Evidence-Based Psychotherapy

Dialectical Behavior Therapy (DBT)

Clinically Validated
Reviewed: April 2026

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 DisordersSubstance UseAdolescent Self-HarmTreatment-Resistant Depression
APA Practice Guideline
NICE Recommended
SAMHSA Evidence-Based

50%

Suicide attempts reduced vs expert therapy

Linehan 2006 RCT · PMID 16818865

Skill Modules

4

Program Length

~1 yr

Endorsed by

APA · NICE · SAMHSA

Developer

Linehan

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

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 behavioral science, Linehan integrates radical acceptance into a behavioral 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:

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.

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

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 behavioral 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 behavioral 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.

Steps in a Chain Analysis

  1. 1.Identify the target behavior - the specific act to be analyzed (e.g., self-harm episode, substance use, missed session)
  2. 2.Vulnerability factors - what made the person more susceptible that day (poor sleep, physical pain, interpersonal stress)
  3. 3.Prompting event - the specific environmental event that started the chain
  4. 4.Links in the chain - thoughts, feelings, sensations, and actions between the prompting event and the behavior
  5. 5.Consequences - what followed the behavior (short-term relief, long-term costs)
  6. 6.Solutions - which specific link in the chain could be broken next time, and what skill would interrupt it

Why Chain Analysis Works

Patients often experience target behaviors as impulsive or random. Chain analysis reveals a lawful sequence, making behavior understandable and changeable. Each link is a potential intervention point, and patterns across repeated chains (same vulnerability factors, same skill deficits) become the treatment targets.

Chain analysis is also a form of validation, the therapist communicates that the patient's behavior made sense given the chain of events, even as they work to change it.

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-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 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 behavioral 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)

Assessments Used in DBT Programs

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

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 behavioral assessment; and crisis intervention protocols including the 24-hour rule.

How is DBT different from CBT?

CBT focuses primarily on changing maladaptive thoughts and behaviors. DBT extends CBT by adding radical acceptance and explicit validation as core therapeutic strategies. Practically, DBT adds a skills training group, phone coaching between sessions, and a therapist consultation team. DBT was specifically developed for clients with chronic suicidality and BPD, where standard CBT had shown limited effectiveness.

How long does a full DBT program take?

Standard full-protocol DBT is typically one year of weekly individual therapy plus weekly skills group. Each skills module runs approximately 6 weeks, cycling twice across the year. Shorter adapted programs (e.g., DBT-A for adolescents) may run 16 to 24 weeks. The year-long commitment reflects the complexity of the populations DBT was designed to treat.

What is the diary card in DBT?

The diary card is a daily tracking form that is the operational core of DBT. Patients record target behaviors every day (suicidal ideation urge intensity (0 to 5 scale), NSSI urges and acts, substance use, and misery level), plus which DBT skills they used and how effective each was. The therapist reviews the diary card at the start of every individual session: whatever is highest on the target hierarchy from that week's card determines the session agenda. Patients who don't complete diary cards are addressed first, as non-compliance with the card is itself a therapy-interfering behavior.

What is DBT-PE and who is it for?

DBT-PE (DBT plus Prolonged Exposure) is a protocol developed by Melanie Harned at the University of Washington that integrates Prolonged Exposure for PTSD directly into standard DBT. It is designed for patients who have both BPD and PTSD, particularly those with complex or childhood trauma where standard PE alone would be destabilizing. Treatment is sequenced: patients first stabilize life-threatening and therapy-interfering behaviors through standard DBT, then begin PE within individual sessions once they have sufficient behavioral control. A 2021 RCT (PMID 32527137) demonstrated significant PTSD symptom reduction versus DBT alone.

Can DBT be delivered via telehealth?

Yes, and the evidence base has grown substantially since 2020. Multiple studies now support video-delivered DBT skills training groups with equivalent outcomes to in-person delivery. Individual therapy via video is similarly effective for most presentations. Phone coaching (which has always been phone-based) translates naturally. Key adaptations for telehealth DBT include establishing clear safety planning protocols for remote clients, documenting jurisdiction requirements for mandatory reporting across state or provincial lines, and ensuring diary card submission systems work digitally.

What is DBT used for?

DBT was developed by Marsha Linehan in the 1980s for chronically suicidal patients with borderline personality disorder, and it remains the first-line evidence-based treatment for BPD. The protocol has since been adapted for substance use disorders (DBT-SUD), eating disorders (DBT for binge eating and bulimia), adolescents with emotion dysregulation (DBT-A), PTSD with complex trauma (DBT-PE), and patients with chronic suicidality without a BPD diagnosis. The common indication is severe emotion dysregulation, not BPD specifically.

Does DBT work?

Yes. Multiple randomized controlled trials and meta-analyses show DBT significantly reduces suicidal behavior, self-harm, hospitalizations, and treatment dropout compared to treatment as usual or other active comparators in patients with BPD. The Linehan et al. trials, replicated independently across the United States, Europe, and Australia, established DBT as the first evidence-based treatment for BPD. Effect sizes are largest for self-harm and suicidality; emotion regulation and interpersonal functioning improvements take longer to emerge.

How much does DBT cost?

Cost varies substantially by setting and country. In the U.S. private market, full-protocol DBT typically runs $200 to $400 per individual session and $40 to $100 per skills group session, with an annual treatment cost in the $10,000 to $30,000 range when both are weekly for a year. Insurance coverage is uneven; some plans cover individual therapy and group separately under standard psychotherapy CPT codes, others limit coverage. Community mental health DBT programs and academic medical center clinics offer reduced-fee or sliding-scale options.

How is DBT different from… · How long does a full… · What is the diary card… · What is DBT-PE and who…

Clinical Evidence & References

  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. NICE CG78
  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. NIMH
  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. APA
  4. 1.
    Linehan MM, Armstrong HE, Suarez A, et al. Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Arch Gen Psychiatry. 1991;48(12):1060-1064. PMID 1845222
  5. 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. PMID 16818865
  1. 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. ICD-11 6B25
  2. 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. SAMHSA
  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. PMID 21114345
  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. PMID 33875025
  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. PMID 35088687
  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. PMID 35913768
  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. PMID 32697288
  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. PMID 34575707
  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. PMID 12062776
  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. PMID 32527137
  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.
Outcome Measurement

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