Dialectical Behavior Therapy: Current Status, Recent Developments, and Future Directions (original) (raw)

2004, Journal of Personality Disorders

Dialectical behavior therapy (DBT) was developed as a treatment for parasuicidal women with borderline personality disorder and has been adapted for several other populations. This article describes standard DBT and several adaptations of it and reviews outcome studies with borderline patients in outpatient, inpatient, and crisis intervention settings, borderline patients with substance use disorders, suicidal adolescents, patients with eating disorders, inmates in correctional settings, depressed elders, and adults with attention-deficit/hyperactivity disorder. This treatment outcome review is followed by discussion of predictors of change in DBT, possible mechanisms of change, and current developments in theory, practice, and research. Dialectical behavior therapy (DBT) was developed as a treatment for chronically parasuicidal women. The first description of the treatment in a peer-reviewed journal was in the first volume of this journal (Linehan, 1987) and subsequently it was described and illustrated in detail as a treatment for borderline personality disorder (BPD) in a pair of published manuals (Linehan, 1993a, b). The most fundamental dialectic addressed by the treatment is that of acceptance and change. The difficulties that Linehan encountered with a more purely change-oriented treatment led to attempts to balance and integrate her efforts to help the patient change with efforts to communicate acceptance of the patient as he or she is. The difficulties borderline patients commonly have in tolerating distress, and in accepting themselves and others, led to attempts to help them develop acceptance-oriented skills and change-oriented skills. Treatment strategies in DBT for helping patients to change draw primarily on standard behavioral and cognitive therapy procedures and on principles and findings from research on learning, emotions, social influence and persuasion, and other areas of psychology. Treatment strategies for helping the therapist to convey his or her acceptance of the patient draw primarily on client-centered and emotion-fo-73