DBT and third-wave therapies

Meet the patient

A 24-year-old woman is in the emergency department for the fourth time this quarter after cutting. The referral says "known BPD, no acute mental illness, for discharge". The registrar who wrote it has already used the word "manipulative" twice on the phone.^[6][8]

She has been in a "DBT group" for five months. There is no individual therapist, no diary card, no chain analysis, and nobody has ever coached her by phone on the night it matters. She still has no idea what she is supposed to do at 2am.^[1][3]

Two exam questions are now live: is what she is receiving actually DBT, and what is the right offer if comprehensive DBT is not available? Everything below answers those two.^[3][4]

References20ShowHide

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2. [2]Linehan MM, Comtois KA, Murray AM, 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 Arch Gen Psychiatry, 2006.PMID 16818865
3. [3]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 Psychiatry, 2015.PMID 25806661
4. [4]McMain SF, Links PS, Gnam WH, et al. A randomized trial of dialectical behavior therapy versus general psychiatric management for borderline personality disorder Am J Psychiatry, 2009.PMID 19755574
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19. [19]Blum N, St John D, Pfohl B, et al. Systems Training for Emotional Predictability and Problem Solving (STEPPS) for outpatients with borderline personality disorder: a randomized controlled trial and 1-year follow-up Am J Psychiatry, 2008.PMID 18281407
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