Mastering DBT: Essential Skills for Emotional Regulation

Introduction to DBT

Dialectical Behavior Therapy (DBT) is a comprehensive evidence-based intervention originally developed by Dr. Marsha Linehan to treat individuals with borderline personality disorder (BPD) (Linehan, 1993). Over time, it has been adapted to address various mental health issues, including emotion regulation difficulties, suicidal ideation, self-harm, and co-occurring disorders such as substance use and eating disorders. Grounded in both cognitive-behavioral and mindfulness practices, DBT offers a structured approach to help individuals manage intense emotions and build a life worth living.

How Does DBT Work?

The core principles of DBT center on balancing acceptance and change. It incorporates strategies from behavioral science, dialectical philosophy, and Zen mindfulness to help individuals achieve emotional regulation and interpersonal effectiveness. The "dialectical" component refers to the integration of opposing concepts—accepting oneself while striving for growth.

DBT’s effectiveness lies in its structured treatment framework, which includes four modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. These modules address skill deficits common in individuals with severe emotional dysregulation. For example, research demonstrates that DBT significantly reduces self-harming behaviors and hospitalizations among people with BPD (Kliem et al., 2010).

Techniques and Strategies

1. Mindfulness
   Mindfulness is the foundation of DBT, teaching individuals to observe and accept their thoughts, feelings, and surroundings without judgment.

   A specific exercise is the "What and How" skill, where clients practice observing, describing, and participating in the moment with mindfulness strategies like deep breathing or body scanning.

2. Distress Tolerance
   These techniques aim to help individuals manage crises without worsening the situation.

   For instance, the TIPP skill (Temperature, Intense exercise, Paced breathing, Paired muscle relaxation) can be used during moments of extreme distress to calm the body and mind.

3. Emotion Regulation
   This module focuses on identifying and changing intense emotional reactions.

   An example is the "PLEASE" skill, which addresses vulnerability factors like poor physical health or sleep.

4. Interpersonal Effectiveness
   These strategies enhance communication and assertiveness while maintaining self-respect and relationships.

   For instance, the DEAR MAN skill (Describe, Express, Assert, Reinforce, Mindful, Appear confident, Negotiate) helps clients navigate difficult conversations.

In-Depth Analysis of DBT Skills

Dialectical Behavior Therapy (DBT) includes a set of skills aimed at improving emotional regulation, interpersonal effectiveness, mindfulness, and distress tolerance. Below is a detailed analysis of several essential DBT skills, including what they stand for, how to practice them, and examples of how they can be used.

1. What and How Skill

• What it stands for:
  The "What" and "How" skills are foundational aspects of DBT's Mindfulness module. They refer to how one approaches the present moment and how to engage in mindful behavior.

• How to Practice:

  • What Skills:

    These skills focus on the basics of observing, describing, and participating in the present moment.

    • Observe:

      Notice what is happening in the present without judgment. This involves simply noticing thoughts, feelings, and physical sensations.

    • Describe:

      Put into words what you observe, focusing on specific details.

    • Participate:

      Fully engage in the activity at hand without self-consciousness. This means immersing oneself in the experience, whether it’s a conversation or task, without distraction.

  • How Skills:

    These skills focus on how you engage in an activity, emphasizing being effective and non-judgmental.

    • One-mindfully:

      Focus on one thing at a time, blocking out distractions. This helps reduce impulsivity and enhances the ability to stay present.

    • Effectively:

      Approach situations in a way that gets the desired result. Be realistic, and avoid distractions or overly complex solutions.

    • Non-judgmentally:

      Focus on being non-evaluative. Accept things as they are without labeling them as good or bad.

• Example:
  A person experiencing anxiety might use the “What” skills to observe their physical symptoms (e.g., rapid heartbeat), describe them as sensations (e.g., "I feel tense in my chest"), and then participate by focusing on breathing exercises. They can practice “How” by focusing on breathing one breath at a time, staying present, and accepting the anxiety without labeling it as “bad.”

