A Review of Dialectical Behavior Therapy
DOI:
https://doi.org/10.47941/japsy.3160Keywords:
Dialectical Behavior Therapy; Borderline Personality Disorder; Emotion Regulation; Skills Training; Multicultural AdaptationAbstract
Purpose: This review examines Dialectical Behavior Therapy (DBT), developed by Marsha M. Linehan, focusing on its theoretical foundations, treatment components, empirical efficacy, and adaptations for diverse clinical populations and settings.
Methodology: A synthesis of empirical studies, meta-analyses, and clinical manuals was conducted to evaluate DBT and its adaptations, including DBT for Adolescents (DBT-A) and DBT Skills Training for Emotional Problem Solving for Adolescents (DBT STEPS-A).
Findings: DBT is effective for borderline personality disorder, suicidality, eating disorders, depression, anxiety, and substance use across adolescents and adults. DBT-A reduces self-harm and suicidal ideation, particularly with family involvement, while DBT-STEPS-A shows promise in school settings. However, research gaps remain in cultural adaptations, social justice practices, and cost-effective delivery models.
Unique Contribution to Theory, Practice, and Policy: The review highlights the need for culturally responsive DBT protocols, school-based and telehealth delivery, and policies supporting equitable access. Future research should examine culturally adapted interventions, evaluate cost-effectiveness, and compare DBT with other evidence-based treatments to enhance its global relevance and impact.
Downloads
References
Adrian, M., McCauley, E., Berk, M. S., Asarnow, J. R., Korslund, K., Avina, C. & Linehan, M. M. (2019). Predictors and moderators of recurring self-harm in adolescents participating in a comparative treatment trial of psychological interventions. Journal of child psychology and psychiatry, 60(10), 1123-1132. https://doi.org/10.1111/jcpp.13099
Barlow, D. H. (2004). Psychological treatments. American Psychologist, 59(9), 869-879. https://doi.org/10.1037/0003-066X.59.9.869
Bernal, G., Jiménez-Chafey, M. I., & Domenech Rodríguez, M. M. (2009). Cultural adaptation of treatments: A resource for considering culture in evidence-based practice. Professional Psychology, Research and Practice, 40(4), 361-368. https://doi.org/10.1037/a0016401
Bolden, L. S., Gaona, L., McFarr, L., & Comtois, K. (2020). DBT–ACES in a multicultural community mental health setting: implications for clinical practice. In J. Bedics (Ed.), The handbook of dialectical behavior therapy (pp. 307-324). Elsevier. https://doi.org/10.1016/B978-0-12-816384-9.00014-2
Carey, B. (2011, June 23). Expert on mental illness reveals her own fight. The New York Times, A1.
Chapman, A. L. (2006). Dialectical behavior therapy: Current indications and unique elements. Psychiatry, 3(9), 62-68.
Chen, E., Matthews, L., Allen, C., Kuo, J., & Linehan, M. (2008). Dialectical behavior therapy for clients with binge eating disorder or bulimia nervosa and borderline personality disorder. International Journal of Eating Disorders, 41(6), 505-512. https://doi.org/10.1002/eat.20522
Cheng, P.-H., & Merrick, E. (2017). Cultural adaptation of dialectical behavior therapy for a Chinese international student with eating disorder and depression. Clinical Case Studies, 16(1), 42–57. https://doi.org/10.1177/1534650116668269
Chidiac, Carole Wehbe. (2019). An update on the medical consequences of anorexia nervosa. Current Opinion in Pediatrics, 31(4), 448-453. https://doi.org/10.1097/MOP.0000000000000755
Chugani, C. D., Murphy, C. E., Talis, J., Miller, E., McAneny, C., Condosta, D., ... & Mazza, J. J. (2022). Implementing dialectical behavior therapy skills training for emotional problem solving for adolescents (DBT STEPS-A) in a low-income school. School Mental Health, 14(2), 391-401. https://doi.org/10.1007/s12310-021-09472-4
Crowell, S. E., Beauchaine, T. P., & Linehan, M. M. (2009). A biosocial developmental model of borderline personality: Elaborating and extending Linehan’s theory. Psychological Bulletin, 135(3), 495-510. https://doi.org/10.1037/a0015616
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
Delgado, R., & Stefancic, J. (2017). Critical race theory: An introduction. NyU press.
