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Dialectical Behavior Therapy for Adolescents: Theory, Treatment Adaptations, and Empirical Outcomes

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Abstract

Dialectical behavior therapy (DBT) was originally developed for chronically suicidal adults with borderline personality disorder (BPD) and emotion dysregulation. Randomized controlled trials (RCTs) indicate DBT is associated with improvements in problem behaviors, including suicide ideation and behavior, non-suicidal self-injury (NSSI), attrition, and hospitalization. Positive outcomes with adults have prompted researchers to adapt DBT for adolescents. Given this interest in DBT for adolescents, it is important to review the theoretical rationale and the evidence base for this treatment and its adaptations. A solid theoretical foundation allows for adequate evaluation of content, structural, and developmental adaptations and provides a framework for understanding which symptoms or behaviors are expected to improve with treatment and why. We first summarize the adult DBT literature, including theory, treatment structure and content, and outcome research. Then, we review theoretical underpinnings, adaptations, and outcomes of DBT for adolescents. DBT has been adapted for adolescents with various psychiatric disorders (i.e., BPD, mood disorders, externalizing disorders, eating disorders, trichotillomania) and problem behaviors (i.e., suicide ideation and behavior, NSSI) across several settings (i.e., outpatient, day program, inpatient, residential, correctional facility). The rationale for using DBT with these adolescents rests in the common underlying dysfunction in emotion regulation among the aforementioned disorders and problem behaviors. Thus, the theoretical underpinnings of DBT suggest that this treatment is likely to be beneficial for adolescents with a broad array of emotion regulation difficulties, particularly underregulation of emotion resulting in behavioral excess. Results from open and quasi-experimental adolescent studies are promising; however, RCTs are sorely needed.

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References

  • Adrian, M., Zeman, J., Erdley, C., Lisa, L., & Sim, L. (2011). Emotional dysregulation and interpersonal difficulties as risk factors for nonsuicidal self-injury in adolescent girls. Journal of Abnormal Child Psychology, 39, 389–400.

    Article  PubMed  Google Scholar 

  • Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30, 217–237.

    Article  PubMed  Google Scholar 

  • Andión, Ó., Ferrer, M., Matali, J., Gancedo, B., Calvo, N., Barral, C., et al. (2012). Effectiveness of combined individual and group dialectical behavior therapy compared to only individual dialectical behavior therapy: A preliminary study. Psychotherapy, 49, 241–250.

    Article  PubMed  Google Scholar 

  • Becker, D. F., Grilo, C. M., Edell, W. S., & McGlashan, T. H. (2002). Diagnostic efficiency of borderline personality disorder criteria in hospitalized adolescents: Comparison with hospitalized adults. The American Journal of Psychiatry, 159, 2042–2047.

    Article  PubMed  Google Scholar 

  • Bedics, J. D., Atkins, D. C., Comtois, K. A., & Linehan, M. M. (2012a). Treatment differences in the therapeutic relationship and introject during a 2-year randomized controlled trial of dialectical behavior therapy versus nonbehavioral psychotherapy experts for borderline personality disorder. Journal of Consulting and Clinical Psychology, 80, 66–77.

    Article  PubMed  Google Scholar 

  • Bedics, J. D., Atkins, D. C., Comtois, K. A., & Linehan, M. M. (2012b). Weekly therapist ratings of the therapeutic relationship and patient introject during the course of dialectical behavioral therapy for the treatment of borderline personality disorder. Psychotherapy, 49, 231–240.

    Article  PubMed  Google Scholar 

  • Berzins, L. G., & Trestman, R. L. (2004). The development and implementation of dialectical behavior therapy in forensic settings. The International Journal of Forensic Mental Health, 3, 93–103.

    Article  Google Scholar 

  • Bjarehed, J., & Lundh, L. G. (2008). Deliberate self-harm in 14-year-old adolescents: How frequent is it, and how is it associated with psychopathology, relationship variables, and styles of emotion regulation. Cognitive and Behaviour Therapy, 37, 26–37.

    Article  Google Scholar 

  • Bohus, M., Haaf, B., Simms, T., Limberger, M. F., Schmahl, C., Unckel, C., et al. (2004). Effectiveness of inpatient dialectical behavioral therapy for borderline personality disorder: A controlled trial. Behaviour Research and Therapy, 42, 487–499.

    Article  PubMed  Google Scholar 

  • Bohus, M., Haaf, B., Stiglmayr, C., Pohl, U., Bohme, R., & Linehan, M. (2000). Evaluation of inpatient dialectical-behavioral therapy for borderline personality disorder—A prospective study. Behaviour Research and Therapy, 38, 875–887.

    Article  PubMed  Google Scholar 

  • Bradley, R. G., & Follingstad, D. R. (2003). Group therapy for incarcerated women who experience interpersonal violence: A pilot study. Journal of Traumatic Stress, 16, 337–340.

    Article  PubMed  Google Scholar 

  • Burke, J. D., & Stepp, S. D. (2012). Adolescent disruptive behavior and borderline personality disorder symptoms in young adult men. Journal of Abnormal Child Psychology, 40, 35–44.

