Topic: Suicide, Emotional Competency, Depression, Case Management
Target Population: Adults
Sector: Community-Based
Military Sector: All Branches
This program is for adults who have borderline personality disorder (BPD) and engage in self-harming behaviors.
Standard Dialectical Behavior Therapy (DBT) for Adults with Borderline Personality Disorder (BPD) (Standard DBT), a community-based program, is a cognitive behavioral treatment that utilizes acceptance strategies and skills training that is designed to help individuals eliminate self-harm behaviors (e.g., self-cutting, suicide attempts), improve management of emotions and relationships, and live more rewarding and satisfying lives.
Modified versions of DBT have been used with various populations; however, only evaluations among individuals with BPD were included in this review. Results from several randomized trials have demonstrated significant decreases in suicidal and non-suicidal self-injurious behaviors, depression, psychiatric hospitalizations, and BPD symptom severity. Additional quasi-experimental and single group studies have demonstrated consistent results. In several randomized trials that evaluated DBT at 1-year post-treatment (e.g., 2 years from the beginning of treatment), results indicated maintenance of these effects.
DBT focuses on finding a balance between acceptance and validation of the client just as he or she is and fostering positive behavioral change. Therapy intends to help clients notice when they get entrenched in their own perspective and simultaneously learn to identify the truth in another person’s perspective that might be missing from their own viewpoint. This process can help clients move away from extreme emotions or positions and encourage them to move forward in life and reach their goals. DBT consists of the following four components:
DBT was originally created as a treatment for adults with BPD; however, the program has been offered as a treatment for other conditions such as depression, anxiety, eating disorders, posttraumatic stress disorder, substance use disorders, and other conditions such as bipolar disorder and ADHD.
DBT has been used in the United States and in several other countries since 1993. This therapy has been used with Service members and veterans.
Clinicians facilitate this program, and implementation of DBT requires that the clinician joins a consultation team of three to eight clinicians who practice DBT, share clinical challenges, and seek advice from peers. Training is required, and options include online, on- and off-site in-person, or self-study. For information and training costs, please visit https://behavioraltech.org/upcoming-trainings/
Considerations for implementing this program include acquiring buy-in and commitment from participants, understanding facilitators must obtain training and must join a team of other professional clinicians, and realizing some costs could be associated with acquiring implementation materials.
The Clearinghouse can help address these considerations. Please call 1-877-382-9185 or email Clearinghouse@psu.edu
If you are interested in implementing Standard DBT, the Clearinghouse is interested in helping you!
Please call 1-877-382-9185 or email Clearinghouse@psu.edu
Standard DBT is a 1-year treatment program that involves weekly, individual sessions; weekly, group skills training; and telephone consultations with a therapist as needed. Individual sessions are 1 to 1.5 hours each. Group skills training sessions last 2 to 2.5 hours each.
Implementation costs vary. Please use details in the Contact section for a list of products and costs.
To move Standard DBT to the Effective category on the Clearinghouse Continuum of Evidence an external evaluation should be performed that demonstrates positive effects lasting at least one year from program completion or two years from the beginning of the program. This study should be conducted independently of the program developer.
The Clearinghouse can help you develop an evaluation plan to ensure the program components are meeting your goals. Please call 1-877-382-9185 or email Clearinghouse@psu.edu
Contact the Clearinghouse with any questions regarding this program.
Phone: 1-877-382-9185 Email: Clearinghouse@psu.edu
You may also contact Behavioral Tech Institute by phone 1-206-222-3489 or visit https://behavioraltech.org/contact/
https://behavioraltech.org/, https://dialecticalbehaviortherapy.com/, and Linehan et al. (2006).
