Dialectical Behavior Therapy (DBT) reduced suicide attempts by half compared with other types of psychotherapy available in the community in patients with borderline personality disorder, an NIMH-funded study has found. DBT also excelled at reducing use of emergency room and inpatient services and more than halved therapy dropout rates compared to the mostly traditional approaches, report Marsha Linehan, Ph.D., University of Washington, and colleagues in the July 2006 issue ofArchives of General Psychiatry.
“All treatments are not equal for such suicidal patients,” said Linehan.
Borderline personality disorder is a difficult-to-treat mental illness affecting up to two percent of adults, 5.8-8.7 million Americans, mostly young women. People with this disorder of emotion regulation experience intense bouts of anger, depression, and anxiety that may last only hours, often in response to perceived rejection. They typically have tumultuous work and family life and may engage in risky, impulsive behaviors. Cutting, burning and other forms of self-harm are common, with up to 9% ultimately killing themselves. Although they account for at least 20 percent of psychiatric inpatient admissions, and frequently seek mental health services, patients with the disorder often fail to respond to commonly available treatments.
Hence, NIMH has supported the development and testing of DBT by Linehan and her colleagues over the past two decades. This variation on cognitive behavioral therapy specifically targets suicidal behavior, behaviors that interfere with treatment, and risky social behaviors. While previous controlled trials had demonstrated DBT’s usefulness, whether this was attributable to psychotherapy generally rather than to specific features of DBT remained unclear.
To help resolve this issue, the researchers created a more tightly-defined comparison condition. They treated for one year 101 female patients with borderline personality disorder, ages 18-45, in the Seattle area with either currently available “Treatment By Experts” (TBE) in the community, or therapists specifically trained in DBT.
The 52 patients randomly assigned to the DBT group received one hour of individual therapy and 2.5 hours of group skills training each week, in addition to phone consultations. DBT focused on improving patients’ coping skills and motivation by helping them reduce interfering emotions and thinking and reinforce functional behaviors. Their 16 DBT therapists also met weekly to enhance their motivation and skills.