    Article  PubMed  Google Scholar 

  • Carlson, G. A., & Meyer, S. E. (2006). Phenomenology and diagnosis of bipolar disorder in children, adolescents, and adults: Complexities and developmental issues. Development and Psychopathology, 18, 939–969.

    Article  PubMed  Google Scholar 

  • Carter, G. L., Willcox, C. H., Lewin, T. J., Conrad, A. M., & Bendit, N. (2010). Hunter DBT project: Randomized controlled trial of dialectical behaviour therapy in women with borderline personality disorder. Australian and New Zealand Journal of Psychiatry, 44, 162–173.

    Article  PubMed  Google Scholar 

  • Chambless, D. L., Baker, M. J., Baucom, D. H., Beutler, L. E., Calhoun, K. S., Crits-Christoph, P., et al. (1998). Update on empirically validated therapies II. The Clinical Psychologist, 51, 3–16.

    Google Scholar 

  • Chambless, D. L., & Hollon, S. D. (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology, 66, 7–18.

    Article  PubMed  Google Scholar 

  • Chambless, D. L., Sanderson, W. C., Shoham, V., Bennett, J. S., Pope, K. S., Crits-Christoph, P., et al. (1996). An update on empirically validated therapies. The Clinical Psychologist, 49, 5–18.

    Google Scholar 

  • Chanen, A. M., Jovev, M., & Jackson, H. J. (2007). Adaptive functioning and psychiatric symptoms in adolescents with borderline personality disorder. Journal of Clinical Psychiatry, 68, 297–306.

    Article  PubMed  Google Scholar 

  • Chapman, A. L., Leung, D. W., & Lynch, T. R. (2008). Impulsivity and emotion dysregulation in borderline personality disorder. Journal of Personality Disorders, 22, 148–164.

    Article  PubMed  Google Scholar 

  • Charlton, M., & Dykstra, E. J. (2011). Dialectical behavior therapy for special populations: Treatment with adolescents and their caregivers. Advances in Mental Health and Intellectual Disabilities, 5, 6–14.

    Article  Google Scholar 

  • Christenson, G., & Mackenzie, T. (1994). Trichotillomania. In M. Hersen & R. T. Ammerman (Eds.), Handbook of prescriptive treatments for adults (pp. 217–235). New York, NY: Plenum Press.

    Google Scholar 

  • Clarkin, J. F., Levy, K. N., Lenzenweger, M. F., & Kernberg, O. F. (2007). Evaluating three treatments for borderline personality disorder: A multiwave study. The American Journal of Psychiatry, 164, 922–928.

    Article  PubMed  Google Scholar 

  • Coletti, D. J., Leigh, E., Gallelli, K. A., & Kafantaris, V. (2005). Patterns of adherence to treatment in adolescents with bipolar disorder. Journal of Child and Adolescent Psychopharmacology, 15, 913–917.

    Article  PubMed  Google Scholar 

  • Comtois, K. A., Elwood, L., Holdcraft, L. C., Smith, W. R., & Simpson, T. L. (2007). Effectiveness of dialectical behavior therapy in a community mental health center. Cognitive and Behavioral Practice, 14, 406–414.

    Article  Google Scholar 

  • Crowell, S. E., Beauchaine, T. P., & Linehan, M. M. (2009). A biosocial developmental model of borderline personality disorder: Elaborating and extending Linehan’s theory. Psychological Bulletin, 135, 495–510.

    Article  PubMed  Google Scholar 

  • Dickstein, D. P., & Leibenluft, E. (2006). Emotion regulation in children and adolescents: Boundaries between normalcy and bipolar disorder. Development and Psychopathology, 18, 1105–1131.

    Article  PubMed  Google Scholar 

  • Diefenbach, G. J., Tolin, D. F., Meunier, S., & Worhunsky, P. (2008). Emotion regulation and trichotillomania: A comparison of clinical and nonclinical hair pulling. Journal of Behavior Therapy and Experimental Psychiatry, 39, 32–41.

    Article  PubMed  Google Scholar 

  • Dimeff, L. A., & Koerner, K. (Eds.). (2007). Dialectical behavior therapy in clinical practice. New York, NY: Guilford Press.

    Google Scholar 

  • Esposito-Smythers, C., Goldstein, T., Birmaher, B., Goldstein, B., Hunt, J., Ryan, N., et al. (2010). Clinical and psychosocial correlated of non-suicidal self-injury within a sample of children and adolescents with bipolar disorder. Journal of Affective Disorders, 125, 89–97.

    Article  PubMed  Google Scholar 

  • Evershed, S., Tennant, A., Boomer, D., Rees, A., Barkham, M., & Watsom, A. (2003). Practice-based outcomes of dialectical behaviour therapy (DBT) targeting anger and violence, with male forensic patients: A pragmatic and non-contemporaneous comparison. Criminal Behaviour and Mental Health, 13, 198–213.

    Article  PubMed  Google Scholar 

  • Feigenbaum, J. D., Fonagy, P., Pilling, S., Jones, A., Wildgoose, A., & Bebbington, P. E. (2012). A real-world study of the effectiveness of DBT in the UK National Health Service. British Journal of Clinical Psychology, 51, 121–141.

