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Current Psychiatry Research and Reviews

Editor-in-Chief

ISSN (Print): 2666-0822
ISSN (Online): 2666-0830

Mini-Review Article

A Narrative Review on Dialectical Behavior Therapy for Patients with Depressive Difficulties

Author(s): Aryendu Kumar Saini*, Pranay Wal, Ankita Wal, Rashmi Saxena Pal and Om Prakash Verma

Volume 18, Issue 1, 2022

Published on: 01 February, 2022

Page: [3 - 16] Pages: 14

DOI: 10.2174/2666082218666211220153312

Price: $65

Abstract

Background: Dialectical behavior therapy (DBT) is a type of cognitive behavioral therapy (CBT) that was earlier intended to treat only patients with borderline personality disorder (BPD), but researchers have found DBT to treat several psychological disorders, including depression.

Aim: The article aims to review the clinical shreds of evidence regarding the use of DBT to treat depression.

Methods: PubMed literature search was done by applying the year filter range, 2010 to 2021. Another filter applied was “Randomized controlled trial”, so that the strength of evidence could be enhanced. The keywords used were “Dialectical Behavior Therapy” AND “Depression”.

Results: 33 articles were found, out of which only 20 relevant articles were reviewed. DBT was found to alleviate depressive symptoms associated with different psychological disorders like bipolar disorder and BPD but the number of studies that validated the aforementioned were less than those studies which showed that DBT had no significant effect on the patients with depressive difficulties. The long-term effect of DBT for treating depression is under suspect, as studies showed that DBT got ineffective during the follow-ups.

Conclusion: DBT shows benefits in depression, but further studies are still required to validate this concretely as DBT did not show a significant effect when compared to its control counterparts. There is much need for future studies which can evaluate the long-term efficacy of DBT in depression, which is another challenging area because follow-up data did not favor DBT.

Keywords: Depression, borderline personality disorder, psychotherapy, group, behavior therapy, diagnostic and statistical manual of mental disorders, bipolar disorder.