Dimidjian, S., & Linehan,M. M. (2003). Defining an agenda for future research on the clinical application of mindfulness practice. Clinical Psychology: Science and Practice, 10(2), 166-171. https://doi.org/10.1093/clipsy.bpg019
Domenech Rodríguez, M. M., & Bernal, G. (2012). Bridging the gap between research and practice in a multicultural world. In G. Bernal & M. M. Domenech Rodríguez (Eds.), Cultural adaptations: Tools for evidence-based practice with diverse populations (pp. 265-287). American Psychological Association. https://doi.org/10.1037/13752-013
Flynn, D., Joyce, M., Weihrauch, M., & Corcoran, P. (2018). Innovations in practice: Dialectical behavior therapy - skills training for emotional problem solving for adolescents (DBT STEPS- A): Evaluation of a pilot implementation in Irish post-primary schools. Child and Adolescent Mental Health, 23(4), 376-380. https://doi.org/10.1111/camh.12284
Fox, K. R., Huang, X., Guzman, 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
Frances, A. (2020). Forward. In M. M. Linehan, Building a life worth living: A memoir (pp. xi-xii). Random House.
Haft, S. L., O’Grady, S. M., Shaller, E. A. L., & Liu, N. H. (2022). Cultural Adaptations of Dialectical Behavior Therapy: A Systematic Review. Journal of Consulting and Clinical Psychology. Advance online publication. http://dx.doi.org/10.1037/ccp0000730
Hall, G. C. N., Ibaraki, A. Y., Huang, E. R., Marti, C. N., & Stice, E. (2016). A meta-analysis of cultural adaptations of psychological interventions. Behavior Therapy, 47(6), 993-1014. https://doi.org/10.1016/j.beth.2016.09.005
Hayes, S. C., Villatte, M., Levin, M., & Hildebrandt, M. (2011). Open, aware, and active: Contextual approaches as an emerging trend in the behavioral and cognitive therapies. Annual Review of Clinical Psychology, 7, 141-168. https://doi.org/10.1146/annurev-clinpsy-032210-104449
Henrich, J., Heine, S. J., & Norenzayan, A. (2010). The weirdest people in the world? Behavioral and Brain Sciences, 33(2-3), 61-83. https://doi.org/10.1017/S0140525X0999152X
Kamody, R. C., Thurston, I. B., & Burton, E. T. (2020). Acceptance-based skill acquisition and cognitive reappraisal in a culturally responsive treatment for binge eating in adolescence. Eating Disorders: The Journal of Treatment & Prevention, 28(2), 184-201. https://doi.org/10.1080/10640266.2020.1731055
Kinsey, K. M. (2014). A critical ethnography of the compatibility of a culturally modified dialectical behavior therapy with Native American culture and context. The University of Arizona.
Koons, C. R., Robins, C. J., Lindsey Tweed, J., Lynch, T. R., Gonzalez, A. M., Morse, J. Q., Bishop, G. K., Butterfield, M. I., & Bastian, L. A. (2001). Efficacy of dialectical behavior therapy in women veterans with borderline personality disorder. Behavior Therapy, 32(2), 371-390. https://doi.org/10.1016/S0005-7894(01)80009-5
Kothgassner, O., Goreis, A., Robinson, K., Huscsava, M., Schmahl, C., & Plener, P. (2021). Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: A systematic review and meta-analysis. Psychological Medicine, 51(7), 1057-1067. https://doi.org/10.1017/S0033291721001355
La Roche, M. J. (2013). Cultural psychotherapy; theory, methods, and practice. Sage.
