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Dialectical Behavior Therapy Study by Linehan

Borderline Personality Disorder is a mental illness that has been difficult to treat using traditional forms of psychotherapy. This disorder affects up to two percent of our population, 5.8-8.7 million Americans, mostly young women. People who have this disorder frequently experience intense bouts of depression, anger, and anxiety that might last only hours, often in response to perceived rejection. A new form of psychotherapy called Dialectical Behavior Therapy has been developed as a therapeutic response to help people with these special needs.

The National Institute of Mental Health (NIMH) has supported the development and testing of Dialectical Behavior Therapy by Marsha Linehan and her colleagues over the past two decades. This therapy is a variation on Cognitive-Behavioral Therapy that specifically targets suicidal behavior, behaviors that interfere with treatment, and risky social behaviors – all characteristics of Borderline Personality Disorder.

While previous controlled trials had demonstrated the usefulness of Dialectical Behavior Therapy, whether this usefulness was attributable to psychotherapy in general rather than to specific features of Dialectical Behavior Therapy remained unclear.

Therefore, to help resolve this issue, the researchers created a more tightly-defined comparison condition: for one year, they treated 101 female patients with Borderline Personality Disorder, ages 18-45, with either currently available "Treatment By Experts" (TBE) in the community, or therapists specifically trained in Dialectical Behavior Therapy.

The 52 patients randomly assigned to the Dialectical Behavior Therapy 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 therapists also met weekly to enhance their motivation and skills.

The 49 patients who received TBE were offered one weekly therapy session plus additional treatment as needed, at the discretion of the therapists. Most of them received psychodynamic therapy, which focused on gaining insight into unconscious motives, needs and defenses of the patients, rather than directly on their behavior change.

Although Dialectical Behavior Therapy patients were provided with significantly more therapy within the study, the two groups ended up with about the same total therapy hours, since TBE patients were more prone to switching therapists and seeing therapists outside the study. The risk of dropping out of therapy was nearly three times higher among the TBE group — 59 percent dropped their first assigned therapist, compared to 25 percent of DBT patients. More than twice as many of the former also dropped out of the study entirely. Fewer DBT patients continued taking psychotropic medications during the study year, perhaps reflecting their therapists' behaviorally-focused treatment philosophies.

While there were no completed suicides, 46.7 percent of the TBE and 23.1 percent of the DBT patients did attempt suicide during the study year. Among TBE patients, 57.8 percent visited Emergency Rooms for psychiatric problems, compared to 43.1 percent among DBT patients. 48.9 percent of TBE patients had at least one psychiatric hospitalization, often for suicidal thoughts, in contrast to 19.6 percent of DBT patients. No significant differences emerged between the groups in proneness to non-suicidal self-injury, and both therapies reduced patients' suicidal thinking and strengthened their appreciation of life.

Noting that Dialectical Behavior Therapy is the only psychosocial treatment shown in multiple randomized clinical trials to be effective for Borderline Personality Disorder, Linehan and the other researchers suggested that "DBT may be uniquely effective in treating suicidal individuals" who have Borderline Personality Disorder.

About the Author

David Oliver is the founder of BorderlineCentral.com a one stop source of information on how to cope and deal with borderline personality disorder.

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