Why dialectical behavior therapy is so effective for multiple disorders
by MATTHEW MCKAY, PHD
Dialectical behavior therapy (DBT), with its four key skills (mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness), was originally developed to treat Axis II borderline personality disorder (Linehan, 1993). All the early research focused on DBT's ability to reduce hospitalization rates, suicide attempts, parasuicidal behaviors, therapy interfering behaviors, and emotion dysregulation. The outcomes of multiple studies have shown that DBT successfully targets some of the most disabling and life-threatening symptoms of borderline personality disorder.
Early on, seeing the treatment's marked success, many clinicians began to wonder whether DBT's emotion regulation skills could be helpful for other disorders. Thomas Marra, in his book DIALECTICAL BEHAVIOR THERAPY IN PRIVATE PRACTICE (2005), argued that DBT could be used with any disorder driven by emotion regulation problems. These would include Axis I diagnoses of anxiety, depression, certain eating disorders, and anger management problems. Now, the research is starting to come in that provides support for the utility of DBT with multiple Axis I problems.
DBT appears to have a positive impact on anxiety (Robins & Chapman, 2004), bulimia (Telch, Agras & Linehan, 2001), bipolar disorder (Goldstein, Axelson, Birmaher & Brent, 2007), substance abuse (Linehan, Schmidt, Dimeff, Craft, Kanter & Comptois, 1999), and domestic violence (Fruzzetti & Levensky, 2000). The ability of DBT's emotion regulation skills to reduce substance abuse relapse is particularly promising. If emotion regulation skills are taught while a person is receiving substance abuse treatment, relapse rates are far lower than with substance abuse treatment alone.
Why is DBT proving helpful with multiple disorders? It seems clear that emotion dysregulation is the driving force behind many problems, not just borderline personality disorder, and treating it can make a huge difference in people's lives. A pattern of over-intense emotional response, whether learned or hardwired, can be replaced with more effective coping skills. These skills are both specific (see the four DBT skills above) and highly learnable.
More and more, psychology will be moving from specific treatment protocols for each disorder to modular treatments that target the underlying driving factors that create most symptoms. DBT's focus on treating emotion dysregulation is an excellent example of where we are heading?a single treatment process that successfully impacts multiple problems.
by MATTHEW MCKAY, PHD
Dialectical behavior therapy (DBT), with its four key skills (mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness), was originally developed to treat Axis II borderline personality disorder (Linehan, 1993). All the early research focused on DBT's ability to reduce hospitalization rates, suicide attempts, parasuicidal behaviors, therapy interfering behaviors, and emotion dysregulation. The outcomes of multiple studies have shown that DBT successfully targets some of the most disabling and life-threatening symptoms of borderline personality disorder.
Early on, seeing the treatment's marked success, many clinicians began to wonder whether DBT's emotion regulation skills could be helpful for other disorders. Thomas Marra, in his book DIALECTICAL BEHAVIOR THERAPY IN PRIVATE PRACTICE (2005), argued that DBT could be used with any disorder driven by emotion regulation problems. These would include Axis I diagnoses of anxiety, depression, certain eating disorders, and anger management problems. Now, the research is starting to come in that provides support for the utility of DBT with multiple Axis I problems.
DBT appears to have a positive impact on anxiety (Robins & Chapman, 2004), bulimia (Telch, Agras & Linehan, 2001), bipolar disorder (Goldstein, Axelson, Birmaher & Brent, 2007), substance abuse (Linehan, Schmidt, Dimeff, Craft, Kanter & Comptois, 1999), and domestic violence (Fruzzetti & Levensky, 2000). The ability of DBT's emotion regulation skills to reduce substance abuse relapse is particularly promising. If emotion regulation skills are taught while a person is receiving substance abuse treatment, relapse rates are far lower than with substance abuse treatment alone.
Why is DBT proving helpful with multiple disorders? It seems clear that emotion dysregulation is the driving force behind many problems, not just borderline personality disorder, and treating it can make a huge difference in people's lives. A pattern of over-intense emotional response, whether learned or hardwired, can be replaced with more effective coping skills. These skills are both specific (see the four DBT skills above) and highly learnable.
More and more, psychology will be moving from specific treatment protocols for each disorder to modular treatments that target the underlying driving factors that create most symptoms. DBT's focus on treating emotion dysregulation is an excellent example of where we are heading?a single treatment process that successfully impacts multiple problems.
