Data Show That DBT Reduces Suicidal Behavior

By Jancin, Bruce | Clinical Psychiatry News, July 2006 | Go to article overview
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Data Show That DBT Reduces Suicidal Behavior


Jancin, Bruce, Clinical Psychiatry News


SEATTLE -- Dialectical behavior therapy possesses far and away the strongest evidence base of any treatment aimed at reducing suicidal behavior, Marsha M. Linehan, Ph.D., said at the annual conference of the American Association of Suicidology.

"There's no other therapy I know of that can show as many randomized studies all with the same effect size. There's consistency from the first study done in 1991 to now. So DBT is not a fluke. It is effective for suicidal behavior. Most people don't know that," said Dr. Linehan, professor of psychology and director of the behavioral research and therapy clinics at the University of Washington, Seattle.

Indeed, most therapists think of DBT in connection with borderline personality disorder (BPD), the challenging psychiatric condition for which Dr. Linehan initially developed the therapy a quarter century ago. DBT is now widely accepted as the first-line therapy for BPD based on nine randomized controlled trials.

Dr. Linehan has since gone on to systematically apply DBT for eating disorders, heroin addiction, and suicidal behavior, all in the context of comorbid borderline personality disorder.

"I know everybody thinks of me as the BPD person, but I've actually never thought of myself that way. I've always thought of myself as a suicide person. It just turns out that BPD is the only disorder where actual suicidal behavior is part of the diagnostic criteria," she said.

"BPD is the disorder of suicide experts," the psychotherapist asserted. "It should be, because that's where most of the suicidal people are. Not all of them, but a lot of them."

It's well known that BPD affects 1%-2% of the general population, and that the disorder is associated with an extremely high suicide rate of about 10%. Much less widely known is that BPD has been systematically excluded from most psychological autopsy studies because of the ranking system used. If a patient had BPD and major depression, for example, only major depression would usually get listed. A closer look at the excluded data reveals that a very large proportion of suicide completers meet diagnostic criteria for BPD.

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