La Roche, M. J., D'Angelo, E., Gualdron, L., & Leavell, J. (2006). Culturally sensitive guided imagery for allocentric Latinos: A pilot study. Psychotherapy: Theory, Research, Practice, Training, 43(4), 555-560. https://doi.org/10.1037/0033-3204.43.4.555
Linardon, J., Fairburn, C. G., Fitzsimmons-Craft, E. E., Wilfley, D. E., & Brennan, L. (2017). The empirical status of the third-wave behavior therapies for the treatment of eating disorders: A systematic review. Clinical psychology review, 58, 125-140. https://doi.org/10.1016/j.cpr.2017.10.005
Linehan, M. M. (2020). Building a life worth living: A memoir. Random House.
Linehan, M. (2014). DBT skills training manual. Guilford Press.
Linehan, M. M. (1993). Cognitive behavioral treatment of borderline personality disorder. Guildford Press.
Linehan, M. M., Korslund, K. E., Harned, M., Gallop, R., Lungu, A., Neacsiu, A., McDavid, J., Comtois, K. A., & Murray-Gregory, A. (2015). Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: A randomized clinical trial and component analysis. JAMA Psychiatry, 72(5), 475-482. https://doi.org/10.1001/jamapsychiatry.2014.3039
Linehan, M. M., Schmidt, H., Dimeff, L. A., Craft, J. C., Kanter, J., & Comtois, K. A. (1999). Dialectical behavior therapy for patients with borderline personality disorder and drug-dependence. American Journal on Addictions, 8(4), 279-292. https://doi.org/10.1080/105504999305686
Martinez Jr., R. R., Marraccini, M. E., Knotek, S. E., Neshkes, R. A., & Vanderburg, J. (2021). Effects of dialectical behavior therapy skills training for emotional problem solving for adolescents (DBT STEPS-A) program of rural ninth-grade students. School Mental Health, 14, 165-178. https://doi.org/10.1007/s12310-021-09463-5
Mazza, J., Dexter-Mazza, E., Miller, A., Rathus, J., & Murphy, H. (2016). DBT skills in schools: Skills training for emotional problem solving for adolescents (DBT STEPS-A). Guilford Press.
McFarr, L., Gaona, L., Barr, N., Ramirez, U., Henriquez, S., Farias, A., & Flores, D. (2014). Cultural considerations in dialectical behavior therapy. In A. Masuda (Ed.), Mindfulness and acceptance in multicultural competency: A contextual approach to sociocultural diversity in theory and practice (pp. 75-92). Context Press/New Harbinger Publications.
Mercado, A., & Hinojosa, Y. (2017). Culturally adapted dialectical behavior therapy in an underserved community mental health setting: A Latina adult case study. Practice Innovations, 2(2), 80-93. https://doi.org/10.1037/pri0000045
Miller, A. L., Rathus, J. H., & Linehan, M. M. (2017). Dialectical behavior therapy with suicidal adolescents. Guilford Press.
Neacsiu, A., Eberle, J., Kramer, R., Wiesmann, T., & Linehan, M. (2014). Dialectical behavior therapy skills for transdiagnostic emotion dysregulation: A pilot randomized controlled trial. Behavior Research and Therapy, 59, 40-51. https://doi.org/10.1016/j.brat.2014.05.005
O’Donohue, W. T. (2005). Cultural sensitivity: A critical examination. In R. H. Wright & N. Cummings (Eds.), Destructive trends in mental health (p. 29-44). Routledge.
