THE EFFECTIVENESS OF DIALECTICAL BEHAVIOR THERAPY IN REDUCING SELF-DIRECTED VIOLENCE AND SUICIDALITY: A META-ANALYSIS

Abstract

Background: Dialectical behavior therapy (DBT), an outpatient intervention, has shown efficacy in reducing suicidality. Less is known about its effectiveness when delivered in usual care (UC), and the resource-intensive nature of the program often results in modifications when implemented in usual care. Methods: A systematic search yielded 83 empirical evaluations of DBT that reported original data on at least one of three suicidality-related outcomes: (a) self-directed violence (SDV), (b) crisis service use (CSU), and (c) suicidal ideation (SI). Using meta-analysis, the current study (1) estimated pooled effect of DBT in UC, (2) compared effects in UC and non-UC settings, and (3) examined predictors of differential outcomes. Results: DBT demonstrated a large effect (g=.81) in reducing SDV and a medium effect in reducing SI (g=.68). The estimated effect on CSU (g=.60) was non-significant after adjusting for publication bias (g=.29). DBT was more effective than control conditions in reducing SDV (g=.50), even after adjusting for publication bias (g=1.63). No differences between UC and non-UC effects were detected. In uncontrolled studies, positive associations emerged between therapist training and SDV reduction, adherence-reporting and CSU reduction, and outpatient and SI reduction. Discussion: Results support DBT’s effectiveness in reducing suicidality-related outcomes in UC, but should be interpreted with caution given the heterogeneity among studies. Potential sources of heterogeneity and the methodological challenges of synthesizing research in UC are discussed. Recommendations for future work are offered.