Primary Treatment Goal for Dialectical Behavior Therapy (DBT)
The primary treatment goal of DBT is to reduce suicidal and self-injurious behaviors in patients with borderline personality disorder, while simultaneously building skills in emotion regulation, distress tolerance, interpersonal effectiveness, and mindfulness. 1, 2
Core Treatment Targets
DBT was specifically developed to address the heightened risk of suicidal and non-suicidal self-directed violence in borderline personality disorder patients, making reduction of these life-threatening behaviors the paramount objective. 3, 1 The treatment operates on a hierarchical goal structure where:
- Life-threatening behaviors (suicidal ideation, suicide attempts, self-harm) are addressed first and take absolute priority 3, 4
- Therapy-interfering behaviors (treatment dropout, non-compliance) are targeted second to ensure patients remain engaged 5
- Quality-of-life interfering behaviors (substance abuse, relationship chaos) are addressed third once safety is established 5, 6
Mechanism of Action
DBT achieves these goals by treating borderline personality disorder fundamentally as a dysfunction of the emotion regulation system. 6 The therapy combines:
- Emotion regulation skills to help patients identify and modulate intense emotional reactions 1, 2
- Distress tolerance techniques teaching acceptance of painful situations and self-soothing without resorting to self-harm 2, 7
- Interpersonal effectiveness skills to navigate chaotic relationships and reduce fear of abandonment 1, 5
- Core mindfulness skills to increase present-moment awareness and reduce impulsive reactions 3, 7
Evidence of Effectiveness
Multiple systematic reviews demonstrate that DBT reduces both suicidal and non-suicidal self-directed violence with moderate to large effect sizes compared to treatment as usual, with benefits maintained up to 24 months post-treatment. 1, 4 The American Academy of Child and Adolescent Psychiatry specifically recommends DBT as the most effective psychiatric treatment and the only therapy with randomized controlled trial evidence for reducing suicidality in this population. 1, 2
Critical Implementation Points
DBT must be delivered as a comprehensive program combining weekly individual therapy sessions with weekly group skills training, typically over one year. 1, 2 The treatment also includes telephone consultation for crisis management and therapist consultation teams. 5
A common pitfall is attempting to use DBT skills training alone without the full treatment package—the evidence supports the complete model including individual therapy, group skills training, phone coaching, and therapist consultation. 5, 8
For adolescents, DBT-A has been modified to include family participation in skills training and has demonstrated efficacy in reducing psychiatric hospitalization rates. 1, 2