This research to and evaluate Dialectical Behavior (DBT), a proposal continues our develop Therapy one-year outpatient treatment for suicidal individuals meeting criteria for Borderline Personality Disorder (BPD). DBT was developed from a combined behavioral management/capability deficit model of BPD. The idea was two-fo d: 1) borderline individuals lack important interpersonal, self-regulation (including emotional regulation) and distress tolerance skills, which are provided via DBT group skills training, and 2) personal and environmental factors inhibit or interfere with the use of behavioral skills the individual does have and often reinforce inappropriate borderline behaviors which are addressed in DBT individual therapy. All empirical studies of DBT with severely dysfunctional BPD patients to date have provided both skills training and individual therapy. In practice, however, DBT skills training is frequently offered with standard case management instead of individual DBT (usually in resource-poor mental health clinics). Other providers offer DBT individual therapy without any skills training (usually in solo private practice where group therapy is not offered). DBT skills training is viewed as a sufficient DBT component in one setting and as expendable in the other. The overarching aim of this proposed study is to begin the process of dismantling DBT by examining the importance of DBT skills training in reducing suicidal behavior and use of crisis services, and improving quality of life in BPD patients. The secondary aim is to evaluate knowledge, use, and perceive benefits of DBT skills and their relation to outcome. The research proposed here is a three arm, randomized component analysis design comparing standard full-program DBT (SDBT), standard DBT Individual therapy without the skills training component (DBT-I), and standard DBT Skills training without the DBT individual therapy (DBT-S). Ninety-nine women meeting criteria for both current chronic suicidal behavior and borderline personality disorder will be enrolled in one year of treatment and one year of follow-up assessments. As in our previous studies, clinical assessments will occur at four-month intervals over the two years.
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