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Table of Contents
Front Cover
The Handbook of Dialectical Behavior Therapy
Copyright Page
Contents
List of contributors
Preface
I. Overview
1 History and overview of dialectical behavior therapy
History of dialectical behavior therapy
Challenges encountered in the development of dialectical behavior therapy
Overview of the major philosophical aspects of dialectical behavior therapy
The biosocial theory
Behavioral and social learning theories
Acceptance-based philosophies
The dialectical philosophy
Dialectical behavior therapy treatment elements
Treatment modes and targets
Individual therapy
Group skills training
Between-session coaching
Therapist consultation team
Ancillary treatment
Stages of treatment
Pretreatment
Stage 1
Stage 2
Stage 3
Stage 4
Treatment strategies
Core strategies
Problem-solving
Validation
Dialectics
Stylistic strategies
Case management strategies
Dialectical behavior therapy assumptions
Assumptions about clients
Assumptions about therapists and therapy
Research on dialectical behavior therapy
Research supporting dialectical behavior therapy for borderline personality disorder
Research on dialectical behavior therapy with other populations
Dialectical behavior therapy effectiveness studies
Summary
References
Further reading
2 The therapeutic alliance and therapeutic relationship in dialectical behavior therapy
The therapeutic alliance and the therapeutic relationship in dialectical behavior therapy
The therapeutic alliance: background and overview
The therapeutic alliance in dialectical behavior therapy
Therapy through the therapeutic relationship: the alliance and problem-solving in dialectical behavior therapy
The alliance and problem-solving in dialectical behavior therapy.
Agreement on goals of therapy
Suicidal behaviors
Therapy-interfering behavior
Quality-of-life-interfering behavior and increase in behavioral skills
Understanding the client
Suicidal behavior
Suicidal behavior as "manipulative" or "attention seeking"
Borderline personality disorder
Biosocial model of borderline personality disorder
Dialectical behavior therapy treatment assumptions
Therapist and team consultation agreements
Agreements on the tasks of therapy
Commitment to the goals and task of therapy
The therapy as the relationship: the therapeutic bond in dialectical behavior therapy
Research on the therapeutic alliance and relationship in dialectical behavior therapy
Summary and conclusion
References
3 Mechanisms of change in dialectical behavior therapy
Mechanisms of change
Theory
Skills and skills training as the key ingredients of dialectical behavior therapy
Mechanisms related to treatment components: group skills training
Evidence for skills training as a potential mechanism
Mechanisms related to changes in the client: increases in skilled behavior
Increased emotion regulation and mindfulness skills as mechanisms
Conclusion and future directions
Acknowledgment
References
Further reading
4 Accreditation, adherence, and training in dialectical behavior therapy: data review and practical applications
DBT training
Modes of training
Outcomes for DBT intensive training
Clinician outcomes
Client outcomes
Outcomes for self-study, computer-based, and short instructor-led trainings in DBT
Community mental health providers
Graduate student trainees
Summary of DBT training findings
Clarifying terminology: adherence, program fidelity, and certification
Adherence in psychotherapy research
Adherence and outcomes in DBT.
Program fidelity
Adherence monitoring in DBT
A dialectical stance on adherence and training: merits and misunderstandings
Situational versus dispositional
Synthesis
Judgments versus behaviorally specific
Synthesis
Proprietary versus pragmatics
Synthesis
Practical suggestions for ongoing assessment of adherence and competence
Options for certification in DBT
Recommendations and future directions
References
Further reading
II. Clinical populations
5 Efficacy of dialectical behavior therapy in the treatment of suicidal behavior
Treating suicidal behaviors in dialectical behavior therapy
Suicide crisis behaviors
Suicide attempts and nonsuicidal self-injury
Suicidal ideation and communications
Suicide-related expectancies and beliefs
Suicide-related affect
Evidence of dialectical behavior therapy efficacy for suicide-specific outcomes
Self-directed violence
Nonsuicidal self-injury
Attempted suicide
Psychiatric crisis services
Suicidal ideation
Settings and adaptations
Conclusion
References
6 Eating disorders
Review of studies
Dialectical behavior therapy for eating disorders comorbid with borderline personality disorder
Dialectical behavior therapy for mixed eating disorder samples
Dialectical behavior therapy for binge-eating disorder
Dialectical behavior therapy for bulimia nervosa
Dialectical behavior therapy for anorexia nervosa
Conclusion and future directions
Summary of the research
Additional considerations and limitations
Conclusion
References
7 Dialectical behavior therapy for individuals with substance use problems: theoretical adaptations and empirical evidence
What is dialectical behavior therapy-substance use disorder.
