Dialectical Behavior Therapy (DBT): Where Are We Now?

Borderline personality disorder (BPD) is a serious public health problem.  Individuals meeting criteria for the disorder constitute up to 40% of the highest utilizers of mental health services, comprising 8 to 11% of outpatients and 14 to 20% of inpatients.  Ten percent of individuals with BPD die by suicide.  Clinical outcomes for treatment of other Axis I conditions are significantly compromised by the presence of BPD.  Dialectical Behavior Therapy (DBT) is a comprehensive cognitive-behavioral treatment program developed at the University of Washington (UW) in the early 1980s for highly suicidal individuals and later expanded to treat those with BPD. Since then, DBT has expanded to treat individuals with other Axis I and Axis II disorders.  The treatment integrates principles of behavioral science with those of Zen practice to provide a synthesis of change and acceptance both at the level of the treatment provider’s actions and at the level of new behaviors taught to clients. DBT was the first efficacious psychosocial intervention for BPD, as demonstrated by rigorous randomized clinical trials (RCTs). Since the original RCTs, multiple independent RCTs demonstrating its effectiveness as well as numerous non-randomized controlled trials have been conducted around the world. This talk will briefly outline key characteristics of DBT, and will review the various outcomes found in clinical trials of BPD and other disorders.