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9: Dialectical Behavioral Therapy

Risk Management and Treatment » Non-pharmacologic Interventions
9: Dialectical Behavioral Therapy

There is insufficient evidence to recommend for or against using dialectical behavioral therapy (DBT) to reduce suicidal ideation and the risk of suicide attempts or suicide.

Strength:

Neither for nor against

Category:

ReviewedNew-replaced

Grades and Definitions

Strong for
or "We recommend offering this option …"
Weak for
or "We suggest offering this option …"
No recommendation
or "There is insufficient evidence …"
Weak against
or "We suggest not offering this option …"
Strong against
or "We recommend against offering this option …"

Categories and Definitions

Evidence Reviewed* Recommendation Category* Definition*
Reviewed New-added New recommendation following review of the evidence
New-replaced Recommendation from previous CPG that has been carried over to the updated CPG that has been changed following review of the evidence
Not changed Recommendation from previous CPG that has been carried forward to the updated CPG where the evidence has been reviewed but the recommendation is not changed
Amended Recommendation from the previous CPG that has been carried forward to the updated CPG where the evidence has been reviewed and a minor amendment has been made
Deleted Recommendation from the previous CPG that has been removed based on review of the evidence
Not reviewed Not changed Recommendation from previous CPG that has been carried forward to the updated CPG, but for which the evidence has not been reviewed
Amended Recommendation from the previous CPG that has been carried forward to the updated CPG where the evidence has not been reviewed and a minor amendment has been made
Deleted Recommendation from the previous CPG that has been removed because it was deemed out of scope for the updated CPG
*Adapted from the NICE guideline manual (2012): The guidelines manual. London: National Institute for Health and Care Excellence;2012. and Martinez Garcia L, McFarlane E, Barnes S, Sanabria AJ, Alonso-Coello P, Alderson P. Updated recommendations: An assessment of NICE clinical guidelines. Implement Sci. 2014;9:72.

Recommendation Resources

The skills taught in Dialectical Behavior Therapy (DBT) are meant to target the factors maintaining clients' suicidal behaviors and include mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness. The structure of DBT involves individual psychotherapy, group skills training, in-the-moment phone coaching, and a DBT consultation team for therapists.

For more information about what DBT is, please see this behavioraltech.org DBT explanation.

Training and Clinical Resources

This section includes links to resources to help connect providers to DBT training in the community and in the VA.

DBT in the Community
Behavioral Tech logo Behavioral Tech Trainings Online Behavioral Tech is a Linehan Institute training company that provides DBT trainings.
Behavioral Tech Trainings in Person
Portland DBT Trainings
DBT in VA
The "DBT in VA" links can only be accessed through VA's intranet and at this time cannot be accessed externally. If you are an outside provider who is interested in learning more about DBT in VA, please contact Laura Meyers, Ph.D., ABPP.
VA DBT Training (VA Intranet access required)
VA DBT Programs (VA Intranet access required)
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Treatment Manuals

This section includes links to the treatment manuals and resources required for DBT including the DBT skills training manual, DBT handouts and worksheets, and a standard DBT diary card.

Resources Required for Full DBT / DBT Manuals
Book cover graphic for DBT Skills Training Handouts and Worksheets DBT Skills Training Handouts and Worksheets: Second Edition Marsha Linehan's (2015) DBT Skills Training Handouts and Worksheets provides the handouts and worksheets necessary for teaching clients DBT skills.
DBT Skills Training Manual: Second Edition
Standard DBT Diary Card
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Videos

This section includes video resources supporting the application of DBT skills.

DBT Skills Videos
DBT-RU skills videos (Shireen Rizvi)
Shireen Rizvi and Jesse Finkelstein's DBT-RU videos provide brief descriptions of how to use specific DBT skills with corresponding animations to improve the accessibility of these skills.
DBT Mindfullness Skills Playlist
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Books

This section includes links to books that are recommended regarding DBT and components of DBT (e.g., chain analysis).

Introduction to DBT and Implementing DBT for Providers
Book cover image for Doing Dialectical Behavior Therapy Doing Dialectical Behavior Therapy: A Practical Guide Kelly Koerner's (2011) book Doing DBT: A Practical Guide provides an accessible introduction to DBT with step-by-step descriptions and clinical vignettes to illustrate the application of DBT for clients with histories of suicidal self-directed violence.
The Oxford Handbook of DBT
Implementing Chain Analysis and Case Conceptualization
Book cover image for Chain Analysis in Dialectical Behavior Therapy Chain analysis in Dialectical Behavior Therapy Shireen Rizvi's (2019) book Chain Analysis in Dialectical Behavior Therapy breaks down the process of the behavioral chain analysis in DBT and provides clinical examples demonstrating the application of chain analysis.
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Webinars

This section includes links to webinars that are recommend regarding DBT and components of DBT (e.g., chain analysis).

