Dialectical behavior therapy was designed by Marsha Linehan for treatment of individuals with self-injurious behaviors, such as cutting, suicidal thoughts, urges, and attempts. Many clients with these behaviors are diagnosed with BPD. It is not unusual for individuals with BPD to also experience comorbidity with other emotional problems, such as depression, mood disorders, PTSD, anxiety, eating disorders, or substance abuse problems. Dialectical behavior therapy is a modification of cognitive-behavioral therapy that integrates individual counseling with concurrent skills training. Clients in standard DBT receive individual counseling, skills group counseling, and phone coaching. The therapy aims to assist clients learn to control behavior, fully experience emotions, improve daily living skills, and achieve a sense of completeness. Skills used to reach these goals include mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. This treatment is of particular interest because it focuses on intervening with a group of clients who are recognized as difficult to treat effectively. Additionally, because this approach is incredibly specific and structured, there are challenges in adapting it to accommodate other treatment populations.
Research to support the efficacy of DBT is rich. From the first randomized control trial of women with severe BPD and suicidal behavior (Linehan, Armstrong, Suarez, Allmon, & Heard, 1991), DBT clients have consistently shown a reduction in the frequency and severity of symptoms (Linehan, Heard & Armstrong, 1993; Linehan & Tutek, 1994; Verheul et al., 2003). These improvements include a decrease in suicidal behaviors, a reduction in the number of inpatient bed days, and increased retention in treatment. Studies also indicate a reduction in suicidal ideation, anger expression, hopelessness, and depression. To date, nine randomized trials have been conducted that show its effectiveness (Van Nuys, 2007).