2. TIPP Skill (Temperature, Intense Exercise, Paced Breathing, Progressive Muscle Relaxation)

• What it stands for:
  TIPP is an acronym for four Distress Tolerance skills used to quickly reduce intense emotions or panic.

  • T = Temperature

  • I = Intense Exercise

  • P = Paced Breathing

  • P = Progressive Muscle Relaxation

• How to Practice:

  • Temperature:

    Change your physical state by applying a cold stimulus (e.g., holding ice to your face or splashing cold water). This triggers a physiological response that can calm intense emotions.

  • Intense Exercise:

    Engage in intense physical activity like running, jumping jacks, or rapid walking. This helps discharge pent-up energy and lowers physiological arousal.

  • Paced Breathing:

    Practice slow, deep breathing (e.g., inhaling for a count of four, holding for four, exhaling for four) to regulate your body's stress response.

  • Progressive Muscle Relaxation:

    Tighten and then relax each muscle group in the body, starting from the toes up to the head. This promotes physical relaxation and reduces emotional tension.

• Example:
  When feeling overwhelmed by anger, a person might use TIPP by splashing cold water on their face (Temperature), followed by a short burst of jumping jacks (Intense Exercise), practicing slow breathing (Paced Breathing), and then completing a muscle relaxation exercise.

3. PLEASE Skill (Treating Physical Illness, Balanced Eating, Avoiding Mood-Altering Substances, Sleep, Exercise)

• What it stands for:
  The PLEASE skill is part of the Emotion Regulation module and is designed to improve overall emotional health by addressing basic physical needs.

  • P = Treat Physical Illness

  • L = Balanced Eating

  • E = Avoid Mood-Altering Substances

  • A = Sleep

  • S = Exercise

  • E = Emotional Self-Care (engage in activities that promote a positive emotional state)

• How to Practice:

  • Treat Physical Illness:

    Address any ongoing health concerns by seeking medical attention or taking prescribed medication. Illness can worsen emotional instability, so it’s essential to manage health proactively.

  • Balanced Eating:

    Eat regular, nutritious meals that stabilize blood sugar and provide energy. Avoid extremes such as skipping meals or overeating.

  • Avoid Mood-Altering Substances:

    Avoid substances like alcohol, drugs, or caffeine that can destabilize mood and worsen emotional dysregulation.

  • Sleep:

    Ensure adequate sleep (7-9 hours) to restore energy, improve cognitive function, and maintain emotional stability.

  • Exercise:

    Engage in regular physical activity, which helps to regulate mood and reduce stress. It can be anything from walking to more intense exercise.

  • Emotional Self-Care:

    Take care of your mental health by engaging in pleasurable activities, such as spending time with loved ones, hobbies, or mindfulness exercises.

• Example:
  A person struggling with emotional instability might use the PLEASE skill by ensuring they get enough sleep (Sleep), eating regularly to maintain blood sugar (Balanced Eating), and engaging in daily exercise, such as walking (Exercise).

4. DEARMAN Skill (Assertiveness Skill)

• What it stands for:
  The DEARMAN skill is part of the Interpersonal Effectiveness module, designed to help individuals assert their needs effectively.

  • D = Describe the situation

  • E = Express feelings and opinions

  • A = Assert your needs or request

  • R = Reinforce the benefits of the request

  • M = Mindfully stay focused on your goal

  • A = Appear confident

  • N = Negotiate if necessary

• How to Practice:

  • Describe: Objectively describe the situation without blaming.

  • Express: Share your feelings and thoughts about the situation.

  • Assert: Make your request clearly and directly.

  • Reinforce: Explain the positive outcome for both parties if your request is met.

  • Mindfully: Stay focused on the goal without getting distracted or defensive.

  • Appear: Maintain a calm and confident demeanor.

  • Negotiate: Be open to compromise and alternative solutions if necessary.