Graphical Abstract
[1]
May JM, Richardi TM, Barth KS. Dialectical behavior therapy as treatment for borderline personality disorder. Ment Health Clin 2016; 6(2): 62-7.
[http://dx.doi.org/10.9740/mhc.2016.03.62] [PMID: 29955449]
[2]
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. (5th ed),. Washington: American Psychiatric Association 2013.
[3]
Chapman AL. Dialectical behavior therapy: Current indications and unique elements. Psychiatry (Edgmont) 2006; 3(9): 62-8.
[PMID: 20975829]
[4]
O’Connell B, Dowling M. Dialectical behaviour therapy (DBT) in the treatment of borderline personality disorder. J Psychiatr Ment Health Nurs 2014; 21(6): 518-25.
[http://dx.doi.org/10.1111/jpm.12116] [PMID: 24191948]
[5]
Fassbinder E, Assmann N, Schaich A, et al. PRO*BPD: effectiveness of outpatient treatment programs for borderline personality disorder: A comparison of Schema therapy and dialectical behavior therapy: Study protocol for a randomized trial. BMC Psychiat 2018; 18(1): 341.
[http://dx.doi.org/10.1186/s12888-018-1905-6] [PMID: 30340474]
[6]
Zeifman RJ, Boritz T, Barnhart R, Labrish C, McMain SF. The independent roles of mindfulness and distress tolerance in treatment outcomes in dialectical behavior therapy skills training. Pers Disord 2020; 11(3): 181-90.
[http://dx.doi.org/10.1037/per0000368] [PMID: 31647267]
[7]
McMain SF, Guimond T, Barnhart R, Habinski L, Streiner DL. A randomized trial of brief dialectical behaviour therapy skills training in suicidal patients suffering from borderline disorder. Acta Psychiat Scand 2017; 135(2): 138-48.
[http://dx.doi.org/10.1111/acps.12664] [PMID: 27858962]
[8]
Bohus M, Dyer AS, Priebe K, et al. Dialectical behaviour therapy for post-traumatic stress disorder after childhood sexual abuse in patients with and without borderline personality disorder: A randomised controlled trial. Psychother Psychosom 2013; 82(4): 221-33.
[http://dx.doi.org/10.1159/000348451] [PMID: 23712109]
[9]
Hidaka BH. Depression as a disease of modernity: Explanations for increasing prevalence. J Affect Disord 2012; 140(3): 205-14.
[http://dx.doi.org/10.1016/j.jad.2011.12.036] [PMID: 22244375]
[10]
World Health Organization (WHO). Available from: https://www.who.int/health-topics/depression#tab= tab_1
[11]
Kanter JW, Busch AM, Weeks CE, Landes SJ. The nature of clinical depression: Symptoms, syndromes, and behavior analysis. Behav Anal 2008; 31(1): 1-21.
[http://dx.doi.org/10.1007/BF03392158] [PMID: 22478499]
[12]
Cuijpers P, Sijbrandij M, Koole SL, Andersson G, Beekman AT, Reynolds CF III. The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: A meta-analysis of direct comparisons. World Psychiatry 2013; 12(2): 137-48.
[http://dx.doi.org/10.1002/wps.20038] [PMID: 23737423]
[13]
Carvalho AF, Sharma MS, Brunoni AR, Vieta E, Fava GA. The safety, tolerability and risks associated with the use of newer generation antidepressant drugs: A critical review of the literature. Psychother Psychosom 2016; 85(5): 270-88.
[http://dx.doi.org/10.1159/000447034] [PMID: 27508501]
[14]
Fenn MK, Byrne B. The key principles of cognitive behavioral therapy. InnovAiT 2013; 6: 579-85.
[http://dx.doi.org/10.1177/1755738012471029]
[15]
David D, Cristea I, Hofmann SG. Why cognitive behavioral therapy is the current gold standard of psychotherapy. Front Psychiat 2018; 9: 4.
[http://dx.doi.org/10.3389/fpsyt.2018.00004] [PMID: 29434552]
[16]
Rudge S, Feigenbaum JD, Fonagy P. Mechanisms of change in dialectical behaviour therapy and cognitive behaviour therapy for borderline personality disorder: A critical review of the literature. J Ment Health 2020; 29(1): 92-102.
[http://dx.doi.org/10.1080/09638237.2017.1322185] [PMID: 28480806]
[17]
Linehan MM. DBT® Skills Training Handouts and Worksheets. (2nd ed.), New York, USA: Guilford Press 2015. In:
[18]
Keng SL, Smoski MJ, Robins CJ. Effects of mindfulness on psychological health: A review of empirical studies. Clin Psychol Rev 2011; 31(6): 1041-56.
[http://dx.doi.org/10.1016/j.cpr.2011.04.006] [PMID: 21802619]
[19]
Soler J, Elices M, Pascual JC, et al. Effects of mindfulness training on different components of impulsivity in borderline personality disorder: Results from a pilot randomized study. Borderline Personal Disord Emot Dysregul 2016; 3: 1.
