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Introduction
Originally developed in 1993 by Marsha Linehan, dialectical behaviour therapy (DBT) is a cognitive behaviour-based treatment primarily designed for women displaying parasuicidal behaviour and who have a diagnosis of borderline personality disorder (BPD) (Linehan, 1993a, b). The primary aim of DBT is to reduce the presence of life-threatening suicidal behaviour, and does this by integrating cognitive, behavioural and spiritual techniques (Blennerhassett and O’Raghallaigh, 2005).
DBT is designed to meet five functions: enhancing the patient’s capabilities; improving the patient’s motivation; generalising skills learnt to everyday life; enhancing the therapists motivation and capabilities; and structuring the environment to support what has been learnt (Rizvi et al., 2013). It does this using a treatment model which involves weekly group skills training and individual therapy, both delivered by trained DBT therapists. Telephone consultation between client and therapists is also offered as well as therapist’s attendance at weekly peer-to-peer supervisory consult sessions, which aim to reduce therapist burnout and increase adherence to the DBT model. DBT aims to address the key components of BPD which are considered problematic and distressing for the individual, including confusion over self-identity, emotional instability, interpersonal problems and impulsive behaviour (Berzins and Trestman, 2004). It does this by teaching the clients skills through four psychoeducational skills modules: core mindfulness; emotional regulation; interpersonal effectiveness; and distress tolerance. Within individual therapy clients also address a hierarchy of treatment targets beginning with life-threatening and self-injurious behaviours, followed by decreasing therapy interfering behaviours (e.g. non-attendance, avoidance of session content), quality of life interfering behaviours (e.g. substance abuse, frequent use of crisis) and finally the development and generalisation of learned skills (Robins and Chapman, 2004).
DBT research
DBT has been recommended as a suitable treatment for male and female clients with BPD (National Institute for Health and Care Excellence, 2009). This follows a number of randomised control trials with females diagnosed with BPD which support outcomes of reductions in parasuicidal behaviour, depression, hospitalisation and substance abuse (e.g. Harned et al., 2010; Koons et al., 2001; Linehan et al., 1991, 2006; Neacsiu et al., 2010; van den Bosch et al., 2005; Verheul et al., 2003). In addition, DBT has been applied to different client groups, including parasuicidal women (Linehan et al., 2006); suicidal male...