    Article  PubMed  Google Scholar 

  • Fleischhaker, C., Böhme, R., Sixt, B., Brück, C., Schneider, C., & Schulz, E. (2011). 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, 5, 3.

    Article  PubMed  Google Scholar 

  • Flessner, C. A., Woods, D. W., Franklin, M. E., Cashin, S. E., & Keuthen, N. J. (2008). The Milwaukee inventory for subtypes of trichotillomania-adult version (MIST-A): Development of an instrument for the assessment of ‘focused’ and ‘automatic’ hair pulling. Journal of Psychopathology and Behavioral Assessment, 30, 20–30.

    Article  Google Scholar 

  • Flessner, C. A., Woods, D. W., Franklin, M. E., Keuthen, N. J., & Piacentini, J. (2009). Cross-sectional study of women with trichotillomania: A preliminary examination of pulling styles, severity, phenomenology, and functional impact. Child Psychiatry and Human Development, 40, 153–167.

    Article  PubMed  Google Scholar 

  • Flessner, C. A., Woods, D. W., Franklin, M. E., Keuthen, N. J., Piacentini, J., Cashin, S. E., et al. (2007). The Milwaukee inventory for style of trichotillomania-child version (MIST-C): Initial development and psychometric properties. Behavior Modification, 31, 896–918.

    Article  PubMed  Google Scholar 

  • Fruzzetti, A. R., & Fruzzetti, A. E. (2008). Dialectics in cognitive and behavior therapy. In W. T. O’Donohue & J. E. Fisher (Eds.), Cognitive behavior therapy: Applying empirically supported techniques in your practice (2nd ed., pp. 132–141). Hoboken, NJ: Wiley.

    Google Scholar 

  • Glenn, C. R., & Klonsky, E. D. (2009). Emotion dysregulation as a core feature of borderline personality disorder. Journal of Personality Disorders, 23, 20–28.

    Article  PubMed  Google Scholar 

  • Goldstein, T. R., Axelson, D. A., Birmaher, B., & Brent, D. A. (2007). Dialectical behavior therapy for adolescents with bipolar disorder: A 1-year open trial. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 820–830.

    Article  PubMed  Google Scholar 

  • Goldstein, T. R., Birmaher, B., Axelson, D., Ryan, N. D., Strober, M. A., Gill, M. K., et al. (2005). History of suicide attempts in pediatric bipolar disorders: Factors associated with increased risk. Bipolar Disorders, 7, 525–535.

    Article  PubMed  Google Scholar 

  • Goldstein, T. R., Miklowitz, D. J., & Mullen, K. L. (2006). Social skills knowledge and performance among adolescents with bipolar disorder. Bipolar Disorders, 8, 350–361.

    Article  PubMed  Google Scholar 

  • Gratz, K. L., Rosenthal, M. Z., Tull, M. T., Lejuez, C. W., & Gunderson, J. G. (2006). An experimental investigation of emotion dysregulation in borderline personality disorder. Journal of Abnormal Psychology, 115, 850–855.

    Article  PubMed  Google Scholar 

  • Gross, J. J. (1998). The emerging field of emotion regulation: An integrative review. Review of General Psychology, 2, 271–299.

    Article  Google Scholar 

  • Groves, S., Backer, H. S., van den Bosch, W., & Miller, A. (2012). Dialectical behavior therapy with adolescents: A review. Child and Adolescent Mental Health, 17, 65–75.

    Article  Google Scholar 

  • Harley, R., Sprich, S., Safren, S., Jacobo, M., & Fava, M. (2008). Adaptation of dialectical behavior therapy skills training group for treatment-resistant depression. Journal of Nervous and Mental Disease, 196, 136–143.

    Article  PubMed  Google Scholar 

  • Harned, M. S., Chapman, A. L., Dexter-Mazza, E., Murray, A., Comtois, K. A., & Linehan, M. M. (2008). Treating co-occurring axis I disorders in recurrently suicidal women with borderline personality disorder: A 2-year randomized trial of dialectical behavior therapy versus community treatment by experts. Journal of Consulting and Clinical Psychology, 76, 1068–1075.

    Article  PubMed  Google Scholar 

  • Hill, D. M., Craighead, L. W., & Safer, D. L. (2011). Appetite-focused dialectical behavior therapy for the treatment of binge eating with purging: A preliminary trial. International Journal of Eating Disorders, 44, 249–261.

    Article  PubMed  Google Scholar 

  • Hirvikoski, T., Waaler, E., Alfredsson, J., Pihlgren, C., Holmström, A., & Johnson, A. (2011). Reduced ADHD symptoms in adults with ADHD after structured skills training group: Results from a randomized controlled trial. Behaviour Research and Therapy, 49, 175–185.

    Article  PubMed  Google Scholar 

  • Hughes, A. E., Crowell, S. E., Uyeji, L., & Coan, J. A. (2012). A developmental neuroscience of borderline pathology: Emotion dysregulation and social baseline theory. Journal of Abnormal Child Psychology, 40, 21–33.