[http://dx.doi.org/10.1186/s40479-015-0035-8] [PMID: 26759718]
[20]
What are the benefits of mindfulness? 2012. Available from: https://www.apa.org/education/ce/mindfulness-benefits.pdf.
[21]
Soler J, Pascual JC, Tiana T, et al. Dialectical behaviour therapy skills training compared to standard group therapy in borderline personality disorder: A 3-month randomised controlled clinical trial. Behav Res Ther 2009; 47(5): 353-8.
[http://dx.doi.org/10.1016/j.brat.2009.01.013] [PMID: 19246029]
[22]
Muhomba M, Chugani CD, Amanda A, Kannan U, Divya U. Distress tolerance skills for college students: A pilot investigation of a brief DBT group skills training program. J Coll Stud Psychother 2017; 31(3): 247-56.
[http://dx.doi.org/10.1080/87568225.2017.1294469]
[23]
Perepletchikova F, Axelrod SR, Kaufman J, Rounsaville BJ, Douglas-Palumberi H, Miller AL. Adapting dialectical behaviour therapy for children: Towards a new research agenda for paediatric suicidal and non- suicidal self-injurious behaviours. Child Adolesc Ment Health 2011; 16(2): 116-21.
[http://dx.doi.org/10.1111/j.1475-3588.2010.00583.x] [PMID: 21643467]
[24]
Salsman NL, Linehan MM. Dialectical-behavioral therapy for borderline personality disorder. Prim Psychiat 2006; 13(5): 51-8.
[25]
Luberto CM, Cotton S, McLeish AC, et al. Mindfulness skills and emotion regulation: The mediating role of coping self-efficacy. Mindfulness 2014; 5: 373-80.
[http://dx.doi.org/10.1007/s12671-012-0190-6]
[26]
Lynch TR, Hempel RJ, Whalley B, et al. Refractory depression - mechanisms and efficacy of radically open dialectical behaviour therapy (RefraMED): Findings of a randomised trial on benefits and harms. Br J Psychiat 2020; 216(4): 204-12.
[http://dx.doi.org/10.1192/bjp.2019.53] [PMID: 31317843]
[27]
Goldstein TR, Fersch-Podrat RK, Rivera M, et al. Dialectical behavior therapy for adolescents with bipolar disorder: Results from a pilot randomized trial. J Child Adolesc Psychopharmacol 2015; 25(2): 140-9.
[http://dx.doi.org/10.1089/cap.2013.0145] [PMID: 25010702]
[28]
Van Dijk S, Jeffrey J, Katz MR. A randomized, controlled, pilot study of dialectical behavior therapy skills in a psychoeducational group for individuals with bipolar disorder. J Affect Disord 2013; 145(3): 386-93.
[http://dx.doi.org/10.1016/j.jad.2012.05.054] [PMID: 22858264]
[29]
Pistorello J, Fruzzetti AE, Maclane C, Gallop R, Iverson KM. Dialectical behavior therapy (DBT) applied to college students: A randomized clinical trial. J Consult Clin Psychol 2012; 80(6): 982-94.
[http://dx.doi.org/10.1037/a0029096] [PMID: 22730955]
[30]
Javaras KN, Pope HG, Lalonde JK, et al. Co-occurrence of binge eating disorder with psychiatric and medical disorders. J Clin Psychiat 2008; 69(2): 266-73.
[http://dx.doi.org/10.4088/JCP.v69n0213] [PMID: 18348600]
[31]
Araujo DM, Santos GF, Nardi AE. Binge eating disorder and depression: A systematic review. World J Biol Psychiat 2010; 11(2 Pt 2): 199-207.
[http://dx.doi.org/10.3109/15622970802563171] [PMID: 20218783]
[32]
Courbasson C, Nishikawa Y, Dixon L. Outcome of dialectical behaviour therapy for concurrent eating and substance use disorders. Clin Psychol Psychother 2012; 19(5): 434-49.
[http://dx.doi.org/10.1002/cpp.748] [PMID: 21416557]
[33]
Cancian ACM, de Souza LAS, Liboni RPA, Machado WL, Oliveira MDS. Effects of a dialectical behavior therapy-based skills group intervention for obese individuals: A Brazilian pilot study. Eat Weight Disord 2019; 24(6): 1099-111.
[http://dx.doi.org/10.1007/s40519-017-0461-2] [PMID: 29197947]
[34]
Goodman M, Banthin D, Blair NJ, et al. A randomized trial of dialectical behavior therapy in high-risk suicidal veterans. J Clin Psychiat 2016; 77(12): e1591-600.
[http://dx.doi.org/10.4088/JCP.15m10235] [PMID: 27780335]
[35]
Lin TJ, Ko HC, Wu JY, Oei TP, Lane HY, Chen CH. The effectiveness of dialectical behavior therapy skills training group vs. Cognitive Therapy Group on reducing depression and suicide attempts for borderline personality disorder in Taiwan. Arch Suicide Res 2019; 23(1): 82-99.
[http://dx.doi.org/10.1080/13811118.2018.1436104] [PMID: 29528807]
[36]
Mehlum L, Ramberg M, Tørmoen AJ, et al. Dialectical behavior therapy compared with enhanced usual care for adolescents with repeated suicidal and self-harming behavior: Outcomes over a one-year follow-up. J Am Acad Child Adolesc Psychiat 2016; 55(4): 295-300.
