Dialectical Behavior Therapy
An Evidence-Based Practice
Description
Dialectical Behavior Therapy (DBT) is a cognitive-behavioral treatment approach with two key characteristics: a behavioral, problem-solving focus blended with acceptance-based strategies, and an emphasis on dialectical processes. "Dialectical" refers to the issues involved in treating patients with multiple disorders and to the type of thought processes and behavioral styles used in the treatment strategies. DBT has five components: (1) capability enhancement (skills training); (2) motivational enhancement (individual behavioral treatment plans); (3) generalization (access to therapist outside clinical setting, homework, and inclusion of family in treatment); (4) structuring of the environment (programmatic emphasis on reinforcement of adaptive behaviors); and (5) capability and motivational enhancement of therapists (therapist team consultation group). DBT emphasizes balancing behavioral change, problem-solving, and emotional regulation with validation, mindfulness, and acceptance of patients. Therapists follow a detailed procedural manual.
Goal / Mission
The goal of Dialectical Behavior Therapy is to use a cognitive-behavioral treatment approach to treat patients with multiple disorders.
Impact
After 1 year of treatment, a smaller percentage of DBT participants reported suicide attempts compared with TBE patients. DBT also reduced Nonsuicidal Self-Injury (NSSI) behavior over the course of 1-year treatment.
Results / Accomplishments
Multiple randomized controlled trials of DBT have been published. Results include the following:
In a randomized controlled trial comparing DBT to treatment by experts (TBE), after 1 year of treatment, 23.1% of DBT participants reported suicide attempts, compared with 46.7% of TBE patients (p = 0.005). In seven randomized controlled trials, DBT reduced Nonsuicidal Self-Injury (NSSI) behavior over the course of 1-year treatment. DBT led to significantly more improvement than wait list, treatment as usual, or other active control conditions in five of the seven trials, and in the other two trials, DBT led to the same reduction in NSSI behavior as an active treatment control group. Probability levels ranged from less than 0.01 to less than 0.05. In one study, after 1 year of treatment, the mean number of NSSI behaviors among DBT participants in the last month was 0.55, compared with 9.33 in the treatment-as-usual group (p = 0.05). In another study of participants in inpatient settings, after 1 year, 62% of DBT participants and 31% of wait-list control participants abstained from NSSI behavior (p < 0.05).
1 year of DBT also improved some measures of psychological, social, and global adjustment. DBT participants were significantly more likely to have drug-free urine screens and reported significantly less binging or purging behavior associated with eating disorders.
In a randomized controlled trial comparing DBT to treatment by experts (TBE), after 1 year of treatment, 23.1% of DBT participants reported suicide attempts, compared with 46.7% of TBE patients (p = 0.005). In seven randomized controlled trials, DBT reduced Nonsuicidal Self-Injury (NSSI) behavior over the course of 1-year treatment. DBT led to significantly more improvement than wait list, treatment as usual, or other active control conditions in five of the seven trials, and in the other two trials, DBT led to the same reduction in NSSI behavior as an active treatment control group. Probability levels ranged from less than 0.01 to less than 0.05. In one study, after 1 year of treatment, the mean number of NSSI behaviors among DBT participants in the last month was 0.55, compared with 9.33 in the treatment-as-usual group (p = 0.05). In another study of participants in inpatient settings, after 1 year, 62% of DBT participants and 31% of wait-list control participants abstained from NSSI behavior (p < 0.05).
1 year of DBT also improved some measures of psychological, social, and global adjustment. DBT participants were significantly more likely to have drug-free urine screens and reported significantly less binging or purging behavior associated with eating disorders.
About this Promising Practice
Organization(s)
Behavioral Tech, LLC
Primary Contact
Behavioral Tech, LLC
1107 NE 45th Street, Suite 230
Seattle, WA 98105
(206) 675-8588
info@behavioraltech.org
http://www.behavioraltech.org
1107 NE 45th Street, Suite 230
Seattle, WA 98105
(206) 675-8588
info@behavioraltech.org
http://www.behavioraltech.org
Topics
Health / Mental Health & Mental Disorders
Health / Alcohol & Drug Use
Health / Alcohol & Drug Use
Organization(s)
Behavioral Tech, LLC
Source
SAMHSA's National Registry of Evidence-Based Practices and Programs
Date of publication
Oct 2006
Date of implementation
1993
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