DBT Literature.
Latest Literature on Benefits of Dialectical Behaviour Therapy (DBT)
Marsha Linehan developed Dialectical Behaviour Therapy (DBT), based on principles of Cognitive Behaviour Therapy (CBT) in the 1980s. The strongest support for CBT is in anxiety disorders, somatoform disorders, bulimia, anger control problems and general stress (Hoffman 2012). CBT/DBT are behaviourist approaches, where psychological state can be changed by new learned behaviours, versus the psychoanalytic approach where reflection on causes help resolve conflicts and improve psychological state. Linehans first experimental study in 1991 on chronically parasuicidal borderline patients, follow up study on parasuicide in 1993 and then on Interpersonal Outcomes in Borderline Personality Disorder (BPD) in 1994 showed the value of DBT. BPD is a disorder characterized by severe disturbances in emotional regulation. Emotional dysregulation emerges because of biological predisposition, vulnerabilities and invalidating environmental experiences (McMain 2001).
A review by Robins (2004) shared the growth in use of DBT beyond patients with BPD, including substance use disorders, eating disorders, depression, and attention deficit/hyperactivity disorder. Berking (2012) similarly suggests that emotional dysregulation occurs in many mental illnesses, including somatoform disorders and a variety of psychopathological conditions.
However, a meta-analysis and systematic review by Panos (2014), based on PRISMA guidelines, show only a marginal improvement with DBT versus treatment as usual for decreasing life-threatening suicidal and parasuicidal acts, attrition, and depression (explicitly with BPD). A systematic review on DBT for emotional regulation difficulties by Harvey (2019), using PRISMA guidelines, indicated that DBT does not show consistent benefits relative to existing psychological treatments. This systematic review was limited to studies that used the construct of emotional regulation as per the Difficulties in Emotion Regulation Scale. A Systematic Review and Meta-Analysis by Kothgassner (2021), using the PRISMA guidelines, on the efficacy of DBT on adolescent self-harm and suicidal ideation showed small to moderate effects, compared to controls. There were larger effect sizes in pre-post evaluations. Another systematic review on the effectiveness of DBT for improving mood symptoms in bipolar disorders by Jones (2023), using PRISMA guidelines, showed that DBT may be an effective treatment for bipolar disorders.
The evidence around DBT is growing albeit slowly. The perceived weakness with scrutiny using evidence-based medicine approach is not unusual given the difficulties around randomized controlled trials in mental health. A systematic review by Berg (2010) of the effectiveness of psychotherapy for adults with depression found that psychotherapy does make a difference but no more so than antidepressants. A Cochrane Review by Gastoldon (2018) found that psychological therapies for the treatment of mental disorders in low- and middle-income countries affected by humanitarian crises showed low quality evidence for benefit.
See a list of research in Marsha Linehans unit at Washington University.
http://depts.washington.edu/uwbrtc/research/publications/
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