[http://dx.doi.org/10.1016/j.jaac.2016.01.005] [PMID: 27015720]
[37]
Boersma K, Södermark M, Hesser H, Flink IK, Gerdle B, Linton SJ. Efficacy of a transdiagnostic emotion-focused exposure treatment for chronic pain patients with comorbid anxiety and depression: A randomized controlled trial. Pain 2019; 160(8): 1708-18.
[http://dx.doi.org/10.1097/j.pain.0000000000001575] [PMID: 31335641]
[38]
Mehlum L, Ramleth RK, Tørmoen AJ, et al. Long term effectiveness of dialectical behavior therapy versus enhanced usual care for adolescents with self-harming and suicidal behavior. J Child Psychol Psychiat 2019; 60(10): 1112-22.
[http://dx.doi.org/10.1111/jcpp.13077] [PMID: 31127612]
[39]
Mehlum L, Tørmoen AJ, Ramberg M, et al. Dialectical behavior therapy for adolescents with repeated suicidal and self-harming behavior: A randomized trial. J Am Acad Child Adolesc Psychiat 2014; 53(10): 1082-91.
[http://dx.doi.org/10.1016/j.jaac.2014.07.003] [PMID: 25245352]
[40]
Andreasson K, Krogh J, Wenneberg C, et al. Effectiveness of dialectical behavior therapy versus collaborative assessment and management of suicidality treatment for reduction of self-harm in adults with borderline personality traits and disorder-a randomized observer-blinded clinical trial. Depress Anxiety 2016; 33(6): 520-30.
[http://dx.doi.org/10.1002/da.22472] [PMID: 26854478]
[41]
Linehan MM, Korslund KE, Harned MS, et al. Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: A randomized clinical trial and component analysis. JAMA Psychiat 2015; 72(5): 475-82.
[http://dx.doi.org/10.1001/jamapsychiatry.2014.3039] [PMID: 25806661]
[42]
McMain SF, Guimond T, Streiner DL, Cardish RJ, Links PS. Dialectical behavior therapy compared with general psychiatric management for borderline personality disorder: Clinical outcomes and functioning over a 2-year follow-up. Am J Psychiat 2012; 169(6): 650-61.
[http://dx.doi.org/10.1176/appi.ajp.2012.11091416] [PMID: 22581157]
[43]
Shamloo N, Gharavi M, Asgharipour N. The effectiveness of dialectical behavior therapy based on emotion regulation training on depression symptoms. JFMH 2014; 16(63): 261-71.
[44]
Neacsiu AD, Rizvi SL, Linehan MM. Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder. Behav Res Ther 2010; 48(9): 832-9.
[http://dx.doi.org/10.1016/j.brat.2010.05.017] [PMID: 20579633]
[45]
Nyamathi AM, Shin SS, Smeltzer J, et al. Achieving drug and alcohol abstinence among recently incarcerated homeless women: A randomized controlled trial comparing dialectical behavioral therapy-case management with a health promotion program. Nurs Res 2017; 66(6): 432-41.
[http://dx.doi.org/10.1097/NNR.0000000000000249] [PMID: 29095374]
[46]
Harned MS, Korslund KE, Linehan MM. A pilot randomized controlled trial of dialectical behavior therapy with and without the dialectical behavior therapy prolonged exposure protocol for suicidal and self-injuring women with borderline personality disorder and PTSD. Behav Res Ther 2014; 55: 7-17.
[http://dx.doi.org/10.1016/j.brat.2014.01.008] [PMID: 24562087]
[47]
Ward-Ciesielski EF, Jones CB, Wielgus MD, Wilks CR, Linehan MM. Single-session dialectical behavior therapy skills training versus relaxation training for non-treatment-engaged suicidal adults: A randomized controlled trial. BMC Psychol 2016; 4: 13.
[http://dx.doi.org/10.1186/s40359-016-0117-4] [PMID: 27009317]
[48]
Bohus M, Kleindienst N, Hahn C, et al. Dialectical behavior therapy for posttraumatic stress disorder (DBT-PTSD) compared with cognitive processing therapy (CPT) in complex presentations of PTSD in women survivors of childhood abuse: A randomized clinical trial. JAMA Psychiat 2020; 77(12): 1235-45.
[http://dx.doi.org/10.1001/jamapsychiatry.2020.2148] [PMID: 32697288]
[49]
Carter JC, Kenny TE, Singleton C, Van Wijk M, Heath O. Dialectical behavior therapy self-help for binge-eating disorder: A randomized controlled study. Int J Eat Disord 2020; 53(3): 451-60.
[http://dx.doi.org/10.1002/eat.23208] [PMID: 31821592]
[50]
DiRocco A, Liu L, Burrets M. Enhancing dialectical behavior therapy for the treatment of bipolar disorder. Psychiatr Q 2020; 91(3): 629-54.
[http://dx.doi.org/10.1007/s11126-020-09709-6] [PMID: 32144641]

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