• Example:
  If a person needs more help at work, they might use DEARMAN by saying, “I’ve been feeling overwhelmed (Describe), and I need more assistance with the project (Assert). If you help me, it will make things much easier for both of us (Reinforce). Can you take on some of these tasks? (Assert) I’m committed to helping as well (Mindfully). I’m confident we can manage this together (Appear).”

5. Observe and Describe Mindfulness Skill

• What it stands for:
  This skill involves Mindfulness, helping individuals stay present and engaged without judgment.

• How to Practice:

  • Observe: Take notice of the environment, your thoughts, and feelings without attachment or judgment. Simply notice what’s going on.

  • Describe: Put into words what you observe, focusing on facts rather than interpretations or judgments.

• Example:
  While experiencing anxiety, a person might practice Observe and Describe by noticing, “I feel tightness in my chest and my mind is racing (Describe). I’m sitting at my desk, and the room is quiet (Observe).”

6. Opposite Action

• What it stands for:

  Opposite Action is part of Emotion Regulation, used to counteract negative emotions by doing the opposite of what the emotion urges.

• How to Practice:
  Identify the emotion and the action it would typically drive (e.g., anger leading to shouting). Then, choose the opposite action (e.g., remaining calm and using a neutral tone). This helps to change the emotional experience.

• Example:
  If feeling angry and wanting to withdraw, you might practice Opposite Action by engaging in a calm conversation or reaching out to a loved one.

7. GIVE Skill (Interpersonal Effectiveness)

• What it stands for:
  The GIVE skill is designed to improve communication in relationships by focusing on maintaining respect and warmth while asserting needs.

  • G = Gentle

  • I = Interested

  • V = Validate

  • E = Easy manner

• How to Practice:

  • Gentle: Avoid using attacks, sarcasm, or demanding language. Be respectful.

  • Interested: Show genuine interest in the other person’s perspective.

  • Validate: Acknowledge the other person’s feelings and experiences.

  • Easy manner: Keep the tone light and approachable.

• Example:
  If feeling upset with a friend, a person might use GIVE by saying, “I feel hurt (Validate), but I want to understand your side (Interested). I’d really appreciate it if we could talk calmly (Gentle), and we can find a way to solve this together (Easy manner).”

These DBT skills are integral to creating emotional stability and effective interpersonal interactions. By practicing these skills consistently, individuals can better manage their emotions, improve relationships, and enhance their quality of life.

Steps to Practice DBT

1. For Clinicians: Formal Training and Certification
Clinicians interested in practicing DBT must undergo specialized training to ensure they can effectively deliver the therapy’s components. Here’s what this entails:

• Training Programs:

  Organizations like Behavioral Tech, co-founded by Dr. Marsha Linehan, offer comprehensive training programs. These include foundational courses, advanced workshops, and team-based learning approaches.

• Supervision and Consultation:

  After completing formal training, clinicians typically participate in supervised practice or consultation groups. This ensures they can navigate the complexities of DBT, such as managing high-risk clients or balancing the dialectical approach of acceptance and change.

• Certification:

  Becoming certified as a DBT therapist involves demonstrating competency in core DBT principles and skills through rigorous evaluations. Certification programs, such as those by the Linehan Institute, standardize high-quality delivery of DBT.

2. For Individuals: Working with a Trained Therapist
For individuals seeking to practice DBT, partnering with a trained therapist is the ideal starting point. A DBT therapist provides tailored guidance and helps clients integrate DBT into their daily lives. Key elements include:

• Individual Therapy:

  Weekly sessions focus on personalized goals, addressing crises, and applying DBT skills to real-life situations. Therapists also use these sessions to review diary cards, which track emotional states and skill usage.

• Group Skills Training:

  In addition to individual therapy, DBT includes weekly group sessions. These sessions are led by therapists and focus on teaching and practicing DBT skills (mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness).

• Coaching Calls:

  Between sessions, clients may access brief coaching calls with their therapist to apply DBT skills during crises.

