Dialectical Behavior Therapy (DBT) Lessens Suicide Attempts in High-Risk Women

DBT treatment

Originally developed to treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD), Dialectical Behavior Therapy (DBT) has since demonstrated success in treating a wide range of additional mental health disorders including depression, post-traumatic stress disorder (PTSD), eating disorders, and substance dependence.

Because DBT is especially effective in treating those who demonstrate greater impulsivity and difficulty in regulating their emotions, it ultimately presents an ideal treatment option for those struggling with suicidal feelings and non-suicidal self-injury (NSSI). The multiple components of DBT (individual therapy, skills training, telephone coaching, and team consultation) have been used independently and in combination to treat those exhibiting suicidal ideation.

In an effort to better understand the effectiveness of DBT’s various components on treating high suicide-risk individuals with borderline personality disorder, a randomized clinical trial was conducted. The primary objective of the study was to assess the significance of the skills training component of DBT.

The study, led by DBT founder Dr. Marsha Linehan, included 99 women diagnosed with borderline personality disorder who had at least two suicide attempts and/or non-suicidal self-injury (NSSI) acts in the last five years, an NSSI act or suicide attempt in the eight weeks before screening, and one suicide attempt in the past year.

The women (mean age 30 years; 71% white) were equally split into three separate treatment groups. Each group used the DBT Suicide Risk Assessment and Management protocol for its participants. The first group received a combination of DBT skills training (DBT-S) and case management to substitute for individual therapy; the second group received DBT individual therapy (DBT-I) along with an activities group to replace DBT skills training, which allowed therapists to focus on the patients’ existing skills; and the third group received standard DBT that included both individual therapy and skills training.

The encouraging results were conclusive in regard to DBT’s overall effectiveness of   reducing suicidal tendencies. Authors of the study found all three treatment options helped to lessen not just suicidal ideation and suicide attempts, but also the severity of self-injury and the need for crisis services due to suicidality. In addition, the DBT interventions in all three groups resulted in a marked increase in group participant’s expressed reasons to live.

It should be noted that while each DBT intervention proved effective in reducing suicidal tendencies, none stood out as a singular, definitive approach to working with this specific population. “Contrary to our expectations, standard DBT was not superior to either comparison condition for any suicide-related outcome, and no significant differences were detected between DBT-S and DBT-I,” said the study’s author. “Thus, all three versions of DBT were comparably effective at reducing suicidality among individuals at high risk for suicide.”