    Article  PubMed  Google Scholar 

  • James, A. C., Taylor, A., Winmill, L., & Alfoadari, K. (2008). A preliminary community study of dialectical behaviour therapy (DBT) with adolescent females demonstrating persistent, deliberate self-harm (DSH). Child and Adolescent Mental Health, 13, 148–152.

    Article  Google Scholar 

  • James, A. C., Winmill, L., Anderson, C., & Alfoadari, K. (2011). A preliminary study of an extension of a community dialectic behaviour therapy (DBT) programme to adolescents in the looked after care system. Child and Adolescent Mental Health, 16, 9–13.

    Article  Google Scholar 

  • Katz, L. Y., Cox, B. J., Gunasekara, S., & Miller, A. L. (2004). Feasibility of dialectical behavior therapy for suicidal adolescent inpatients. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 276–282.

    Article  PubMed  Google Scholar 

  • Keuthen, N. J., Rothbaum, B. O., Falkenstein, M. J., Meunier, S., Timpano, K. R., Jenike, M. A., et al. (2011). DBT-enhanced habit reversal treatment for trichotillomania: 3- and 6-month follow-up results. Depression and Anxiety, 28, 310–313.

    Article  PubMed  Google Scholar 

  • Keuthen, N. J., Rothbaum, B. O., Welch, S. S., Taylor, C., Falkenstein, M., Heekin, M., et al. (2010). Pilot trial of dialectical behavior therapy-enhanced habit reversal for trichotillomania. Depression and Anxiety, 27, 953–959.

    Article  PubMed  Google Scholar 

  • Keuthen, N. J., & Spirch, S. E. (2012). Utilizing DBT skills to augment traditional CBT for trichotillomania: An adult case study. Cognitive and Behavioral Practice, 19, 372–380.

    Article  Google Scholar 

  • Klein, D. A., & Miller, A. L. (2011). Dialectical behavior therapy for suicidal adolescents with borderline personality disorder. Child and Adolescent Psychiatric Clinics of North America, 20, 205–216.

    Article  PubMed  Google Scholar 

  • Kliem, S., Kröger, C., & Kosfelder, J. (2010). Dialectical behavior therapy for borderline personality disorder: A meta-analysis using mixed-effects modeling. Journal of Consulting and Clinical Psychology, 78, 936–951.

    Article  PubMed  Google Scholar 

  • Koons, C. R., Robins, C. J., Tweed, J. L., Lynch, T. R., Gonzalez, A. M., Morse, J. Q., et al. (2001). Efficacy of dialectical behavior therapy in women veterans with borderline personality disorder. Behavior Therapy, 32, 371–390.

    Article  Google Scholar 

  • Kring, A. M., & Sloan, D. M. (Eds.). (2010). Emotion regulation and psychopathology: A transdiagnostic approach to etiology and treatment. New York, NY: Guilford Press.

    Google Scholar 

  • Kröger, C., Schweiger, U., Sipos, V., Arnold, R., Kahl, K. G., Schunert, T., et al. (2006). Effectiveness of dialectical behaviour therapy for borderline personality disorder in an inpatient setting. Behaviour Research and Therapy, 44, 1211–1217.

    Article  PubMed  Google Scholar 

  • Kröger, C., Schweiger, U., Sipos, V., Kliem, S., Arnold, R., Schunert, T., et al. (2010). Dialectical behaviour therapy and an added cognitive behavioural treatment module for eating disorders in women with borderline personality disorder and anorexia nervosa or bulimia nervosa who failed to respond to previous treatments: An open trial with a 15-month follow-up. Journal of Behavior Therapy and Experimental Psychiatry, 41, 381–388.

    Article  PubMed  Google Scholar 

  • Leibenluft, E., Charney, D. S., & Pine, D. S. (2003). Researching the pathophysiology of pediatric bipolar disorder. Biological Psychiatry, 53, 1009–1020.

    Article  PubMed  Google Scholar 

  • Linehan, M. M. (1993a). Cognitive-behavioral treatment of borderline personality disorder. New York, NY: Guilford Press.

    Google Scholar 

  • Linehan, M. M. (1993b). Skills training manual for treating borderline personality disorder. New York, NY: Guilford Press.

    Google Scholar 

  • Linehan, M. M. (1997). Validation and psychotherapy. In A. C. Bohart & L. S. Greenberg (Eds.), Empathy reconsidered: New directions in psychotherapy (pp. 353–392). Washington, DC: American Psychological Association.

    Chapter  Google Scholar 

  • Linehan, M. M., Armstrong, H. E., Suarez, A., Allmon, D., & Heard, H. L. (1991). Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48, 1060–1064.

    Article  PubMed  Google Scholar 

  • Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard, H. L., et al. (2006). 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, 63, 757–766.

    Article  PubMed  Google Scholar 

  • Linehan, M. M., Dimeff, L. A., Reynolds, S. K., Comtois, K. A., Welch, S. S., Heagerty, P., et al. (2002). Dialectal behavior therapy versus comprehensive validation therapy plus 12-step for the treatment of opioid dependent women meeting criteria for borderline personality disorder. Drug and Alcohol Dependence, 67, 13–26.

