Marsha Marie Linehan

Dialectical behavior therapy was originally developed from early efforts to apply standard behavior therapy to treat individuals who were highly suicidal. Its development was a trial and error effo...

This double-blind study examined whether olanzapine augments the efficacy of dialectical behavior therapy (DBT) in reducing anger and hostility in borderline personality disorder patients. Twenty-four women with borderline personality disorder (DSM-IV criteria) and high levels of irritability and anger received 6 months of DBT. Subjects were randomly assigned to receive either low-dose olanzapine or placebo and were assessed with standardized measures in a double-blind manner. The study was conducted from September 2000 to December 2002. Intent-to-treat analyses indicated that both treatment conditions resulted in significant improvement in irritability, aggression, depression, and self-inflicted injury (p < .01 for each). Irritability and aggression scores tended (p < .10) to decrease more quickly for the olanzapine group than for the placebo group. Self-inflicted injury tended (p < .10) to decrease more for the placebo group than for the olanzapine group. Olanzapine may promote more rapid reduction of irritability and aggression than placebo for highly irritable women with borderline personality disorder. Effect sizes were moderate to large, with the small sample size likely limiting the ability to detect significant results. Overall, there were large and consistent reductions in irritability, aggression, depression, and self-injury for both groups of subjects receiving DBT.

The authors describe the development of the Suicide Attempt Self-Injury Interview (SASII), an instrument designed to assess the factors involved in nonfatal suicide attempts and intentional self-injury. Using 4 cohorts of participants, authors generated SASII items and evaluated them with factor and content analyses and internal consistency statistics. The final measure was assessed for reliability and validity with collateral measures. The SASII assesses variables related to method, lethality and impulsivity of the act, likelihood of rescue, suicide intent or ambivalence and other motivations, consequences, and habitual self-injury. The SASII was found to have very good interrater reliability and adequate validity.

Research from JAMA Psychiatry — Two-Year Randomized Controlled Trial and Follow-up of Dialectical Behavior Therapy vs Therapy by Experts for Suicidal Behaviors and Borderline Personality Disorder

Worldwide, almost a million people die by suicide each year. Intentional, nonfatal, self‐inflicted injury, including both suicide attempts and acts without suicide intent, also has very high prevalence. This article provides a practice‐friendly review of controlled studies of psychosocial treatments aiming to prevent suicide, attempted suicide, and nonsuicidal self‐inflicted injuries. Despite relatively small sample sizes for a low‐base‐rate outcome such as self‐inflicted injury, several psychotherapies have been found effective, including cognitive therapy, dialectical behavior therapy, problem‐solving therapy, and interpersonal psychotherapy, as well as outreach interventions, such as sending caring letters. The clinical implications of the review are discussed with the goal of translating the science to service—particularly the importance of outreach and treatment of non‐compliance, the assessment and management of suicide risk, and competency in effective psychotherapies. These are critical steps for clinical psychology and psychotherapists to take in their role in suicide prevention. © 2005 Wiley Periodicals, Inc. J Clin Psychol: In Session 62: 161–170, 2006.

A randomized clinical trial was conducted to evaluate whether Dialectical Behavior Therapy (DBT), an effective cognitive‐behavioral treatment for suicidal individuals with borderline personality disorder (BPD), would also be effective for drug‐dependent women with BPD when compared with treatment‐as‐usual (TAU) in the community. Subjects were randomly assigned to either DBT or TAU for a year of treatment. Subjects were assessed at 4, 8, and 12 months, and at a 16‐month follow‐up. Subjects assigned to DBT had significantly greater reductions in drug abuse measured both by structured interviews and urinalyses throughout the treatment year and at follow‐up than did subjects assigned to TAU. DBT also maintained subjects in treatment better than did TAU, and subjects assigned to DBT had significantly greater gains in global and social adjustment at follow‐up than did those assigned to TAU. DBT has been shown to be more effective than treatment‐as‐usual in treating drug abuse in this study, providing more support for DBT as an effective treatment for severely dysfunctional BPD patients across a range of presenting problems.