Randomized controlled trials of dialectical behavior therapy for individuals with substance use problems
Randomized controlled trials of comprehensive dialectical behavior therapy
Summary of randomized controlled trials of comprehensive dialectical behavior therapy
Randomized controlled trials of modified dialectical behavior therapy
Summary of randomized controlled trials of modified dialectical behavior therapy
Uncontrolled trials and quasiexperimental trials of dialectical behavior therapy for individuals with substance use problems
Uncontrolled and quasiexperimental trials of comprehensive dialectical behavior therapy
Summary of uncontrolled and quasiexperimental trials of comprehensive dialectical behavior therapy
Uncontrolled and quasiexperimental trials of modified dialectical behavior therapy
Summary of uncontrolled and quasiexperimental trials of modified dialectical behavior therapy
Small N pilot studies and case studies involving dialectical behavior therapy for individuals with substance use
Conclusion
Limitations and future directions for dialectical behavior therapy with individuals with substance use problems
References
Further reading
8 Dialectical behavior therapy for adolescents: a review of the research
Introduction
Dialectical behavior therapy
Dialectical behavior therapy for adolescents
Empirical support for dialectical behavior therapy for adolescents
Randomized controlled trials of dialectical behavior therapy for adolescents
Dialectical behavior therapy with preteens/children
Nonrandomized studies of dialectical behavior therapy for adolescents
Future directions and conclusions
References
9 Clinical illustration of the dialectical behavior therapy for preadolescent children: addressing primary targets
Treatment targets
Case illustration.
Child emotional and behavioral difficulties
Diagnostic impressions
Primary diagnosis-disruptive mood dysregulation disorder
Provisional diagnoses-anxiety other specified and attention deficit hyperactivity disorder other type
Parental emotional and behavioral difficulties
Treatment structure
Treatment target hierarchy
Illustrative transcripts
Parent training component: evaluation of parental readiness for treatment
Individual therapy with the child
Summary
References
III. Specific settings and populations
10 Research of dialectical behavior therapy in schools
Introduction
Mental health disorders among youth in the United States
Impact of mental health disorders among youth
Mental health services in schools
Development of dialectical behavior therapy in schools
Research examining dialectical behavior therapy in schools
Feasibility of comprehensive school-based dialectical behavior therapy
Comprehensive school-based dialectical behavior therapy in schools: Outcomes data
Staff outcomes related to comprehensive school-based dialectical behavior therapy implementation: reducing burnout
Universal application of dialectical behavior therapy skills in schools
Development of dialectical behavior therapy skills in schools: skills training for emotional problem solving for adolescents
Dialectical behavior therapy skills in schools: skills training for emotional problem solving for adolescents: outcome data
Future directions
References
11 Dialectical behavior therapy in college counseling centers
Introduction
Comprehensive dialectical behavior therapy in college counseling centers
Dialectical behavior therapy skills training groups in college counseling centers
All skills modules
Specific skills modules
Summary: dialectical behavior therapy group skills training.
Other dialectical behavior therapy research with college students.
The Handbook of Dialectical Behavior Therapy
Copyright Page
Contents
List of contributors
Preface
I. Overview
1 History and overview of dialectical behavior therapy
History of dialectical behavior therapy
Challenges encountered in the development of dialectical behavior therapy
Overview of the major philosophical aspects of dialectical behavior therapy
The biosocial theory
Behavioral and social learning theories
Acceptance-based philosophies
The dialectical philosophy
Dialectical behavior therapy treatment elements
Treatment modes and targets
Individual therapy
Group skills training
Between-session coaching
Therapist consultation team
Ancillary treatment
Stages of treatment
Pretreatment
Stage 1
Stage 2
Stage 3
Stage 4
Treatment strategies
Core strategies
Problem-solving
Validation
Dialectics
Stylistic strategies
Case management strategies
Dialectical behavior therapy assumptions
Assumptions about clients
Assumptions about therapists and therapy
Research on dialectical behavior therapy
Research supporting dialectical behavior therapy for borderline personality disorder
Research on dialectical behavior therapy with other populations
Dialectical behavior therapy effectiveness studies
Summary
References
Further reading
2 The therapeutic alliance and therapeutic relationship in dialectical behavior therapy
The therapeutic alliance and the therapeutic relationship in dialectical behavior therapy
The therapeutic alliance: background and overview
The therapeutic alliance in dialectical behavior therapy
Therapy through the therapeutic relationship: the alliance and problem-solving in dialectical behavior therapy
The alliance and problem-solving in dialectical behavior therapy.
Agreement on goals of therapy
Suicidal behaviors
Therapy-interfering behavior
Quality-of-life-interfering behavior and increase in behavioral skills
Understanding the client
Suicidal behavior
Suicidal behavior as "manipulative" or "attention seeking"
Borderline personality disorder
Biosocial model of borderline personality disorder
Dialectical behavior therapy treatment assumptions
Therapist and team consultation agreements
Agreements on the tasks of therapy
Commitment to the goals and task of therapy
The therapy as the relationship: the therapeutic bond in dialectical behavior therapy
Research on the therapeutic alliance and relationship in dialectical behavior therapy
Summary and conclusion
References
3 Mechanisms of change in dialectical behavior therapy
Mechanisms of change
Theory
Skills and skills training as the key ingredients of dialectical behavior therapy
Mechanisms related to treatment components: group skills training
Evidence for skills training as a potential mechanism
Mechanisms related to changes in the client: increases in skilled behavior
Increased emotion regulation and mindfulness skills as mechanisms
Conclusion and future directions
Acknowledgment
References
Further reading
4 Accreditation, adherence, and training in dialectical behavior therapy: data review and practical applications
DBT training
Modes of training
Outcomes for DBT intensive training
Clinician outcomes
Client outcomes
Outcomes for self-study, computer-based, and short instructor-led trainings in DBT
Community mental health providers
Graduate student trainees
Summary of DBT training findings
Clarifying terminology: adherence, program fidelity, and certification
Adherence in psychotherapy research
Adherence and outcomes in DBT.