3. Self-Guided Practice with DBT Workbooks
Individuals who cannot access DBT therapy directly can benefit from self-guided workbooks based on DBT principles. Recommended resources include:

• Marsha Linehan’s Skills Training Manual for Treating Borderline Personality Disorder:

  This workbook offers comprehensive exercises and guidelines for practicing DBT skills.

• Supplementary Workbooks:

  Books like The Dialectical Behavior Therapy Skills Workbook by McKay, Wood, and Brantley provide simplified explanations and exercises for practicing skills independently.

4. Integrating DBT Into Therapy Sessions
For both clinicians and clients, incorporating DBT skills into therapy requires structure and consistency:

• Start with Mindfulness:

  Mindfulness is the foundation of DBT and can be integrated as the first skill in any session. Both therapists and clients can practice mindfulness exercises together to set the tone.

• Skill-Building:

  Sessions often follow a pattern: introducing a new skill, practicing it with examples or role-play, and reviewing how clients applied previous skills during the week.

• Use of Tools:

  Diary cards and behavior chains are essential tools in DBT.

  • Diary Cards:

    Help track emotions, behaviors, and skill use daily.

  • Behavior Chains:

    Map out triggers, responses, and consequences of specific behaviors to identify opportunities for skill use.

5. The Importance of Commitment
DBT requires a significant time and emotional investment from both clients and therapists. Key commitments include:

• Attending Regular Sessions:

  Clients must commit to weekly individual and group sessions.

• Practicing Skills Daily:

  Consistent daily practice of DBT skills is necessary for long-term change.

• Staying Engaged:

  Both clients and therapists must approach DBT with a collaborative and problem-solving mindset.

6. Tips for Starting DBT

• For Clinicians:

  • Join a consultation team to stay grounded in the dialectical approach.

  • Regularly revisit training material to strengthen your DBT delivery.

• For Clients:

  • Start with one module (e.g., mindfulness) and gradually build skills.

  • Use visual reminders, such as skill cards or posters, to stay engaged.

  • Practice skills during non-crisis moments to make them second nature when stress arises.

Who Benefits From DBT?

Primary Beneficiaries of DBT

1. Individuals with Borderline Personality Disorder (BPD)

   • Why it works:

     DBT was initially designed for individuals with BPD, a condition characterized by intense emotional dysregulation, unstable relationships, impulsive behaviors, and chronic suicidality.

   • Key outcomes:

     Research shows DBT reduces suicidal ideation, self-harm behaviors, and emotional distress in people with BPD. Over time, clients experience improved emotional stability, better interpersonal relationships, and an increased quality of life (Linehan et al., 2006).

2. Individuals Experiencing Chronic Suicidality or Self-Harm

   • Why it works:

     DBT addresses self-harm and suicidal behaviors by teaching distress tolerance and emotion regulation skills to manage crisis moments. It also includes coaching calls for real-time support.

   • Key outcomes:

     Studies have found a 50% reduction in suicide attempts in individuals with high suicidality who undergo DBT compared to other treatment modalities (Linehan et al., 2015).

3. People with Post-Traumatic Stress Disorder (PTSD)

   • Why it works:

     DBT helps individuals with PTSD manage hyperarousal, intrusive thoughts, and emotion dysregulation. Techniques like mindfulness and distress tolerance reduce the impact of trauma triggers.

   • Key outcomes:

     DBT-PTSD, an adaptation of DBT, has shown to significantly reduce trauma symptoms and improve emotional resilience (Bohus et al., 2013).

4. Adolescents with Emotional Dysregulation

   • Why it works:

     Adolescents often struggle with regulating emotions, managing interpersonal conflicts, and impulsive behaviors. DBT skills help them build healthier coping mechanisms and improve relationships.

   • Key outcomes:

     DBT for adolescents (DBT-A) is particularly effective in reducing suicidal ideation, self-harm, and risky behaviors. It also improves family dynamics by involving caregivers in the therapeutic process.