    Article  PubMed  Google Scholar 

  • Linehan, M. M., Heard, H. L., & Armstrong, H. E. (1993). Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patients. Archives of General Psychiatry, 50, 971–974.

    Article  PubMed  Google Scholar 

  • Linehan, M. M., McDavid, J. D., Brown, M. Z., Sayrs, J. H. R., & Gallop, R. J. (2008). Olanzapine plus dialectical behavior therapy for women with high irritability who meet criteria for borderline personality disorder: A double-blind, placebo-controlled pilot study. Journal of Clinical Psychiatry, 69, 999–1005.

    Article  PubMed  Google Scholar 

  • Linehan, M. M., & Schmidt, H. (1995). The dialectics of effective treatment of borderline personality disorder. In W. O’Donohue & L. Krasner (Eds.), Theories of behavior therapy: Exploring behavior change (pp. 553–584). Washington, DC: American Psychological Association.

    Chapter  Google Scholar 

  • Linehan, M. M., Schmidt, H., Dimeff, L. A., Craft, J. C., Kanter, J., & Comtois, K. A. (1999). Dialectical behavior therapy for patients with borderline personality disorder and drug-dependence. The American Journal on Addictions, 8, 279–292.

    Article  PubMed  Google Scholar 

  • Linehan, M. M., Tutek, D. A., Heard, H. L., & Armstrong, H. E. (1994). Interpersonal outcome of cognitive behavioral treatment for chronically suicidal borderline patients. The American Journal of Psychiatry, 151, 1771–1776.

    PubMed  Google Scholar 

  • Lynch, T. R., Cheavens, J. S., Cukrowicz, K. C., Thorp, S. R., Bronner, L., & Beyer, J. (2007a). Treatment of older adults with co-morbid personality disorder and depression: A dialectical behavior therapy approach. International Journal of Geriatric Psychiatry, 22, 131–143.

    Article  PubMed  Google Scholar 

  • Lynch, T. R., Morse, J. Q., Mendelson, T., & Robins, C. J. (2003). Dialectical behavior therapy for depressed older adults: A randomized pilot study. American Journal of Geriatric Psychiatry, 11, 33–45.

    PubMed  Google Scholar 

  • Lynch, T. R., Trost, W. T., Salsman, N., & Linehan, M. M. (2007b). Dialectical behavior therapy for borderline personality disorder. Annual Review of Clinical Psychology, 3, 181–205.

    Article  PubMed  Google Scholar 

  • McDonell, M. G., Tarantino, J., Dubose, A. P., Matestic, P., Steinmetz, K., Galbreath, H., et al. (2010). A pilot evaluation of dialectical behavioural therapy in adolescent long-term inpatient care. Child and Adolescent Mental Health, 15, 193–196.

    Article  Google Scholar 

  • McLaughlin, K. A., Hatzenbuehler, M. L., Mennin, D. S., & Nolen-Hoeksema, S. (2011). Emotion dysregulation and adolescent psychopathology: A prospective study. Behaviour Research and Therapy, 49, 544–554.

    Article  PubMed  Google Scholar 

  • McMain, S. F., Guimond, T., Streiner, D. L., Cardish, R. J., & Links, P. S. (2012). Dialectical behavior therapy compared with general psychiatric management for borderline personality disorder: Clinical outcomes and functioning over a 2-year follow-up. American Journal of Psychiatry, 169, 650–661.

    PubMed  Google Scholar 

  • McMain, S. F., Links, P. S., Gnam, W. H., Guimond, T., Cardish, R. J., Korman, L., et al. (2009). A randomized trial of dialectical behavior therapy versus general psychiatric management for borderline personality disorder. The American Journal of Psychiatry, 166, 1365–1374.

    Article  PubMed  Google Scholar 

  • Miller, A. L., Glinski, J., Woodberry, K. A., Mitchell, A. G., & Indik, J. (2002). Family therapy and dialectical behavior therapy with adolescents: Part I: Proposing a clinical synthesis. American Journal of Psychotherapy, 56, 568–584.

    PubMed  Google Scholar 

  • Miller, A. L., Muehlenkamp, J. J., & Jacobson, C. M. (2008). Fact or fiction: Diagnosing borderline personality disorder in adolescents. Clinical Psychology Review, 28, 969–981.

    Article  PubMed  Google Scholar 

  • Miller, A. L., Rathus, J. H., DuBose, A. P., Dexter-Mazza, E. T., & Goldklang, A. R. (2007a). Dialectical behavior therapy for adolescents. In L. A. Dimeff & K. Koerner (Eds.), Dialectical behavior therapy in clinical practice: Applications across disorders and settings (pp. 245–263). New York, NY: Guilford Press.

    Google Scholar 

  • Miller, A. L., Rathus, J. H., & Linehan, M. M. (2007b). Dialectical behavior therapy with suicidal adolescents. New York, NY: Guilford Press.

    Google Scholar 

  • Miller, A. L., Rathus, J. H., Linehan, M. M., Wetzler, S., & Leigh, E. (1997). Dialectical behavior therapy adapted for suicidal adolescents. Journal of Practical Psychiatry and Behavioral Health, 3, 78–86.

