Dialectical behaviour therapy (DBT; Linehan, 1993) is based on the principle that BPD is essentially the result of deficits in interpersonal and self-regulatory skills and that these skills can be taught in therapy. Defective affect regulation is seen as particularly important. Treatment consists of weekly individual and group therapy sessions based on a skills-training model, together with out-of-hours telephone contact with the therapist.
Dialectical behaviour therapy has been shown, in a single study, to be superior to 'treatment as usual' in reducing self-harm and time spent in hospital, but not subjective experiences such as depression and hopelessness (Linehan et al, 1991). There were also significant improvements in social and global functioning and anger (Linehan et al, 1994). However by one year after the end of treatment, rates of self-harm were no different in the DBT group and treatment-as-usual groups, although both had improved (Linehan et al, 1993).
Despite this essentially negative finding, DBT has attracted considerable interest; however, Linehan's study is open to a number of methodological criticisms. Only 39 patients were studied, all of them female, and of these only 20 were fully assessed. The level of self-harm required for entry into the study (two episodes in the last five years and one in the last eight weeks) may have led to the inclusion of patients who were less severely disturbed than those commonly seen in clinical practice. Furthermore, DBT involves a high level of input from professionals and it is not yet clear whether it is the skills training itself or simply the high level of support which leads to the reduction in self-harm.
-Anthony P. Winston, "Recent Developments in Borderline Personality Disorder" (2000)
This assessment of DBT surprised me. I had never heard negative remarks about this therapeutic approach before. Reading Linehan's dense tome on CBT for borderlines helped me a lot in reconfiguring my attitudes. The idea of radical acceptance was at first a big frustrating puzzle to me - another opaque window - but gradually it settled inside me as something useful that I can draw on, especially regarding family relationships.
Anybody else have thoughts on DBT, CBT, Linehan, or this methodological critique from Winston?