5. Individuals with Co-Occurring Disorders

   • Why it works:

     DBT effectively addresses co-occurring conditions, such as substance use disorders or eating disorders, alongside emotional dysregulation.

   • Key outcomes:

     For example, DBT-SUD, a variant for substance use, helps clients manage cravings, prevent relapse, and build healthier coping strategies while addressing the underlying emotional triggers for substance use (Axelrod et al., 2011).

Other Populations That Benefit

• People with Mood Disorders:

  DBT helps those with depression or bipolar disorder better regulate their emotional highs and lows.

• Neurodiverse Individuals:

  DBT can benefit individuals with autism spectrum disorder (ASD) or ADHD, particularly those who struggle with emotional dysregulation or interpersonal challenges.

• Adults with High-Functioning Anxiety:

  DBT’s mindfulness and emotion regulation skills can help reduce the intensity of anxious thoughts and promote greater self-acceptance.

Considerations for Enhancing Engagement

• For Clinicians:

  • Tailor the therapy to the individual’s needs and readiness.

  • Use motivational interviewing to help clients explore their willingness to engage in DBT.

  • Start with small, manageable steps to build momentum and confidence.

• For Clients:

  • Begin with one skill or module to avoid feeling overwhelmed.

  • Use DBT apps or visual aids to make practicing skills more accessible.

  • Seek out a therapist who emphasizes collaboration and fosters a supportive environment.

In summary, DBT offers transformative benefits for individuals with emotional dysregulation and high-risk behaviors, making it a leading intervention for conditions like BPD, PTSD, and more. However, it requires commitment, readiness, and the ability to engage in structured therapy, highlighting the importance of a tailored approach to maximize its effectiveness.

Evidence and Research

The efficacy of Dialectical Behavior Therapy (DBT) has been validated through numerous studies and meta-analyses, solidifying its position as a gold-standard treatment for emotional dysregulation and high-risk behaviors.

• Meta-Analysis Findings
  A meta-analysis by Kliem et al. (2010), which reviewed 16 studies involving DBT, found significant reductions in self-harm, suicidal behaviors, and other high-risk behaviors among individuals receiving DBT. These benefits were not only immediate but also sustained over time, emphasizing the long-term impact of the therapy. Participants also reported improved interpersonal functioning and quality of life, demonstrating DBT’s comprehensive approach to addressing emotional and behavioral challenges.

• DBT vs. Treatment-as-Usual (TAU)
  Linehan et al. (2015) conducted a landmark randomized clinical trial comparing DBT to treatment-as-usual (TAU) in individuals with borderline personality disorder and chronic suicidality. The study revealed that DBT significantly outperformed TAU in several key areas:

  • Reduction in Emotional Dysregulation:

    Participants reported fewer instances of emotional instability and reactive behaviors.

  • Lower Rates of Suicidal Behavior:

    DBT participants experienced a 50% reduction in suicide attempts compared to those receiving TAU.

  • Improved Functioning:

    Participants demonstrated better interpersonal relationships, increased coping skills, and higher overall life satisfaction.

• Adaptations for Specific Populations
  Research has also highlighted the effectiveness of DBT in populations beyond those with borderline personality disorder. For example:

  • Adolescents:

    A study by Mehlum et al. (2014) found that DBT-A (adapted for adolescents) reduced suicidal ideation and self-harm in teens, with improvements in family dynamics and emotional regulation.

  • Substance Use Disorders:

    DBT-SUD has shown promising results in reducing substance use, preventing relapse, and addressing co-occurring emotional dysregulation (Axelrod et al., 2011).

  • Post-Traumatic Stress Disorder (PTSD):

    DBT-PTSD has been effective in managing trauma-related symptoms, particularly in individuals with complex PTSD, by integrating trauma processing with DBT skills training (Bohus et al., 2013).