Assmann, N., Schaich, A., Arntz, A., Wagner, T., Herzog, P., Alvarez-Fischer, D., … Fassbinder, E. (2024). The effectiveness of dialectical behavior therapy compared to schema therapy for borderline personality disorder: A randomized clinical trial. Psychotherapy and Psychosomatics, 93(4), 249-263. https://doi.org/10.1159/000538404
Barnicot, K., & Crawford, M. (2019). Dialectical behaviour therapy v. mentalisation-based therapy for borderline personality disorder. Psychological Medicine, 49(12), 2060-2068. https://doi.org/10.1017/S0033291718002878
Ip, J. W. Y., McMain, S. F., Chapman, A. L., & Kuo, J. R. (2024). The role of emotion dysregulation and interpersonal dysfunction in nonsuicidal self-injury during dialectical behavior therapy for borderline personality disorder. Behaviour Research and Therapy, 180, 104594. https://doi.org/10.1016/j.brat.2024.104594
Koons, C. R., Robins, C. J., Tweed, J. L., Lynch, T. R., Gonzalez, A. M., Morse, J. Q., … Bastian, L. A. (2001). Efficacy of dialectical behavior therapy in women veterans with borderline personality disorder. Behavior Therapy, 32(2), 371-390. https://doi.org/10.1016/S0005-7894(01)80009-5
Linehan, M. M., Armstrong, H. E., Suarez, A., Allmon, D., & Heard, H. L. (1991). Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48(12), 1060-1064. https://doi.org/10.1001/archpsyc.1991.01810360024003
Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard, H. L., … Lindenboim, N. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63(7), 757-766. https://doi.org/10.1001/archpsyc.63.7.757
Linehan, M. M., Heard, H. L., & Armstrong, H. E. (1993). Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patients. Archives of General Psychiatry, 50(12), 971-974. https://doi.org/10.1001/archpsyc.1993.01820240055007
McMain, S. F., Chapman, A. L., Kuo, J. R., Dixon-Gordon, K. L., Guimond, T. H., Labrish, C., … Streiner, D. L. (2022). The effectiveness of 6 versus 12 months of dialectical behavior therapy for borderline personality disorder: A noninferiority randomized clinical trial. Psychotherapy and Psychosomatics, 91(6), 382-397. https://doi.org/10.1159/000525102
McMain, S. F., Links, P. S., Gnam, W. H., Guimond, T., Cardish, R. J., Korman, L., & Streiner, D. L. (2009). A randomized trial of dialectical behavior therapy versus general psychiatric management for borderline personality disorder. The American Journal of Psychiatry, 166(12), 1365-1374. https://doi.org/10.1176/appi.ajp.2009.09010039
Salamin, V., Kratzel, A., Gothuey, I., & Guenot, F. (2021). Compliant patients with borderline personality disorder non-responsive to one-year dialectical behavior therapy: Outcomes of a second year. Journal of Behavioral and Cognitive Therapy, 31(2), 115-124. https://doi.org/10.1016/j.jbct.2021.01.001
Verheul, R., van den Bosch, L. M., Koeter, M. W., de Ridder, M. A., Stijnen, T., & van den Brink, W. (2003). Dialectical behaviour therapy for women with borderline personality disorder: 12-month, randomised clinical trial in the Netherlands. The British Journal of Psychiatry, 182(2), 135-140. https://doi.org/10.1192/bjp.182.2.135
Walton, C. J., Bendit, N., Baker, A. L., Carter, G. L., & Lewin, T. J. (2020). A randomised trial of dialectical behaviour therapy and the conversational model for the treatment of borderline personality disorder with recent suicidal and/or non-suicidal self-injury: An effectiveness study in an Australian public mental health service. Australian and New Zealand Journal of Psychiatry, 54(10), 1020-1034. https://doi.org/10.1177/0004867420931164
Wibbelink, C. J. M., Kamphuis, J. H., Sinnaeve, R., Grasman, Raoul P. P. P, Alberts, J., Alkema, M., … Arntz, A. (2026). Dialectical behavior therapy vs schema therapy for patients with borderline personality disorder: The BOOTS multicenter randomized clinical trial. JAMA Psychiatry, https://doi.org/10.1001/jamapsychiatry.2026.0418
