Dialectical Behavioral Therapy for Adults with Mental Illness: A Review of Clinical Effectiveness and Guidelines

Key Message

The findings from one RCT2 suggest no statistically significant differences between DBT and treatment as usual (TAU) for reducing attempted suicide, suicidal ideation, and hospitalization among veterans. The findings from four RCTs1,3-5 suggest no statistically significant differences between DBT or DBT-based interventions and various comparators at improving symptoms of emotional dysregulation,3 bipolar disorders,5 mindfulness and awareness,1 attention deficit hyperactivity disorders (ADHD),4 executive functioning,4 and quality of life4 in adults with mental illness. Overall, DBT or DBT-based interventions were not statistically significantly greater than comparators at reducing depressive and anxiety symptoms. However, in one RCT,1 clinician-reported Hamilton depression rating scale (HDRS) scores indicated a significantly greater improvement in depressive symptoms with DBT than psychoeducation (PE_ (p= 0 .048) although patient-reported Beck depression inventory (BDI-II) scores showed no significant difference between the two groups. Results from one RCT5 indicated a significantly greater reduction in the severity of anxiety compared to a wait-list control. The results of one RCT6, which also included a post-hoc secondary data analysis7 based on a subgroup of its population, indicated that in women with CSA-related PTSD, residential treatment with DBT-post-traumatic stress disorder (PTSD) significantly reduced PTSD symptoms and trauma-related emotions, and also increased acceptance of trauma-related facts and on psychosocial aspects.Given the limitations associated with the RCTs1-5 included in this review, more robust studies are needed to confirm their reported efficacy of DBT or DBT-based interventions in the adult patients with mental illness. The literature search did not identify any evidence-based guidelines with recommendations specific for the use of DBT in the treatment patients with mental illness.