• Mechanisms of Action
  The effectiveness of DBT lies in its multi-faceted approach, targeting the following areas:

  • Skill Acquisition:

    Clients develop practical skills for mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness.

  • Behavioral Change:

    DBT uses behavioral analysis to identify and replace maladaptive behaviors with healthier alternatives.

  • Therapeutic Alliance:

    The strong, collaborative relationship between client and therapist fosters trust, motivation, and engagement in the therapeutic process.

• Statistical Evidence
  The results of various studies consistently highlight DBT's effectiveness:

  • Self-harm incidents are reduced by up to 70% after completing DBT (Kliem et al., 2010).

  • Over 80% of individuals who complete DBT report sustained emotional stability and improved functioning six months post-treatment (Linehan et al., 2015).

• Strength of DBT’s Research Base

  DBT’s robust evidence base distinguishes it from other therapeutic models. Its empirical support spans decades, populations, and diagnoses, making it one of the most versatile and reliable interventions in mental health care.

By combining rigorous research with practical strategies, DBT continues to transform the lives of individuals grappling with some of the most challenging mental health issues.

Real-Life Examples

Below are detailed real-life examples of individuals facing challenges and how they use DBT skills from each module to navigate their situations:

Mindfulness Skills

1. Example: A Student with Racing Thoughts During Exams

   • Situation: A college student experiences anxiety and racing thoughts before an important exam. They feel overwhelmed and can’t focus.

   • Skill: The "Observe and Describe" mindfulness skill.

   • Application:

     • They pause, take deep breaths, and begin to observe their surroundings—the sound of the clock ticking, the feel of their pen in their hand.

     • They describe their experience: "I feel a tightness in my chest and a lump in my throat. I’m thinking I’m going to fail."

     • By acknowledging and naming their emotions, they create mental distance from their anxiety and refocus on their exam.

Distress Tolerance Skills

1. Example: Managing a Panic Attack

   • Situation: An individual feels a panic attack coming on in a crowded mall.

   • Skill: TIPP (Temperature, Intense exercise, Paced breathing, Paired muscle relaxation).

   • Application:

     • They step outside and use the T (Temperature) skill by splashing cold water on their face, which activates the dive reflex and calms their body.

     • They perform Paced Breathing, inhaling for four counts and exhaling for eight.

     • As they calm down, they pair breathing with muscle relaxation, tensing and relaxing their shoulders and fists.

     • This helps the individual regain control and prevents the panic from escalating.

Emotion Regulation Skills

1. Example: Handling Anger at Work

   • Situation: An employee feels intense anger after receiving criticism from their manager during a team meeting.

   • Skill: Opposite Action.

   • Application:

     • Instead of impulsively reacting or leaving the meeting, the employee identifies the urge to lash out or shut down.

     • They choose to engage in the opposite action by smiling slightly, sitting upright, and responding in a calm tone, saying, "Thank you for the feedback; I’ll reflect on this and follow up."

     • Later, they use the Check the Facts skill to evaluate if the criticism was personal or constructive, reframing the situation rationally.

Interpersonal Effectiveness Skills

1. Example: Setting Boundaries in a Relationship

   • Situation: A young adult feels drained because their roommate frequently borrows their belongings without asking.

   • Skill: DEAR MAN (Describe, Express, Assert, Reinforce, Mindful, Appear confident, Negotiate).

   • Application:

     • Describe: "I’ve noticed you’ve borrowed my things without asking."

     • Express: "I feel frustrated because it makes me feel like my boundaries aren’t being respected."

     • Assert: "I need you to ask me before borrowing anything in the future."

     • Reinforce: "If you ask first, I’m more likely to feel comfortable sharing."

     • They stay Mindful, focusing on their goal despite the roommate’s defensiveness, and Appear Confident by maintaining a calm and steady tone.

     • If needed, they Negotiate, agreeing to share certain items but keeping others off-limits.