Alavi, N., Stephenson, C., & Rivera, M. (2021). Effectiveness of delivering dialectical behavioral therapy techniques by email in patients with borderline personality disorder: Nonrandomized controlled trial. JMIR Mental Health, 8(4), e27308. https://doi.org/10.2196/27308
Brodsky, B. S., Galfalvy, H., Mann, J. J., Grunebaum, M. F., & Stanley, B. (2025). Dialectical behavior therapy versus serotonin reuptake inhibitor treatment for suicidal behavior in borderline personality disorder: A randomized controlled trial. The American Journal of Psychiatry, 182(12), 1083-1092. https://doi.org/10.1176/appi.ajp.20240298
Fox, E., Krawczyk, K., Staniford, J., & Dickens, G. L. (2015). A service evaluation of a 1-year dialectical behaviour therapy programme for women with borderline personality disorder in a low secure unit. Behavioural and Cognitive Psychotherapy, 43(6), 676-691. https://doi.org/10.1017/S1352465813001124
Gaillard, C., Salamin, V., Gothuey, I., & Guenot, F. (2025). Longitudinal trajectory of borderline symptoms and associated problematic behaviors throughout a standard 12-month dialectical behavior therapy in adults with borderline personality disorder. Journal of Personality Disorders, 39(5), 388-417. https://doi.org/10.1521/pedi.2025.39.5.388
Gillespie, C., Murphy, M., & Joyce, M. (2022). Dialectical behavior therapy for individuals with borderline personality disorder: A systematic review of outcomes after one year of follow-up. Journal of Personality Disorders, 36(4), 431-454.
Gregory, R. J., & Sachdeva, S. (2016). Naturalistic outcomes of evidence-based therapies for borderline personality disorder at a medical university clinic. American Journal of Psychotherapy, 70(2), 167-184. https://doi.org/10.1176/appi.psychotherapy.2016.70.2.167
Guillén Botella, V., García-Palacios, A., Bolo Miñana, S., Baños, R., Botella, C., & Marco, J. H. (2021). Exploring the effectiveness of dialectical behavior therapy versus systems training for emotional predictability and problem solving in a sample of patients with borderline personality disorder. Journal of Personality Disorders, 35(Supplement A), 21-38.
Hernandez-Bustamante, M., Cjuno, J., Hernández, R. M., & Ponce-Meza, J. C. (2024). Efficacy of dialectical behavior therapy in the treatment of borderline personality disorder: A systematic review of randomized controlled trials. Iranian Journal of Psychiatry, 19(1), 119-129. https://doi.org/10.18502/ijps.v19i1.14347
Linehan, M. M., Korslund, K. E., Harned, M. S., Gallop, R. J., Lungu, A., Neacsiu, A. D., … Murray-Gregory, A. (2015). Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: A randomized clinical trial and component analysis. JAMA Psychiatry, 72(5), 475-482. https://doi.org/10.1001/jamapsychiatry.2014.3039
Murphy, A., Bourke, J., Flynn, D., Kells, M., & Joyce, M. (2020). A cost-effectiveness analysis of dialectical behaviour therapy for treating individuals with borderline personality disorder in the community. Irish Journal of Medical Science, 189(2), 415-423. https://doi.org/10.1007/s11845-019-02091-8
Panos, P. T., Jackson, J. W., Hasan, O., & Panos, A. (2014). Meta-analysis and systematic review assessing the efficacy of dialectical behavior therapy (DBT). Research on Social Work Practice, 24(2), 213-223. https://doi.org/10.1177/1049731513503047
Vonderlin, R., Boritz, T., Claus, C., Senyüz, B., Mahalingam, S., Tennenhouse, R., . . . Bohus, M. (2025). Acceptance, safety, and effect sizes in online dialectical behavior therapy for borderline personality disorder: Interventional pilot study. JMIR Formative Research, 9, e66181. https://doi.org/10.2196/66181
Wilks, C. R., Korslund, K. E., Harned, M. S., & Linehan, M. M. (2016). Dialectical behavior therapy and domains of functioning over two years. Behaviour Research and Therapy, 77, 162-169. https://doi.org/10.1016/j.brat.2015.12.013
