Cited by 116Personality Disorders and PsychopathologyPsychotherapy Techniques and ApplicationsBipolar Disorder and Treatment

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The effectiveness of dialectical behaviour therapy in routine public mental health settings: An Australian controlled trial

Pasieczny, Nathan, Connor, Jason·2011·Behaviour Research and Therapy

DOI 10.1016/j.brat.2010.09.006

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Abstract

Randomised controlled studies in research environments have demonstrated dialectical behaviour therapy (DBT) to be more efficacious than treatment as usual in reducing suicidal behaviour in patients with borderline personality disorder (BPD). Limited evidence exists for the effectiveness of DBT in the treatment of BPD within routine clinical settings. This study examines the clinical and cost effectiveness of providing DBT over treatment as usual in a routine Australian public mental health service. Forty-three adult patients with BPD were provided with outpatient DBT for six months with patient outcomes compared to those obtained from patients in a wait list group receiving treatment as usual (TAU) from the same service. After six months of treatment the DBT group showed significantly greater reductions in suicidal/non-suicidal self-injury, emergency department visits, psychiatric admissions and bed days. Self-report measures were administered to a reduced sample of patients. With this group, DBT patients demonstrated significantly improved depression, anxiety and general symptom severity scores compared to TAU at six months. Average treatment costs were significantly lower for those patients in DBT than those receiving TAU. Therapists who received intensive DBT training were shown to produce significantly greater improvements in patients' suicidal and non-suicidal self-injury than therapists who received only 4 day basic training. Further clinical improvements were achieved in patients offered an additional six months of DBT. This study demonstrates that providing DBT to patients within routine public mental health settings can be both clinically effective and cost effective.

