Marsha M Linehan

Marsha M Linehan
University of Washington Seattle | UW · Psychology, School or Arts and Sciences

PhD

About

230
Publications
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Introduction

Publications

Publications (230)
Article
Objective This study evaluated mechanisms, mediation, and secondary/exploratory outcomes in our randomized controlled trial evaluating Dialectical Behavior Therapy (DBT) compared to Individual and Group Supportive Therapy (IGST), expanding on previously reported results indicating a DBT advantage at post-treatment on planned suicide/self-harm outco...
Article
Objective To elucidate processes contributing to continuing self‐harm in youth at very high risk for suicide, focusing on sleep disturbance, a putative warning sign of imminent suicide risk. Method 101 youth (ages 12–18) selected for high risk of suicide/suicide attempts based on suicidal episodes plus repeated self‐harm (suicide attempts and/or n...
Article
Full-text available
Objective: Suicide remains a leading cause of death in the United States, and recent reports have suggested the suicide rate is increasing. One of the most robust predictors of future suicidal behavior is a history of attempting suicide. Despite this, little is known about the factors that reduce the likelihood of reattempting suicide. This study...
Article
Borderline personality disorder (BPD) is often accompanied by other diagnoses. Some comorbidities have received a good deal of attention, but others, including somatization, have not. As effective treatments for BPD are identified, the secondary effects of these treatments on BPD comorbidities are of clinical relevance. Secondary data were used fro...
Article
Background: In primary analyses, dialectical behavior therapy (DBT) was associated with greater reduction in self-harm during treatment than individual/group supportive therapy (IGST). The objective of this paper was to examine predictors and moderators of treatment outcomes for suicidal adolescents who participated in a randomized controlled tria...
Article
Full-text available
Dialectical behavior therapy (DBT) is an evidence-based treatment for borderline personality disorder. The DBT Intensive Training™ is widely used to train community clinicians to deliver DBT, but little is known about its effectiveness. This study prospectively evaluated predictors of adoption and reach of DBT among 52 community teams (212 clinicia...
Article
Objective Both suicide and nonsuicidal self‐injury (NSSI) represent major public health concerns, and effective assessment, management, and treatment requires assessment tools that can simultaneously be quick and accurate. This study compared the validity of a self‐report measure of suicide attempts and NSSI acts with a gold standard in depth inter...
Chapter
Dialectical behaviour therapy is a comprehensive behavioural treatment that can be applied trans- and multi-diagnostically to address clinical problems involving behavioural, emotional, or cognitive dysregulation, and target mild to severe dysfunction, including high suicide risk. Dissemination of treatment, particularly to those with severe mental...
Article
This study was designed to evaluate family processes theoretically implicated in the onset and maintenance of adolescent self-harm. We focused on understanding parental validation and invalidation in response to their adolescent children to estimate the association between parental responses and self-harm in a high-risk group of adolescents. We als...
Article
Full-text available
Importance Suicide is a leading cause of death among 10- to 24-year-old individuals in the United States; evidence on effective treatment for adolescents who engage in suicidal and self-harm behaviors is limited. Objective To evaluate the efficacy of dialectical behavior therapy (DBT) compared with individual and group supportive therapy (IGST) fo...
Conference Paper
Mental health disorders are a leading cause of disability worldwide. Although evidence-based psychotherapy is effective, engagement from such programs can be low. Mobile apps have the potential to help engage and support people in their therapy. We developed Pocket Skills, a mobile web app based on Dialectical Behavior Therapy (DBT). Pocket Skills...
Article
Full-text available
Introduction: Paralysis from a spinal cord injury (SCI) increases risk of psychological problems including suicide attempts, substance use disorder, negative emotions (e.g., anger), depression, anxiety, ASD/PTSD. Dialectical Behavioral Therapy® (DBT®) has been shown to be effective for treating similar psychological symptoms in non-SCI patient popu...
Article
Objective: Although previous research has suggested that people with a history of using psychiatric crisis services are at higher risk for suicide, it is unclear whether this link is attributable to individual risk factors or iatrogenic effects of service utilization. We examined this question by analyzing data from a randomized controlled trial o...
