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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.

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
Topics
Health / Mental Health & Mental Disorders
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
For more details
http://behavioraltech.org/resources/whatisDBT.cfm

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An Evidence-Based Practice meets the following HCI criteria:

  1. The program description includes at a minimum: the sponsoring organization, program goals, program implementation steps, and outcomes that have demonstrated program success in achieving the program goal in one or more localities.
  2. The results from an evaluation of the program include quantitative measures showing improvement in the outcome(s) of interest after the implementation of the program (i.e. increase in smoking cessation, not just the delivery of a smoking cessation program). The outcome measure(s) is/are compared at relevant time periods before and after the intervention or program implementation. Alternatively, the evaluation study compares the outcome(s) between an intervention group and an appropriate control group.
  3. The study is of peer-review quality and presents numbers in a scientific manner; measurements of precision and reliability are included (e.g. confidence intervals, standard errors), results from statistical tests show a significant difference or change in the outcome measure(s), and relevant point estimates and p-values are presented. Note: if the results from an evaluation of a program are presented in a scientific manner and the outcome measure is improved compared to the baseline measurement or the control group but the difference is not statistically significant, the practice is classified as effective and not evidence-based.