    Article  Google Scholar 

  • Miller, A. L., Wyman, S. E., Huppert, J. D., Glassman, S. L., & Rathus, J. H. (2000). Analysis of behavioral skills utilized by suicidal adolescents receiving dialectical behavior therapy. Cognitive and Behavioral Practice, 7, 183–187.

    Article  Google Scholar 

  • Neacsiu, A. D., Rizvi, S. L., & Linehan, M. M. (2010). Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder. Behaviour Research and Therapy, 48, 832–839.

    Article  PubMed  Google Scholar 

  • Nelson-Gray, R., Keane, S. P., Hurst, R. M., Mitchell, J. T., Warburton, J. B., Chok, J. T., et al. (2006). A modified DBT skills training program for oppositional defiant adolescents: Promising preliminary findings. Behaviour Research and Therapy, 44, 1811–1820.

    Article  PubMed  Google Scholar 

  • Nock, M. K., & Prinstein, M. J. (2004). A functional approach to the assessment of self-mutilative behavior. Journal of Consulting and Clinical Psychology, 72, 885–890.

    Article  PubMed  Google Scholar 

  • Nock, M. K., & Prinstein, M. J. (2005). Contextual features and behavioral functions of self-mutilation among adolescents. Journal of Abnormal Psychology, 114, 140–146.

    Article  PubMed  Google Scholar 

  • Nock, M. K., Prinstein, M. J., & Sterba, S. K. (2009). Revealing the form and function of self-injurious thoughts and behaviors: A real-time ecological assessment study among adolescents and young adults. Journal of Abnormal Psychology, 118, 816–827.

    Article  PubMed  Google Scholar 

  • Nolen-Hoeksema, S. (2012). Emotion regulation and psychopathology: The role of gender. Annual Review of Clinical Psychology, 8, 161–187.

    Article  PubMed  Google Scholar 

  • Orbach, I., Blomenson, R., Mikulincer, M., Gilboa-Schechtman, E., Rogolsky, M., & Retzoni, G. (2007). Perceiving a problem-solving task as a threat and suicidal behavior in adolescents. Journal of Social and Clinical Psychology, 26, 1010–1034.

    Article  Google Scholar 

  • Pasieczny, N., & Connor, J. (2011). The effectiveness of dialectical behaviour therapy in routine public mental health settings: An Australian controlled trial. Behaviour Research and Therapy, 49, 4–10.

    Article  PubMed  Google Scholar 

  • Peebles, R., Wilson, J. L., & Lock, J. D. (2011). Self-injury in adolescents with eating disorders: Correlates and provider bias. Journal of Adolescent Health, 48, 310–313.

    Article  PubMed  Google Scholar 

  • Pistorello, J., Fruzzetti, A. E., MacLane, C., Gallop, R., & Iverson, K. M. (2012). Dialectical behavior therapy (DBT) applied to college students: A randomized clinical trial. Journal of Consulting and Clinical Psychology. Advance online publication. doi:10.1037/a0029096.

  • Prendergast, N., & McCausland, J. (2007). Dialectic behaviour therapy: A 12-month collaborative program in a local community setting. Behaviour Change, 24, 25–35.

    Article  Google Scholar 

  • Putnam, K. M., & Silk, K. R. (2005). Emotion dysregulation and the development of borderline personality disorder. Development and Psychopathology, 17, 899–925.

    Article  PubMed  Google Scholar 

  • Rathus, J. H., & Miller, A. L. (2000). DBT for adolescents: Dialectical dilemmas and secondary treatment targets. Cognitive and Behavioral Practice, 7, 425–434.

    Article  Google Scholar 

  • Rathus, J. H., & Miller, A. L. (2002). Dialectical behavior therapy adapted for suicidal adolescents. Suicide and Life-Threatening Behavior, 32, 146–157.

    Article  PubMed  Google Scholar 

  • Reeves, M., James, L. M., Pizzarello, S. M., & Taylor, J. E. (2010). Support for Linehan’s biosocial theory from a nonclinical sample. Journal of Personality Disorders, 24, 312–326.

    Article  PubMed  Google Scholar 

  • Rizvi, S. L., Steffel, L. M., & Carson-Wong, A. (2012). An overview of dialectical behavior therapy for professional psychologists. Professional Psychology: Research and Practice. Advance online publication. doi:10.1037/a0029808.

  • Robins, C. J., & Chapman, A. L. (2004). Dialectical behavior therapy: Current status, recent developments, and future directions. Journal of Personality Disorders, 18, 73–89.

    Article  PubMed  Google Scholar 

  • Robins, C. J., & Rosenthal, M. Z. (2011). Dialectical behavior therapy. In J. D. Herbert & E. M. Forman (Eds.), Acceptance and mindfulness in cognitive behavior therapy: Understanding and applying the new therapies (pp. 164–192). Hoboken, NJ: Wiley.

    Google Scholar 

  • Ruuska, J., Kaltiala-Heino, R., Rantanen, P., & Koivisto, A. M. (2005). Psychopathological distress predicts suicidal ideation and self-harm in adolescent eating disorder patients. European Child and Adolescent Psychiatry, 14, 276–281.