Program fidelity
Adherence monitoring in DBT
A dialectical stance on adherence and training: merits and misunderstandings
Situational versus dispositional
Synthesis
Judgments versus behaviorally specific
Synthesis
Proprietary versus pragmatics
Synthesis
Practical suggestions for ongoing assessment of adherence and competence
Options for certification in DBT
Recommendations and future directions
References
Further reading
II. Clinical populations
5 Efficacy of dialectical behavior therapy in the treatment of suicidal behavior
Treating suicidal behaviors in dialectical behavior therapy
Suicide crisis behaviors
Suicide attempts and nonsuicidal self-injury
Suicidal ideation and communications
Suicide-related expectancies and beliefs
Suicide-related affect
Evidence of dialectical behavior therapy efficacy for suicide-specific outcomes
Self-directed violence
Nonsuicidal self-injury
Attempted suicide
Psychiatric crisis services
Suicidal ideation
Settings and adaptations
Conclusion
References
6 Eating disorders
Review of studies
Dialectical behavior therapy for eating disorders comorbid with borderline personality disorder
Dialectical behavior therapy for mixed eating disorder samples
Dialectical behavior therapy for binge-eating disorder
Dialectical behavior therapy for bulimia nervosa
Dialectical behavior therapy for anorexia nervosa
Conclusion and future directions
Summary of the research
Additional considerations and limitations
Conclusion
References
7 Dialectical behavior therapy for individuals with substance use problems: theoretical adaptations and empirical evidence
What is dialectical behavior therapy-substance use disorder.
Randomized controlled trials of dialectical behavior therapy for individuals with substance use problems
Randomized controlled trials of comprehensive dialectical behavior therapy
Summary of randomized controlled trials of comprehensive dialectical behavior therapy
Randomized controlled trials of modified dialectical behavior therapy
Summary of randomized controlled trials of modified dialectical behavior therapy
Uncontrolled trials and quasiexperimental trials of dialectical behavior therapy for individuals with substance use problems
Uncontrolled and quasiexperimental trials of comprehensive dialectical behavior therapy
Summary of uncontrolled and quasiexperimental trials of comprehensive dialectical behavior therapy
Uncontrolled and quasiexperimental trials of modified dialectical behavior therapy
Summary of uncontrolled and quasiexperimental trials of modified dialectical behavior therapy
Small N pilot studies and case studies involving dialectical behavior therapy for individuals with substance use
Conclusion
Limitations and future directions for dialectical behavior therapy with individuals with substance use problems
References
Further reading
8 Dialectical behavior therapy for adolescents: a review of the research
Introduction
Dialectical behavior therapy
Dialectical behavior therapy for adolescents
Empirical support for dialectical behavior therapy for adolescents
Randomized controlled trials of dialectical behavior therapy for adolescents
Dialectical behavior therapy with preteens/children
Nonrandomized studies of dialectical behavior therapy for adolescents
Future directions and conclusions
References
9 Clinical illustration of the dialectical behavior therapy for preadolescent children: addressing primary targets
Treatment targets
Case illustration.
Child emotional and behavioral difficulties
Diagnostic impressions
Primary diagnosis-disruptive mood dysregulation disorder
Provisional diagnoses-anxiety other specified and attention deficit hyperactivity disorder other type
Parental emotional and behavioral difficulties
Treatment structure
Treatment target hierarchy
Illustrative transcripts
Parent training component: evaluation of parental readiness for treatment
Individual therapy with the child
Summary
References
III. Specific settings and populations
10 Research of dialectical behavior therapy in schools
Introduction
Mental health disorders among youth in the United States
Impact of mental health disorders among youth
Mental health services in schools
Development of dialectical behavior therapy in schools
Research examining dialectical behavior therapy in schools
Feasibility of comprehensive school-based dialectical behavior therapy
Comprehensive school-based dialectical behavior therapy in schools: Outcomes data
Staff outcomes related to comprehensive school-based dialectical behavior therapy implementation: reducing burnout
Universal application of dialectical behavior therapy skills in schools
Development of dialectical behavior therapy skills in schools: skills training for emotional problem solving for adolescents
Dialectical behavior therapy skills in schools: skills training for emotional problem solving for adolescents: outcome data
Future directions
References
11 Dialectical behavior therapy in college counseling centers
Introduction
Comprehensive dialectical behavior therapy in college counseling centers
Dialectical behavior therapy skills training groups in college counseling centers
All skills modules
Specific skills modules
Summary: dialectical behavior therapy group skills training.
Other dialectical behavior therapy research with college students.