Article
Background: Given that alcohol misuse elevates risk of suicide death among ideators, the paucity of treatment outcome research for individuals presenting with both suicide ideation and problem drinking is particularly troubling. Dialectical behavior therapy (DBT) skills training, which effectively targets behaviors associated with emotion dysregul...
Chapter
Dialectical behavior therapy (DBT) is a comprehensive trans-diagnostic and multidiagnostic cognitive behavioral intervention designed to target individuals with complex clinical presentations that include life-threatening behaviors and severe dysregulation across emotion, cognition, and behavioral domains. The treatment initially targeted adult ind...
Chapter
Full-text available
Borderline Personality Disorder (BPD) is a serious disorder characterized by a pervasive pattern of dysregulation and instability across all domains of functioning. Individuals with BPD have difficulty with emotion regulation and often exhibit suicidal and non-suicidal self-injurious (NSSI) behaviors. Approximately 10% of individuals with BPD commi...
Article
Full-text available
Regular mindfulness practice benefits people both mentally and physically, but many populations who could benefit do not practice mindfulness. Virtual Reality (VR) is a new technology that helps capture participants’ attention and gives users the illusion of “being there” in the 3D computer generated environment, facilitating sense of presence. By...
Article
Full-text available
Background: The need to develop effective and accessible interventions for suicidal individuals engaging in heavy episodic drinking (HED) cannot be understated. While the link between alcohol use and suicidality is a complex one that remains to be elucidated, emotion dysregulation may play a key role in alcohol-related suicide risk in these indivi...
Article
Full-text available
Sustaining a burn injury increases an individual's risk of developing psychological problems such as generalized anxiety, negative emotions, depression, acute stress disorder, or post-traumatic stress disorder. Despite the growing use of Dialectical Behavioral Therapy® (DBT®) by clinical psychologists, to date, there are no published studies using...
Article
Background Non-treatment-engaged individuals experiencing suicidal thoughts have been largely overlooked in the intervention literature, despite reviews suggesting most individuals who die by suicide were not in treatment immediately prior to their death. Most intervention studies recruit individuals from treatment providers, potentially neglecting...
Chapter
Brief Thoughts on Zen and Behavior Therapy is presented by one of the leading researchers and clinicians in behavior therapy today: Marsha Linehan, creator of Dialectical Behavior Therapy. In it, Dr. Linehan describes her journey in becoming a behavior therapist and a Zen Roshi, elaborating on the similarities and differences between these two prof...
Article
Objective: We examined the psychometric properties of the Dialectical Behavior Therapy (DBT) Barriers to Implementation Scale (BTI-S). Method: Participants were clinicians completing a bipartite training, separated by 6 months of self-study, to implement DBT. Exploratory factor analysis was conducted with data collected from the initial training...
Conference Paper
Full-text available
A formative study of a mobile application for introducing skills related to Dialectical Behavior Therapy (DBT) is reviewed with an eye toward next iteration design. DBT is considered the gold standard for the treatment of suicide and borderline personality disorder, among other complex behavioral disorders. A multidisciplinary design team took lice...
Preprint
BACKGROUND The need to develop effective and accessible interventions for suicidal individuals engaging in heavy episodic drinking (HED) cannot be understated. While the link between alcohol use and suicidality is a complex one that remains to be elucidated, emotion dysregulation may play a key role in alcohol-related suicide risk in these individu...
Chapter
The leaders in treatment of suicidal complex consumers offer insight into the best strategies to promote engagement in life-saving care. The authors, however, go beyond this traditional application of Dialectical Behavior Therapy (DBT) and discuss how strategies may be applied across a wide range of populations. Particularly, readers will gain an a...
Article
Full-text available
Borderline personality disorder (BPD) is a severe mental disorder characterized by a dysfunctional pattern of affective instability, impulsivity, and disturbed interpersonal relationships. Dialectical Behavior Therapy (DBT®) is the most effective treatment for Borderline Personality Disorder, but demand for DBT® far exceeds existing clinical resour...
Article
Full-text available
Family members of individuals with behavioral disorders are a valuable source of logistical and emotional support for patients. Family members may take on tremendous financial and/or psychological responsibility to care for their loved ones, which can result in poor psychological outcomes for the family and, in turn, impede the recovery of the pati...