Combination of Skills in Real Life

1. Example: Coping After a Breakup

   • Situation: A person recently ended a long-term relationship and feels overwhelmed with sadness and loneliness.

   • Skills Used:

     • Mindfulness: They practice "Nonjudgmental Stance" by acknowledging their feelings without labeling them as bad or weak. "I’m sad, and that’s okay."

     • Distress Tolerance: They create a "Self-Soothing Kit" with comforting items like scented candles, a favorite book, and a playlist of calming music. During overwhelming moments, they use this kit to ground themselves.

     • Emotion Regulation: They use the "PLEASE" skill by ensuring they eat balanced meals, exercise lightly, and stick to a consistent sleep schedule to minimize emotional vulnerability.

     • Interpersonal Effectiveness: They reach out to a trusted friend using GIVE (Gentle, Interested, Validate, Easy manner) to share their feelings and gain support.

   Example: Parenting a Child with Emotional Outbursts

   • Situation: A parent struggles with their child’s frequent tantrums.

   • Skills Used:

     • Mindfulness: The parent practices "One-Mindfully" by giving their full attention to the child during a tantrum, rather than multitasking or reacting impulsively.

     • Distress Tolerance: They use the "STOP" skill (Stop, Take a step back, Observe, Proceed mindfully) when they feel triggered, ensuring their response is measured rather than reactive.

     • Emotion Regulation: The parent uses "Accumulate Positive Emotions" by scheduling pleasant activities with their child, such as a weekly game night, to strengthen their bond.

     • Interpersonal Effectiveness: They use DEAR MAN to advocate for additional support at school, requesting a meeting with the teacher to create a behavioral plan for the child.

Conclusion

DBT is a powerful, evidence-based approach that helps individuals build the skills necessary to navigate life’s challenges. It provides individuals with essential skills for managing intense emotions, improving relationships, and fostering mindfulness. By incorporating techniques such as Mindfulness, Distress Tolerance, and Interpersonal Effectiveness, DBT helps individuals create lasting changes in their emotional regulation and overall well-being. While it requires commitment and practice, DBT offers a powerful framework for those struggling with emotional dysregulation and interpersonal challenges, ultimately empowering them to lead more balanced and fulfilling lives.

References

• Axelrod, S. R., Perepletchikova, F., Holtzman, K., & Sinha, R. (2011). Emotion regulation and substance use: A dialectical behavior therapy model. Journal of Psychopathology and Behavioral Assessment, 33(3), 497-507. https://doi.org/10.1007/s10862-011-9251-x

• Bohus, M., Dyer, A. S., Priebe, K., Krüger, A., Kleindienst, N., Schmahl, C., & Steil, R. (2013). Dialectical behavior therapy for post-traumatic stress disorder (DBT-PTSD) compared with cognitive processing therapy in complex presentations of PTSD: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 81(4), 625–636. https://doi.org/10.1037/a0032606

• Kliem, S., Kröger, C., & Schwarzer, G. (2010). The efficacy of dialectical behavior therapy: A meta-analysis of randomized controlled trials. Journal of Consulting and Clinical Psychology, 78(6), 936–951. https://doi.org/10.1037/a0020641

• Linehan, M. M., Armstrong, H. E., Suarez, A., Allmon, D., & Heard, H. L. (1991). Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48(12), 1060–1064. https://doi.org/10.1001/archpsyc.1991.01810360024003

• Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard, H. L., & Lindenboim, N. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63(7), 757–766. https://doi.org/10.1001/archpsyc.63.7.757

• Linehan, M. M., Korslund, K. E., Harned, M. S., Gallop, R. J., Lungu, A., & Murray-Gregory, A. M. (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

• Mehlum, L., Tørmoen, A. J., Haga, L., Ramberg, M., & Johansen, R. E. (2014). Dialectical behavior therapy for adolescents with parasuicidal behavior: A randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 53(8), 876-884. https://doi.org/10.1016/j.jaac.2014.05.013