Variety of Dialectical Behavior Therapy Interventions Help Prevent Suicide Attempts
Dialectical behavior therapy (DBT) is widely acknowledged for its ability to ease suicide-related behavior in people affected by borderline personality disorder (BPD). However, the therapy now comes in multiple forms, and no one knows for sure if all of these forms have equal chances of producing beneficial treatment outcomes. In a study published in the American Medical Association journal JAMA Psychiatry, researchers from four U.S. institutions compared the effectiveness of three forms of dialectical behavior therapy in the context of managing BPD-related suicide risks.
Borderline Personality Disorder and Suicide
Borderline personality disorder produces a number of symptoms that can potentially increase a person’s chances of thinking about suicide, actively making plans to commit suicide and/or making actual suicide attempts. Examples of these symptoms include emotional volatility in close or intimate relationships, a poorly defined and inconsistent sense of self, a sense of detachment from the self in high-stress situations, a tendency to react in extreme ways when faced with real or imagined instances of abandonment, episodes of general mood volatility and a recurring sense of personal emptiness. In addition to contributing to suicide-related risks, these problems can contribute to episodes of non-suicide-oriented self-harm.
At least three-quarters of all people with BPD injure themselves without any intention to produce death (although death is sometimes the end result of such behavior). In addition, as few as 4 percent and as many as 10 percent of all people with the disorder will eventually kill themselves. Generally speaking, suicide risks are highest in those individuals who already engage in some form of intentional self-injury. Relatively few people with borderline personality disorder knowingly attempt suicide as a classic cry for help. For this and other reasons, doctors typically treat cases of BPD promptly and aggressively in order to reduce any given patient’s chances of dying from suicide.
Dialectical Behavior Therapy
Many forms of modern psychotherapy are change-oriented approaches designed to help people dealing with certain forms of mental illness. In this vein, dialectical behavior therapy was originally developed specifically to lower the odds that a person with BPD will make a suicide attempt. The main difference between DBT and other change-oriented forms of psychotherapy is an initial emphasis on acceptance of existing unpleasant moods/emotions and negative thought processes. Practitioners believe that this acceptance makes it easier for therapy participants to put their problems in perspective and gradually adopt emotional responses and thought processes that support well-being. An offshoot of dialectical behavior therapy, called DBT-S, combines the main goals of treatment with an emphasis on skills training and the involvement of a case manager. Another offshoot, called DBT-I, pursues the main goals of treatment with a mixture of one-on-one sessions and group therapy sessions.
Effectiveness as BPD Treatments
In the study published in JAMA Psychiatry, researchers from the University of Washington, West Chester University, Duke University and the U.S. Department of State used information gathered from 99 women to explore the relative effectiveness of standard dialectical behavior therapy, DBT-S and DBT-I. All of the participants had a BPD diagnosis, had made a suicide attempt at least once in the previous 365 days, had made at least one suicide attempt or committed at least one act of self-harm in the two months prior to study enrollment and had a history of two or more suicide attempts and/or incidents of self-harm within the half decade prior to study enrollment. Some of the women received a year of standard dialectical behavior therapy, while others received a year of DBT-S or a year of DBT-I. One year after treatment, the researchers assessed the outcomes in each of these groups.
Before beginning the study, the researchers believed that a standard course of dialectical behavior therapy would likely produce better outcomes for borderline personality disorder treatment than DBT-S or DBT-I. However, after analyzing their results, they concluded that standard DBT, DBT-S and DBT-I all produce fairly equal results in terms of reductions in suicidal thinking, reductions in the number of suicide attempts and reduction in the seriousness of any specific suicide attempt. The researchers also concluded that DBT-I can decrease depression risks and the rate of participation in self-harming behavior, while standard DBT can decrease anxiety risks. In addition, they concluded that people receiving standard DBT remain in treatment more often than people receiving DBT-I.