The empirical basis of dialectical behavior therapy: Development of new treatments versus evaluation of existing treatments

Borderline personality disorder is a severe and pervasive personality disorder. The high prevalence of disorder, together with poor outcomes in traditional treatments, low compliance with treatment, high hospitalization rates, and serious suicide risk, suggests that any new treatment with even marginal data on empirical validity would be greeted with enthusiasm by the clinical community. Dialectical behavior therapy (DBT) is such a treatment. Describing and defining a comprehensive principle-driven treatment such as DBT,;however, and selecting strategies and methods for development and evaluation of new treatments for severe and high-risk mental disorders raise complex issues. Although there have been a number of controlled trials examining the efficacy of DBI, the extent of the treatment's efficacy, the mechanisms of efficacy, and the degree to which the treatment should be adopted in community mental health are not clear.