Panepinto, A., Uschold, C., Olandese, M., & Linn, B. (2015). Beyond borderline personality disorder: dialectical behavior therapy in a college counseling center. Journal of College Student Psychotherapy, 29(3), 211-226. https://doi.org/10.1080/87568225.2015.1045782
Pierson, A. M., Arunagiri, V., & Bond, D. M. (2022). “You didn’t cause racism, and you have to solve it anyways”: Antiracist adaptations to dialectical behavior therapy for White therapists. Cognitive and Behavioral Practice, 29(4), 796-815. https://doi.org/10.1016/j.cbpra.2021.11.001
Rathod, S., Gega, L., Degnan, A., Pikard, J., Khan, T., Husain, N., Munshi, T., & Naeem, F. (2018). The current status of culturally adapted mental health interventions: A practice-focused review of meta-analyses. Neuropsychiatric Disease and Treatment, 14(1), 165-178. https://doi.org/10.2147/NDT.S138430
Rathus, J. H., & Miller, A. L. (2015). DBT skills manual for adolescents. Guilford Publications.
Ritschel, L., Lim, N., & Stewart, L. (2015). Transdiagnostic applications of DBT for adolescents and adults. American Journal of Psychotherapy, 69(2), 111-128. https://doi.org/10.1176/appi.psychotherapy.2015.69.2.111
Rizvi, S. L., Steffel, L. M., & Carson-Wong, A. (2013). An overview of dialectical behavior therapy for professional psychologists. Professional Psychology: Research and Practice, 44(2), 73-80. https://doi.org/10.1037/a0029808
Salter, P., & Adams, G. (2013). Toward a critical race psychology. Social and Personality Psychology Compass, 7(11), 781-793. https://doi.org/10.1111/spc3.12068
Santiago-Rivera, A. L., Arredondo, P., & Gallardo- Cooper, M. (2002). Counseling Latinos and la familia; A practical guide. Sage.
Smythe, J., Colebourn, C., Prisco, L., Petrinic, T., & Leeson, P. (2021). Cardiac abnormalities identified with echocardiography in anorexia nervosa: Systematic review and meta-analysis. The British Journal of Psychiatry, 219(3), 477-486. https://doi.org/10.1192/bjp.2020.1
Springer, T., Lohr, N. E., Buchtel, H. A., & Silk, K. R. (1996). A preliminary report of short-term cognitive-behavioral group therapy for inpatients with personality disorders. The Journal of Psychotherapy Practice and Research, 5(1), 57-71.
van Hoeken, D., & Hoek, H. W. (2020). Review of the burden of eating disorders: mortality, disability, costs, quality of life, and family burden. Current opinion in psychiatry, 33(6), 521-527. https://doi.org/10.1097/YCO.0000000000000641
Vogel, E. N., Singh, S., & Accurso, E. C. (2021). A systematic review of cognitive behavior therapy and dialectical behavior therapy for adolescent eating disorders. Journal of eating disorders, 9(1), 1-38. https://doi.org/10.1186/s40337-021-00461-1
Wilks, C., Ang, S., Matsumiya, B., Lungu, A., & Linehan, M. (2017). Internet-delivered dialectical behavioral therapy skills training for suicidal and heavy episodic drinkers: Protocol and preliminary results of a randomized controlled trial. JMIR Research Protocols, 25(6), e207. https://doi.org/10.2196/resprot.7767
Wisniewski, L., & Kelly, E. (2003). The application of dialectical behavior therapy to the treatment of eating disorders. Cognitive and Behavioral Practice, 10(2), 131-138. https://doi.org/10.1016/S1077-7229(03)80021-4
Wyman, P. A. (2014). Developmental approach to prevent adolescent suicides: Research pathways to effective upstream preventive interventions. American Journal of Preventive Medicine, 47(3), S251-S256.https://doi.org/10.1016/j.amepre.2014.05.039
Yao, S., Kuja-Halkola, R., Martin, J., Lu, Y., Lichtenstein, P., Norring, C., ... & Strengman, E. (2019). Associations between attention-deficit/hyperactivity disorder and various eating disorders: a Swedish nationwide population study using multiple genetically informative approaches. Biological psychiatry, 86(8), 577-586. https://doi.org/10.1016/j.biopsych.2019.04.036
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Aazi Ahmadi, Jessica Gerthe

This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution (CC-BY) 4.0 License that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.