  • What are the 7 core strategies in DBT?

    While DBT is often summarized by its four skill modules, the treatment rests on seven core therapeutic strategies: dialectical strategies balancing acceptance and change; core strategies combining validation and problem-solving; stylistic strategies using irreverence and reciprocal communication; case management via therapist consultation; an integrated treatment structure; chain analysis for behavioural assessment; and crisis intervention protocols including the 24-hour rule.

Clinical Evidence & References

  • Clinical Guidelines & Institutional Sources

    1. G1.National Institute for Health and Care Excellence (NICE). Borderline personality disorder: recognition and management. Clinical guideline CG78. London: NICE; 2009 (updated 2023). Recommends DBT as a first-line psychological treatment.
    2. G2.National Institute of Mental Health (NIMH). Borderline Personality Disorder. U.S. Department of Health and Human Services. Identifies DBT as among the most studied and effective treatments for BPD.
    3. G3.American Psychological Association (APA). Psychotherapy: Understanding group therapy. Washington, DC: APA. Recognizes DBT as an evidence-based treatment for BPD and suicidal behavior.
    4. G4.World Health Organization (WHO). ICD-11: Emotionally unstable personality disorder (6B25). Geneva: WHO; 2022. Classifies BPD/EUPD and identifies psychological interventions including DBT as the primary treatment approach.
    5. G5.Substance Abuse and Mental Health Services Administration (SAMHSA). Dialectical Behavior Therapy. Listed in the National Registry of Evidence-based Programs as an evidence-based practice for BPD and suicidal behavior.

  • Peer-Reviewed Research

    1. 1.Linehan MM, Armstrong HE, Suarez A, et al. Cognitive-behavioural treatment of chronically parasuicidal borderline patients. Arch Gen Psychiatry. 1991;48(12):1060-1064.
    2. 2.Linehan MM, Comtois KA, Murray AM, et al. Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Arch Gen Psychiatry. 2006;63(7):757-766.
    3. 3.Kliem S, Kröger C, Kosfelder J. Dialectical behavior therapy for borderline personality disorder: a meta-analysis using mixed-effects modeling. J Consult Clin Psychol. 2010;78(6):936-951.
    4. 4.Kothgassner OD, Goreis A, Robinson K, et al. Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis. Psychol Med. 2021;51(7):1057-1067.
    5. 5.Stoffers-Winterling JM, Storebø OJ, Kongerslev MT, et al. Psychotherapies for borderline personality disorder: a focused systematic review and meta-analysis. Br J Psychiatry. 2022;221(3):538-552.
    6. 6.Gillespie C, Murphy M, Joyce M. Dialectical Behavior Therapy for Individuals With Borderline Personality Disorder: A Systematic Review of Outcomes After One Year of Follow-Up. J Pers Disord. 2022;36(4):431-454.
    7. 7.Bohus M, Kleindienst N, Hahn C, et al. Dialectical Behavior Therapy for Posttraumatic Stress Disorder (DBT-PTSD) Compared With Cognitive Processing Therapy (CPT) in Complex PTSD in Women Survivors of Childhood Abuse. JAMA Psychiatry. 2020;77(12):1235-1245.
    8. 8.Rozakou-Soumalia N, Dârvariu S, Sjögren JM. Dialectical Behaviour Therapy Improves Emotion Dysregulation Mainly in Binge Eating Disorder and Bulimia Nervosa: A Systematic Review and Meta-Analysis. J Pers Med. 2021;11(9):931.
    9. 9.Linehan MM, Dimeff LA, Reynolds SK, et al. Dialectical behavior therapy versus comprehensive validation therapy plus 12-step for the treatment of opioid dependent women meeting criteria for borderline personality disorder. Drug Alcohol Depend. 2002;67(1):13-26.
    10. 10.Harned MS, Korslund KE, Linehan MM. A pilot randomized controlled trial of Dialectical Behavior Therapy with and without the Dialectical Behavior Therapy Prolonged Exposure (DBT-PE) protocol for suicidal and self-injuring women with borderline personality disorder and PTSD. Behav Res Ther. 2014;55:7-17. Updated with 2021 RCT: Harned et al. J Consult Clin Psychol. 2021.
    11. 11.Betthauser LM, Sigurvinsdottir R, O'Cleirigh C. A Systematic Review of the Effectiveness of Telehealth Dialectical Behavior Therapy. Cognit Behav Pract. 2022;29(4):869-881. PMID unavailable; see also Cavanaugh MM, Soloff N, Solomon M. Dialectical Behavior Therapy via Telehealth: A Systematic Review. Psychol Serv. 2023.