    Article  PubMed  Google Scholar 

  • Safer, D. L., Lock, J., & Couturier, J. L. (2007). Dialectical behavior therapy modified for adolescent binge eating disorder: A case report. Cognitive and Behavioral Practice, 14, 157–167.

    Article  Google Scholar 

  • Safer, D. L., Robinson, A. H., & Jo, B. (2010). Outcome from a randomized controlled trial of group therapy for binge eating disorder: Comparing dialectical behavior therapy adapted for binge eating to an active comparison group therapy. Behavior Therapy, 41, 106–120.

    Article  PubMed  Google Scholar 

  • Safer, D. L., Telch, C. F., & Agras, W. S. (2001). Dialectical behavior therapy for bulimia nervosa. The American Journal of Psychiatry, 158, 632–634.

    Article  PubMed  Google Scholar 

  • Salbach-Andrae, H., Bohnekamp, I., Pfeiffer, E., Lehmkuhl, U., & Miller, A. L. (2008). Dialectical behavior therapy of anorexia and bulimia nervosa among adolescents: A case series. Cognitive and Behavioral Practice, 15, 415–425.

    Article  Google Scholar 

  • Selby, E. A., & Joiner, T. E. (2009). Cascades of emotion: The emergence of borderline personality disorder from emotional and behavioral dysregulation. Review of General Psychology, 13, 219–229.

    Article  PubMed  Google Scholar 

  • Shelton, D., Kesten, K., Zhang, W., & Trestman, R. (2011). Impact of dialectical behavior therapy—Corrections modified (DBT-CM) upon behaviorally challenged incarcerated male adolescents. Journal of Child and Adolescent Psychiatric Nursing, 24, 105–113.

    Article  PubMed  Google Scholar 

  • Shenk, C. E., & Fruzzetti, A. E. (2011). The impact of validating and invalidating responses on emotion reactivity. Journal of Social and Clinical Psychology, 30, 163–183.

    Article  Google Scholar 

  • Shusterman, A., Feld, L., Baer, L., & Keuthen, N. (2009). Affective regulation in trichotillomania: Evidence from a large-scale internet survey. Behaviour Research and Therapy, 47, 637–644.

    Article  PubMed  Google Scholar 

  • Sim, L., & Zeman, J. (2005). Emotion regulation factors as mediators between body dissatisfaction and bulimic symptoms in early adolescent girls. The Journal of Early Adolescence, 25, 478–496.

    Article  Google Scholar 

  • Simpson, E. B., Yen, S., Costello, E., Rosen, K., Begin, A., Pistorello, J., et al. (2004). Combined dialectical behavior therapy and fluoxetine in the treatment of borderline personality disorder. Journal of Clinical Psychiatry, 65, 379–385.

    Article  PubMed  Google Scholar 

  • Soler, J., Pascual, J. C., Campins, J., Barrachina, J., Puigdemont, D., Alvarez, E., et al. (2005). Double-blind, placebo-controlled study of dialectical behavior therapy plus olanzapine for borderline personality disorder. The American Journal of Psychiatry, 162, 1221–1224.

    Article  PubMed  Google Scholar 

  • Soler, J., Pascual, J. C., Tiana, T., Cebrià, A., Barrachina, J., Campins, M. J., et al. (2009). Dialectical behavior therapy skills training compared to standard group therapy in borderline personality disorders: A 3-month randomised controlled clinical trial. Behaviour Research and Therapy, 47, 353–358.

    Article  PubMed  Google Scholar 

  • Steinberg, J. A., Steinberg, S. J., & Miller, A. L. (2011). Orienting adolescents and families to DBT telephone consultation: Principles, procedures, and pitfalls. Cognitive and Behavioral Practice, 18, 196–206.

    Article  Google Scholar 

  • Stepp, S. D., Burke, J. D., Hipwell, A. E., & Loeber, R. (2012). Trajectories of attention deficit hyperactivity disorder and oppositional defiant disorder symptoms as precursors of borderline personality disorder symptoms in adolescent girls. Journal of Abnormal Child Psychology, 40, 7–20.

    Article  PubMed  Google Scholar 

  • Stingaris, A., Maughan, B., & Goodman, R. (2010). What is a disruptive disorder? Temperamental antecedents of oppositional defiant disorder: Findings from the Avon longitudinal study. Journal of the American Academy of Child and Adolescent Psychiatry, 49, 474–483.

    Google Scholar 

  • Sunseri, P. A. (2004). Preliminary outcomes on the use of dialectical behavior therapy to reduce hospitalization among adolescents in residential care. Residential Treatment for Children and Youth, 21, 59–76.

    Article  Google Scholar 

  • Tamás, Z., Kovacs, M., Gentzler, A. L., Tepper, P., Gádoros, J., Kiss, E., et al. (2007). The relations of temperament and emotion self-regulation with suicidal behaviors in a clinical sample of depressed children in Hungary. Journal of Abnormal Child Psychology, 35, 640–652.

