The document summarizes evidence from randomized clinical trials and studies supporting the effectiveness of Dialectical Behavior Therapy (DBT) for treating borderline personality disorder and other mental health conditions. Specifically, DBT has been shown to be effective in reducing self-harm, suicide attempts, depression, and treatment dropout rates while improving social and emotional adjustment. The document also notes some studies that did not find DBT to be more effective than other treatments or that had limitations.

1. Evidence base for DBT
Support for DBT
Randomized Clinical Trials = 7 with BPD
(see Lynch, Trost, Salsman, Linehan, 2007 and NICE Guidelines for BPD,
2009).
 Reducing:
 Suicide attempts and self-injury
 Medical risk
 Premature drop-out
 Inpatient/ER admissions and days
 Drug abuse
 Depression, hopelessness, anger
Increasing:
 Global adjustment
 Social adjustment
DBT has recently been conceptualized as a treatment with utility for
intervening with difficult-to-treat & multiply-disordered clients not
just BPD
(Linehan, Bohus, & Lynch, 2007; Lynch et al., 2006).
Randomized Clinical Trials = Three for Treatment Resistant Depression and
Emotionally Constricted Personality Disorders
(Lynch et al., 2003; 2006; Harley et al., 2008)
 DBT Superior to Controls:
Reducing:
 Interpersonal Sensitivity (2006)
 Interpersonal Aggression (2006)
 Depressive symptoms (2008)
 Quicker reductions in depression (2006)
Increasing:
 Depression remission (2003)
Verheul et al. (2004): Lower attrition rates than other treatments, Better at reducing
self-harm in fairly severe self-harm group, Can effectively treat people with substance
misuse problems, No better at reducing suicide than TAU, No better at reducing
depression than TAU
Stanley et al. (1998). DBT better than treatment as usual (TAU): self-mutilation,
suicidal ideation, suicidal urges, urges to self-mutilate
Miller & Rathmus (1991). DBT better than TAU: treatment drop-out, inpatient psych
days, (outpatient adolescents).DBT = TAU suicide attempts However, DBT subject
group had much higher initial rates of suicide attempts
McCann & Ball (1996). DBT pre-treatment scores better than post-treatment scores:
depressed and hostile mood, paranoia, psychotic behaviours, maladaptive
interpersonal coping styles, staff burn-out (trend) (forensic inpatients).

2. Bohus et al. (2001). DBT vs. waiting list: the people who had the greatest response as
measured by the difference in individual pre and post measures were all in the DBT
group. (German inpatients)
Linehan et al. (1999). DBT better than TAU: dropouts, dirty urine post treatment
(drug use), global adjustment, social adjustment
Manchester, New Hampshire study. People receiving DBT showed 77% decrease in
hospital days, 76% decrease in partial hospital days, 56% decrease in crisis beds, 80%
decrease in face-to-face contact with emergency services, and significant increase in
outpatient services.
Linehan et al. (1991, 1992, 1993, 1994). DBT better than TAU: % of subjects with
parasuicidal behaviour, number of parasuicides, medical risk of parasuicide, treatment
drop-outs, psychiatric inpatient days, anger, social adjustment, global adjustment.
DBT is about 50% of TAU: inpatient days, self-harm, A&E, MAU, therapy drop out.
Koons, et al. (2001). DBT better than TAU: number of parasuicides (at start DBT
group had higher incidence of parasuicide), SI, depression, hopelessness, anger out.
Katz et al (2004). DBT better than TAU: decreased behavioural incidents (number of
incident reports). (inpatient adolescents) study compared outcome of patients before
and after DBT was implemented on the ward.
Barley et al. (1993). Psychodynamic unit incorporates DBT skills training. Rates of
parasuicide post DBT significantly lower than pre DBT.
Trupin et al.(in press) DBT vs TAU: behavioural problems (Parasuicide, aggression,
class disruption) in DBT cottage significantly higher pre-DBT, but decreased
significantly compared to other cottage. Staff in juvenile offenders in mental health
cottages used significantly fewer restrictive, punitive responses than those in other
cottage.
Verheul et al. (2004) DBT>TAU: retention rates, reductions in self-harm especially in
those with history of frequent self-harm.
Data which do not support DBT above other treatments
Linehan (2002). Opiate dependent women, DBT no better than validation and 12
steps. Worse drop-out rate.
Linehan (1993). General psychotherapy with or without DBT skills group – DBT
group no better than other.
Leichsenring & Leibing (2003). meta-analysis. Empirical data needs improving, but
both CBT (including DBT) and Psychodynamic therapy seem to work.

3. Stanley et al (1998) DBT = TAU depression, hopelessness and global adjustment
scores
Linehan et al (1999) DBT vs TAU for sample of substance abusers: no significant
difference parasuicide episodes and anger.
Linehan et al. (1991,1992,1993,1994). DBT vs TAU: no significant difference pre-
treatment >12 month, depression, hopelessness, suicide ideation.
Katz et al. (2004) DBT= TAU for sample of adolescent inpatients: parasuicidal
behaviour, depressive symptoms, and SI at 1 year.
Verheul et al. (2004) DBT=TAU, DBT pre=DBT post: Suicidal behaviours, self-harm
in patients who infrequently self-harm.
DBT studies are small, few randomized controlled trials, amount of DBT given
varied, adherence to the manual varies.
References
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