Introduction to DBT Webinars
CPG Webinars graphic An Introduction to Dialectical Behavior Therapy Presented by Dr. Sara Landes, this webinar provides an introduction to DBT ideal for those who are new to DBT and those who are interested in making client referrals to DBT programs.
CPG Webinar Cultural Considerations in DBT Presented by Dr. Meredith Sears
CPG Webinar Dialectical Behavior Therapy via Telehealth Presented by Dr. Sara Landes
CPG Webinar Suicide Prevention 2.0 Clinical Telehealth Program Presented by Dr. Jessica A Walker
Webinar icon Intro to DBT video from 2011 Conference of the National Educational Alliance for Borderline Personality Disorder (Alan Fruzzetti)
Webinars Supporting Chain Analysis
CPG WebinarUsing Chain Analysis to Assess and Intervene on Suicidal Ideation and Behavior Presented by Drs. Lauren Borges & Sean Barnes
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Mobile Applications

This section includes links to mobile applications that are relevant to DBT.

DBT Diary Card & Skills Coach app logo DBT Diary Card & Skills Coach The "DBT Diary Card & Skills Coach" application was developed by Sammy Banawan of Durham DBT to help clients practice being more effective with their DBT skills.
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Podcasts

This section includes links to podcast series and podcast episodes that are relevant to DBT.

Short Takes on Suicide Prevention logo Rocky Mountain Short Takes on Suicide Prevention: Chain Analysis for Suicidal Thoughts and Behaviors In this episode of "Short Takes on Suicide Prevention" Lauren Borges and Sean Barnes highlight the utility of chain analysis as a method of therapeutic risk management of suicidal self-directed violence.
Podcast IconA Podcast with Charlie: To Hell and Back. In Collaboration with National Education Alliance for Borderline Personality Disorder.
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Articles

This section includes links to articles where the clinical application of DBT is described.

Implementing DBT Skills
Borges, L. M., Nazem, S., Matarazzo, B. B., Barnes, S. M., & Wortzel, H. S. (2019). Therapeutic risk management: Chain analysis of suicidal ideation and behavior. Journal of Psychiatric Practice, 25(1), 46-53. https://doi.org/10.1097/PRA.0000000000000358
DeCou, C. R., Comtois, K. A., & Landes, S. J. (2019). Dialectical Behavior Therapy Is Effective for the Treatment of Suicidal Behavior: A Meta-Analysis. Behavior therapy, 50(1). 60–72. https://doi.org/10.1016/j.beth.2018.03.009
Fox, K. R., Huang, X., Guzmán, E. M., Funsch, K. M., Cha, C. B., Ribeiro, J. D., & Franklin, J. C. (2020). Interventions for suicide and self-injury: A meta-analysis of randomized controlled trials across nearly 50 years of research. Psychological bulletin, 146(12). 1117–1145. https://doi.org/10.1037/bul0000305
Lynch, T. R., Chapman, A. L., Rosenthal, M. Z., Kuo, J. R., & Linehan, M. M. (2006). (2006). Mechanisms of change in dialectal behavior therapy: Theoretical and empirical observations. Journal of Clinical Psychology, 62, 459-480. https://doi.org/10.1002/jclp.20243
Rizvi, S. L. & Ritschel, L. A. (2014). Mastering the art of chain analysis in dialectical behavior therapy. Cognitive and Behavioral Practice, 21, 335-349. https://doi.org/10.1016/j.cbpra.2013.09.002
Rizvi, S. L. & Sayrs, J. H. R (2020). Assessment driven case formulation and treatment planning in dialectical behavior therapy: Using principles to guide effective treatment. Cognitive and Behavioral Practice, 27(1), 4-14. https://doi.org/10.1016/j.cbpra.2017.06.002
Swales, M. & Dunkley, C. (2020). Principles of Skills Assessment in DBT. Cognitive and Behavioral Practice, 27(1), 18-29. https://doi.org/10.1016/j.cbpra.2019.05.001
Witt, K. G., Hetrick, S. E., Rajaram, G., Hazell, P., Taylor Salisbury, T. L., Townsend, E., & Hawton, K. (2021). Psychosocial interventions for self-harm in adults. The Cochrane database of systematic reviews, 4(4). CD013668. https://doi.org/10.1002/14651858.CD013668.pub2
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