Article
Objective: The present study examined the usability and effectiveness of the Linehan Suicide Safety Net (LSSN), a web-based, multimedia tool designed to support clinicians working with individuals who are suicidal. The core feature of LSSN is the Linehan Risk Assessment and Management Protocol (LRAMP), an empirically derived protocol that provides...
Article
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Table of contents Introduction to the 3rd Biennial Conference of the Society for Implementation Research Collaboration: advancing efficient methodologies through team science and community partnerships Cara Lewis, Doyanne Darnell, Suzanne Kerns, Maria Monroe-DeVita, Sara J. Landes, Aaron R. Lyon, Cameo Stanick, Shannon Dorsey, Jill Locke, Brigid Ma...
Article
Full-text available
Background Individuals who are not engaged in treatment are commonly overlooked in the design of intervention trials targeting suicidal populations as a result of recruitment methodology that requires individuals to be referred from their current provider. In fact, research suggests that the majority of individuals who die by suicide have not been...
Article
In this overview of behavior therapy both in the early days, as it is now and where I believe it needs to go, I start with identifying those who had such an enormous effect on my own growth as a behavior therapist, starting from my days as a believer in Freudian psychology to my present passion in developing computerized behavioral treatments. I be...
Poster
In this poster we review previous research that included cost of treatment information for participants involved in dialectical behavior therapy (DBT) to ascertain overall cost reductions resulting from DBT.
Article
There is a high rate of comorbidity between borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD; Pagura et al., 2010). Preliminary studies have evaluated the treatment of PTSD in a BPD population and found positive outcomes for the integration of dialectical behavior therapy (DBT) and prolonged exposure (PE). This case stu...
Article
Full-text available
Dialectical behavior therapy was originally developed from early efforts to apply standard behavior therapy to treat individuals who were highly suicidal. Its development was a trial and error effort driven primarily from clinical experience. Dialectical behavior therapy is a modular and hierarchical treatment consisting of a combination of individ...
Article
Full-text available
Dialectical behavior therapy (DBT) is an empirically supported treatment for suicidal individuals. However, DBT consists of multiple components, including individual therapy, skills training, telephone coaching, and a therapist consultation team, and little is known about which components are needed to achieve positive outcomes. To evaluate the imp...
Article
Full-text available
The purpose of the present study was to explore facets of the client- and therapist-rated therapeutic alliance as predictors of suicide attempts, nonsuicidal self-injury, depression, and introject during the course of 2 psychosocial treatments for borderline personality disorder. A total of 101 women meeting Diagnostic and Statistical Manual of Men...
Article
Full-text available
Objective Anorexia Nervosa (AN) is associated with excessive self-control. This iterative case series describes the augmentation of Dialectical Behavior Therapy (DBT) for outpatient adult AN with skills addressing emotional and behavioral overcontrol. An overly controlled style is theorized to develop from the transaction between an individual with...
Book
The Book is the Italian Edition of M-M: Linehan DBT skills training manual pp.900
Article
Objective Difficulties with emotions are common across mood and anxiety disorders. Dialectical behavior therapy skills training (DBT-ST) reduces emotion dysregulation in borderline personality disorder (BPD). Preliminary evidence suggests that use of DBT skills mediates changes seen in BPD treatments. Therefore, we assessed DBT-ST as a stand-alone,...
Article
Full-text available
Research on effective treatments for adolescent suicide attempters is urgently needed. However, there has been a lack of research in this area. This is likely a result of the multiple challenges faced by investigators working with individuals at high risk of suicide. Based on our experiences conducting a large, randomized clinical trial with adoles...
Chapter
Suicide is a consistent and considerable public health problem for which effective interventions are needed. This review outlines the weaknesses and shortfalls of the current research literature aimed at developing and evaluating interventions for this population. Randomized controlled trials targeting suicidal behaviors in which cognitive behavior...
Article
Full-text available
Dialectical Behavior Therapy (DBT) is a comprehensive, multimodal cognitive behavioral treatment originally developed for individuals who met criteria for borderline personality disorder (BPD) who displayed suicidal tendencies. DBT is based on behavioral theory but also includes principles of acceptance, mindfulness, and validation. Since its devel...
Article
Full-text available
Self-inflicted injury (SII) in adolescence marks heightened risk for suicide attempts, completed suicide, and adult psychopathology. Although several studies have revealed elevated rates of depression among adolescents who self injure, no one has compared adolescent self injury with adolescent depression on biological, self-, and informant-report m...
