Abstract
Dialectical Behavior Therapy (DBT) (Linehan, 1993) has been well-established as an evidenced-based practice through several randomized controlled trials (e.g. Linehan, Armstrong, Suarez, Allmon, & Heard, 1991; Linehan, Heard, & Armstrong, 1993). The popularity of DBT has led to its widespread dissemination across settings and populations, including numerous modifications to standard DBT to meet the needs of local communities. However, this trend has created a growing gap between the empirical evidence for DBT and the implementation of DBT. Thus, little is known about the effectiveness of DBT in naturalistic settings. Similarly, there is a growing debate in psychotherapy literature about the usefulness of adapting DBT (e.g. Koerner, Dimeff, & Swenson, 2007). This project consisted of a critical literature review and a quantitative study. The study was designed in response to the need for more practice-based research on DBT. The aim of this study was to investigate the effectiveness of pre-existing DBT programs using standardized outcome data. Three DBT programs were assessed; two adapted DBT programs and one standard DBT program. The author analyzed aggregate data of 93 clients who successfully completed DBT using routine assessment with the Treatment Outcome Package (TOP) (Kraus, Seligman, & Jordan, 2005) at a local outpatient mental health clinic. Results of this study demonstrated that the DBT programs in this real-world setting were associated with participant improvements across several domains of functioning, most notably, suicidal ideation and self-injury, depression, anxiety, social functioning, and quality of life. In addition, findings suggested that the adapted programs were at least as effective as the standard DBT program. Additional practice-based research is needed to increase the evidence for the external validity of DBT, and to better understand the moderators of DBT that impact client iv outcomes. Finally, challenges in executing practice-based research with proprietary outcomes assessment instruments are discussed.