Marsha M Linehan

University of Washington | UW · Psychology, School or Arts and Sciences

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...

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...

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...

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...

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 trial...

This chapter elaborates on the multiple integrative aspects of dialectical behavior therapy (DBT), an evidenced-based treatment for individuals who meet criteria for borderline personality disorder (BPD). It discusses how behavioral theory, Zen, and dialectics provide the primary principles and describes how the dialectical principles perform vario...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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.

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...

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...

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...

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...

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...

The Book is the Italian Edition of M-M: Linehan DBT skills training manual pp.900

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,...

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...

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...

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...

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...

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...

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...

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...

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...

Building upon the multidisciplinary literature on the science of dissemination and implementation, this title examines state-of-the-art programs to improve access to psychological interventions. Renowned experts describe leading efforts to facilitate the transport of evidence-based treatments, alongside innovative strategies for achieving the goals...

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...

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...

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...

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...

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...

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...

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...

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...

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...

Dialectical behavior therapy (DBT) is a comprehensive, multimodal cognitive-behavioral treatment developed for clients with complex and difficult-to-treat mental disorders. Originally developed to treat chronically suicidal clients, DBT evolved into a treatment for suicidal clients meeting criteria for borderline personality disorder (BPD). Since i...

The primary aim of this study was to examine the prospective association of shame with self-inflicted injury (SII), including suicide attempts and nonsuicidal self-injury, among women with borderline personality disorder (BPD) who were enrolled in a clinical trial (N = 77). A multi-method approach was used to assess self-reported shame, nonverbal s...

This study examines the degree to which an eating disorder (ED) is associated with the recurrence and severity of suicide attempts, non-suicidal self-injury, rates of co-occurring Axis I and II disorders, and psychosocial functioning among Borderline Personality Disorder (BPD) outpatients. A group of 135 treatment-seeking women with BPD were assess...

This study investigated M. Linehan's (1993) theory that individuals meeting criteria for borderline personality disorder (BPD) have high biological vulnerability to emotion dysregulation, including high baseline emotional intensity and high reactivity to emotionally evocative stimuli. Twenty individuals with BPD, 20 age-matched individuals with gen...

This study evaluated whether dialectical behavior therapy (DBT) was more efficacious than treatment by nonbehavioral psychotherapy experts in reducing co-occurring Axis I disorders among suicidal individuals with borderline personality disorder (BPD). Women with BPD and recent and repeated suicidal and/or self-injurious behavior (n = 101) were rand...

Reducing symptoms of depression is an important target in the treatment of borderline personality disorder (BPD). Although current treatments for BPD are effective in reducing depression, the average post-treatment level of depression remains high. To test whether experiential avoidance (EA) impedes the reduction of depression during treatment for...

This study tested the feasibility of using a psychoeducational video recording to teach a behavioral skill from the Dialectical Behavior Therapy (DBT; Linehan, 1993a, 1993b) skills training program to individuals meeting criteria for borderline personality disorder. A video presenting a DBT emotion-regulation skill was developed and the extent to w...

Over the past several decades, research has focused increasingly on developmental precursors to psychological disorders that were previously assumed to emerge only in adulthood. This change in focus follows from the recognition that complex transactions between biological vulnerabilities and psychosocial risk factors shape emotional and behavioral...

This study examined the association of novelty seeking, harm avoidance, and reward dependence with different types (suicide attempts vs. nonsuicidal self-injury) and aspects (medical risk, impulsiveness, suicide intent) of self-injury over a 12-month period. Fifty-five female patients with borderline personality disorder enrolled in clinical trials...