Article
The American Psychological Foundation (APF) Gold Medal Awards recognize distinguished and enduring records of accomplishment in four areas of psychology: the application of psychology, the practice of psychology, psychology in the public interest, and the science of psychology. The 2012 recipient of the Gold Medal Award for Life Achievement in the...
Article
Full-text available
The purpose of the present study was to examine theory-driven hypotheses of the therapeutic relationship and patient introject in dialectical behavior therapy (DBT; Linehan, 1993) for the treatment of borderline personality disorder. A total of 14 DBT therapists provided weekly ratings of the therapeutic relationship and patient introject (N=41) du...
Article
Full-text available
This study investigated the indirect effects of problematic emotion regulation on features of Borderline Personality Disorder (BPD) when accounting for negative affect in 456 participants from two distinct geographic regions. Participants completed the Affect Intensity Measure (AIM), Difficulties in Emotion Regulation Scale (DERS), the Emotion Regu...
Article
The University of Washington Risk Assessment Protocol (UWRAP) and Risk Assessment and Management Protocol (UWRAMP) have been used in numerous clinical trials treating high-risk suicidal individuals over several years. These protocols structure assessors and treatment providers to provide a thorough suicide risk assessment, review standards of care...
Article
Dialectical behavior therapy (DBT) has received strong empirical support and is practiced widely as a treatment for borderline personality disorder (BPD) and BPD with comorbid substance use disorders (BPD-SUD). Therapeutic success in DBT requires that individuals generalize newly acquired skills to their natural environment. However, there have bee...
Article
Full-text available
The present study explored the role of the therapeutic relationship and introject during the course of dialectical behavior therapy (DBT; Linehan, 1993) for the treatment of borderline personality disorder. Women meeting DSM-IV criteria for borderline personality disorder (N = 101) were randomized to receive DBT or community treatment by experts. T...
Article
This study examined the prevalence and correlates of sexual risk behaviors and sexually transmitted infections (STIs) in two samples of outpatients with borderline personality disorder (BPD), including suicidal BPD women (n = 99) and opiate-dependent BPD men and women (n = 125). High rates of sexual risk behaviors and STIs were found, particularly...
Article
Full-text available
Opiate dependence (OD) and borderline personality disorder (BPD), separately and together, are significant public health problems with poor treatment outcomes. BPD is associated with difficulties in emotion regulation, and brain-imaging studies in BPD individuals indicate differential activation in prefrontal cingulate cortices and their interactio...
Article
Full-text available
We inquire into parental correlates of illness expression in three pediatric diagnoses: Inflammatory Bowel Disease, cancer and renal disease. Children with cancer and renal disease were the comparison groups, using valid pediatric measures for comparison across diagnostic categories in chronic illness. We found compromised parental support in famil...
Article
Full-text available
The authors examined the impact of co-occurring posttraumatic stress disorder (PTSD) on women with borderline personality disorder who had attempted suicide in the preceding year. Female borderline personality disorder outpatients (N=94) either with (N=53, 56.4%) or without PTSD (N=41, 43.6%) and with recent and repeated suicidal or self-injurious...
Article
A central component of Dialectical Behavior Therapy (DBT) is the teaching of specific behavioral skills with the aim of helping individuals with Borderline Personality Disorder (BPD) replace maladaptive behaviors with skillful behavior. Although existing evidence indirectly supports this proposed mechanism of action, no study to date has directly t...
Article
This study examined the efficacy of dialectical behavior therapy (DBT) in reducing behaviors commonly used as exclusion criteria for posttraumatic stress disorder (PTSD) treatment. The sample included 51 suicidal and/or self-injuring women with borderline personality disorder (BPD), 26 (51%) of whom met criteria for PTSD. BPD clients with and witho...
Article
Skills training is a crucial mode of treatment in dialectical behavioral therapy (DBT; Linehan, 1993b), yet a psychometrically sound measure of DBT skills use does not exist. We adapted the Revised Ways of Coping Checklist (RWCCL; Vitaliano, Russo, Carr, Maiuro, & Becker, 1985) to create the DBT Ways of Coping Checklist (DBT-WCCL). Using factor ana...