    Article  PubMed  Google Scholar 

  • Telch, C. F., Agras, W. S., & Linehan, M. M. (2001). Dialectical behavior therapy for binge eating disorder. Journal of Consulting and Clinical Psychology, 69, 1061–1065.

    Article  PubMed  Google Scholar 

  • Thompson, R. A. (1994). Emotion regulation: A theme in search of definition. Monographs of the Society for Research in Child Development, 59, 25–52.

    Article  PubMed  Google Scholar 

  • Trautman, P. D., Stewart, N., & Morishima, A. (1993). Are adolescent suicide attempters non-compliant with outpatient care? Journal of the American Academy of Child and Adolescent Psychiatry, 32, 89–94.

    Article  PubMed  Google Scholar 

  • Trupin, E. W., Stewart, D. G., Beach, B., & Boesky, L. (2002). Effectiveness of dialectical behaviour therapy program for incarcerated female juvenile offenders. Child and Adolescent Mental Health, 7, 121–127.

    Article  Google Scholar 

  • van den Bosch, L. M. C., Koeter, M. W. J., Stijnen, T., Verheul, R., & van den Brink, W. (2005). Sustained efficacy of dialectical behaviour therapy for borderline personality disorder. Behaviour Research and Therapy, 43, 1231–1241.

    Article  PubMed  Google Scholar 

  • van den Bosch, L. M. C., Verheul, R., Schippers, G. M., & van den Brink, W. (2002). Dialectical behavior therapy of borderline patients with and without substance use problems: Implementation and long-term effects. Addictive Behaviors, 27, 911–923.

    Article  PubMed  Google Scholar 

  • Van Dijk, S., Jeffrey, J., & Katz, M. R. (2012). A randomized, controlled, pilot study of dialectical behavior therapy skills in a psychoeducational group for individuals with bipolar disorder. Journal of Affective Disorders. Advance online publication. doi:10.1016/j.jad.2012.05.054

  • Verheul, R., van den Bosch, L. M. C., Koeter, M. W. J., de Ridder, M. A., Stijnen, T., & van den Brink, W. (2003). Dialectical behaviour therapy for women with borderline personality disorder: 12-month, randomised clinical trial in The Netherlands. British Journal of Psychiatry, 182, 135–140.

    Article  PubMed  Google Scholar 

  • Wasser, T., Tyler, R., Mcllhaney, K., Taplin, R., & Henderson, L. (2008). Effectiveness of dialectical behavior therapy (DBT) versus standard therapeutic milieu (STM) in a cohort of adolescents receiving residential treatment. Best Practices in Mental Health, 4, 114–125.

    Google Scholar 

  • Welch, S. S., & Kim, J. (2012). DBT-enhanced cognitive behavioral therapy for adolescent trichotillomania: An adolescent case study. Cognitive and Behavioral Practice, 19, 483–493.

    Article  Google Scholar 

  • Wisniewski, L., & Kelly, E. (2003). The application of dialectical behavior therapy to the treatment of eating disorders. Cognitive and Behavioral Practice, 10, 131–138.

    Article  Google Scholar 

  • Wisniewski, L., Safer, D., & Chen, E. (2007). Dialectical behavior therapy and eating disorders. In L. A. Dimeff & K. Koerner (Eds.), Dialectical behavior therapy in clinical practice: Applications across disorders and settings (pp. 174–221). New York, NY: Guilford Press.

    Google Scholar 

  • Woodberry, K. A., Miller, A. L., Glinski, J., Indik, J., & Mitchell, A. G. (2002). Family therapy and dialectical behavior therapy with adolescents: Part II: A theoretical review. American Journal of Psychotherapy, 56, 585–602.

    PubMed  Google Scholar 

  • Woodberry, K. A., & Popenoe, E. J. (2008). Implementing dialectical behavior therapy with adolescents and their families in a community outpatient clinic. Cognitive and Behavioral Practice, 15, 277–286.

    Article  Google Scholar 

  • Zanarini, M. C., Frankenburg, F. R., Reich, D. B., & Fitzmaurice, G. (2010). Time to attainment of recovery from borderline personality disorder and stability of recovery: A 10-year prospective follow-up study. American Journal of Psychiatry, 167, 663–667.

    Article  PubMed  Google Scholar 

  • Zanarini, M. C., Frakenburg, F. R., Reich, D. B., Silk, K. R., Hudson, J. I., & McSweeney, L. B. (2007). The subsyndromal phenomenology of borderline personality disorder: A 10-year follow-up study. American Journal of Psychiatry, 164, 929–935.

    Article  PubMed  Google Scholar 

  • Zlotnick, C., Donaldson, D., Spirito, A., & Pearlstein, T. (1997). Affect regulation and suicide attempts in adolescent inpatients. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 793–798.

    Article  PubMed  Google Scholar 

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MacPherson, H.A., Cheavens, J.S. & Fristad, M.A. Dialectical Behavior Therapy for Adolescents: Theory, Treatment Adaptations, and Empirical Outcomes. Clin Child Fam Psychol Rev 16, 59–80 (2013). https://doi.org/10.1007/s10567-012-0126-7

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