Dialectical Behavior Therapy for Suicidal Thoughts and Attempts

The dialectical behavior therapy (DBT) may not stop people from thinking about suicide, but it works to prevent people from attempting suicide.

DBT and Suicide Attempts in Adults


Marsha Linehan, the creator of dialectical behavior therapy, once led a two-year study to find out the efficacy of DBT in preventing suicide attempts. The study consisted of a one-year randomized controlled trial, plus one year of posttreatment follow-up.


In a 2006 research report, Linehan said the research team recruited 101 clinically referred women with recent suicidal and self-injurious behaviors. The participants were between the ages of 18 and 45 years, who had at least 2 suicide attempts or self-injuries in the past 5 years prior to the study, with at least 1 in the past 8 weeks.


The results indicated that DBT was effective in preventing suicide attempts.


In comparison with the control group, patients receiving DBT were half as likely to make a suicide attempt, required less hospitalization for suicide ideation, and had lower medical risk across all suicide attempts and self-injurious acts combined.


In addition, patients receiving DBT were less likely to drop out of treatment and had fewer psychiatric hospitalizations and psychiatric emergency department visits.


DBT and Suicide Attempts in Adolescents


There have been research studies that showed DBT also works to prevent suicide attempts in adolescents.


In a 2011 research article, researchers report that they recruited 12 adolescents between the ages of 13 and 19 years for a study. These adolescent patients all had suicidal behavior and/or non-suicidal self-injuries in the past 16 weeks.


The efficacy of DBT treatment was measured by a pre-/post- comparison and a one-year follow-up with the aid of standardized instruments.


During treatment, non-suicidal self-injurious behavior reduced significantly. Before the start of therapy, 8 of 12 patients had attempted suicide at least once. There were neither suicidal attempts during the DBT treatment nor at the one-year follow-up.


Researchers say that the promising results suggest that the DBT interventions were well accepted by the patients and their families, and were associated with improvement in multiple domains including suicidality, non-suicidal self-injurious behavior, emotion dysregulation and depression from the beginning of therapy to the one-year follow-up.


DBT and Suicidal Thoughts


Whereas research findings indicate that DBT is effective in preventing suicide attempts, there is not enough evidence that DBT also prevents suicidal thoughts.


In a comprehensive literature review, three researchers synthesized findings from 18 controlled trials of DBT that assessed self-directed violence and suicidality, including suicide attempts, non-suicidal self-injury (NSSI), suicidal ideation, and accessing psychiatric crisis services.


Although the pooled findings support DBT efficacy in treating suicidal behaviors or attempts, there was no statistically significant pooled effect of DBT with regard to suicidal ideation.


Researchers say the reason might be that the dialectical behavior therapy (DBT) itself prioritizes suicidal behavior and other self-directed violence as the primary treatment targets; in other words, DBT has the explicit prioritization of suicidal behaviors before suicidal thoughts and expectancies.


It could also be that fewer DBT studies measured suicidal ideation and DBT therapists may not have given suicidal ideation as much attention in the course of treatment.

Sources consulted:

Fleischhaker, Christian, et al. “Dialectical Behavioral Therapy for Adolescents (DBT-A): a clinical Trial for Patients with suicidal and self-injurious Behavior and Borderline Symptoms with a one-year Follow-up.” Child and Adolescent Psychiatry and Mental Health, vol. 5, no. 3, 2011, http://www.capmh.com/content/5/1/3

Linehan, Marsha M., et al. “Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder.” Archives of general psychiatry vol. 63,7 (2006): 757-66. doi:10.1001/archpsyc.63.7.757

DeCou, Christopher R., et al. “Dialectical Behavior Therapy Is Effective for the Treatment of Suicidal Behavior: A Meta-Analysis.” Behavior Therapy, vol. 50, 2019, pp. 60-72.

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