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Marsha Linehan Discusses DBT and Suicidal Behaviors

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When Marsha Linehan, PhD, came up with the idea of Dialectical Behavior Therapy (DBT) in the ’80s, she originally intended it to be used for treating patients who were at a high risk of suicide, with multiple suicide attempts and self-injuries. 

As her research developed, she moved toward using DBT as an effective way to treat people struggling with Borderline Personality Disorder (BPD). That is because people with BPD deal with issues of self-harm, suicide attempts, emotional dysregulation, low distress tolerance, and poor emotion regulation – all behaviors that DBT targets. 

“Dialectical Behavior Therapy is really good about getting someone out of control back into control,” Linehan told a crowd of DBT therapists and other attendees at a March 29 presentation in Los Angeles. “Once a patient is in control, we can treat other things.” 

DBT helps people get back into control with the development of four DBT skills: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. Using these skills, Linehan found that DBT can successfully reduce the following behaviors that are commonly found in people diagnosed with Borderline Personality Disorder: 

  • Suicidal behaviors
  • Intentional self-injury
  • Depression
  • Hopelessness
  • Anger
  • Eating disorders
  • Substance dependence
  • Impulsiveness

At the same time, DBT skills can increase positive self-esteem and general and social adjustment. 

DBT and Suicidal Behaviors 

Studies performed by Linehan and other researchers found that Dialectical Behavior Therapy can significantly decrease suicide attempts in people learning DBT skills. In studies where about 14 percent of patients who had attempted suicide began DBT treatment, less than a year later, that percentage dropped to five. 

To compare, in the control group of people not receiving DBT treatment, that number went from about 18 percent to 16 percent.    

A DBT therapist can help someone who engages in suicide behaviors by teaching them skills in mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance. By learning healthy ways to handle distress and becoming better attuned to one’s emotions, people with BPD and other mental health disorders can significantly decrease their risk of self-harm. 

The challenge when treating people with suicidal tendencies – especially those with Borderline Personality Disorder – is to get them to believe that they have everything to lose by not solving their problems, Linehan said. 

“The average person who kills themselves thinks they’re going to feel better when they’re dead,” she said. “But there’s no evidence this is true.”

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