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“However, in the context of this review, the description of model details and cost data was suboptimal in most of the studies, with Pasciezny and Conner (2011) [43] being the exception (8 quality criteria were fulfilled).”
Background
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Background
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BackgroundInfluential
Assertive Anger Mediates Effects of Dialectical Behaviour‐informed Skills Training for Borderline Personality Disorder: A Randomized Controlled Trial
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Background
Changing from a traditional psychodynamic treatment programme to mentalization‐based treatment for patients with borderline personality disorder – Does it make a difference?
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“Another study found that, compared with DBT, those receiving treatment as usual (TAU) incurred six times more costs because of the high cost of inpatient bed days (Pasieczny & Connor, 2011).”
Result
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Background
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BackgroundResult
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BackgroundInfluential
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Method
Living through distress: A skills training group for reducing deliberate self-harm
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“DBT vs specialist RCT [77-82] 6 20-100 (n=3); >100 (n=3) 2000-2009 (n=4); 20102019 (n=2) North America (n=5); Oceania (n=1) Diagnoses: “BPD” diagnosis (n=2); “BPD” diagnosis and self-harm (n=3); “BPD” diagnosis and opiate dependence diagnosis (n=1).”
Background
Suicide Prevention Interventions and Referral/Follow-Up Services: A Systematic Review
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Background
Concepciones de salud mental en el campo de la salud pública
Restrepo, A. O. D., & Jaramillo, C. E. J. (2012) · Revista de la Escuela Nacional de Salud Pública · Cited by 18
Dialectical behaviour therapy for treating adults and adolescents with emotional and behavioural dysregulation: study protocol of a coordinated implementation in a publicly funded health service
Flynn, D., Kells, M., Joyce, M., Suarez, C., & Gillespie, C. (2018) · BMC Psychiatry · doi:10.1186/s12888-018-1627-9 · Cited by 17
“[30, 31]) or have reported on cluster B personality presentations, including but not focusing exclusively on BPD [32].”
Background
Self-inflicted burns: A case series
Henderson, A. F., Wijewardena, A., Streimer, J. H., & Vandervord, J. G. (2012) · Burns · doi:10.1016/j.burns.2012.07.014 · Cited by 16
Training frontline community agency staff in dialectical behaviour therapy: building capacity to meet the mental health needs of street-involved youth
McCay, E. A., Carter, C., Aiello, A., Quesnel, S., Howes, C., Beanlands, H. J., Langley, J., MacLaurin, B. J., Hwang, S. W., Cooper, L., et al. (2017) · The Journal of Mental Health Training Education and Practice · doi:10.1108/jmhtep-07-2015-0034 · Cited by 16
Multisite Implementation and Evaluation of 12-Month Standard Dialectical Behavior Therapy in a Public Community Setting
Flynn, D., Kells, M., Joyce, M., Corcoran, P. E., Hurley, J., Gillespie, C., Suarez, C., Swales, M. A., & Arensman, E. (2018) · Journal of Personality Disorders · doi:10.1521/pedi_2018_32_402 · Cited by 15
“The findings from the current study corroborate those of previous studies where significant improvements were found when evaluating DBT in real-world settings (Flynn et al., 2017; Pasieczny & Connor, 2011; Stiglmayr et al. 2014).”
BackgroundResult
A Comprehensive Cohort Description and Statistical Grouping of Community-Based Residential Rehabilitation Service Users in Australia
Parker, S., Siskind, D. J., Hermens, D. F., Dark, F. L., McKeon, G. L., Korman, N., Arnautovska, U., Harris, M., & Whiteford, H. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00798 · Cited by 14
“One option to achieve this may be external linkage with therapeutic programs available in the community such as Dialectical Behaviour Therapy (57).”
Background
Just try it: Preliminary results of a six‐month therapy for borderline personality disorder
Martin, S. S., & Del-Monte, J. (2022) · Personality and Mental Health · doi:10.1002/pmh.1555 · Cited by 11
“Further research is needed to examine different timeframes considering both clinical and practical aspects (Pasieczny & Connor, 2011).”
Background
Dialectical behavioral therapy informed treatment with Deaf mental health consumers: an Australian pilot program
Davidson, F., Cave, M., Reedman, R., Briffa, D., & Dark, F. L. (2012) · Australasian Psychiatry · doi:10.1177/1039856212458981 · Cited by 12
Exploring the Effectiveness of Dialectical Behavior Therapy Versus Systems Training for Emotional Predictability and Problem Solving in a Sample of Patients With Borderline Personality Disorder
Guillén, V., García‐Palacios, A., Miñana, S. B., Baños, R., Botella, C., & Marco, J. H. (2020) · Journal of Personality Disorders · doi:10.1521/pedi_2020_34_477 · Cited by 14
Toward Treatment Integrity: Developing an Approach to Measure the Treatment Integrity of a Dialectical Behavior Therapy Intervention With Homeless Youth in the Community
McCay, E. A., Carter, C., Aiello, A., Quesnel, S., Howes, C., & Johansson, B. (2016) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2016.04.001 · Cited by 11
“Other DBT studies have used raters with a similar level of experience (Pasieczny & Connor, 2011; Nelson-Gray et al., 2006; Segal, Teasdale, Williams & Gemar, 2002).”
BackgroundMethod
Community interventions for people with complex emotional needs that meet the criteria for personality disorder diagnoses: systematic review of economic evaluations and expert commentary
Botham, J., Clark, A., Steare, T., Stuart, R., Oram, S., Lloyd‐Evans, B., Jeynes, T., Broeckelmann, E., Crawford, M., Johnson, S., et al. (2021) · BJPsych Open · doi:10.1192/bjo.2021.1043 · Cited by 8
The Effectiveness of a Mindfulness Induction as a Buffer Against Stress Among University Students With and Without a History of Self-Injury
Petrovic, J., Bastien, L., Mettler, J., & Heath, N. L. (2022) · Psychological Reports · doi:10.1177/00332941221089282 · Cited by 15
“Numerous studies have documented the effectiveness of mindfulness practice at decreasing NSSI in the context of DBT (e.g., Linehan et al., 2006; Pasieczny & Connor, 2011).”
Background
Borderline Personality Disorder
Rizvi, S. L., & Thomas, M. C. (2017) · Wiley eBooks · doi:10.1002/9781118877142.ch24 · Cited by 9
Surprise and delight: Response to informal versus formal mindfulness among university students with self-injury.
Petrovic, J., Milad, J. M., Mettler, J., Hamza, C. A., & Heath, N. L. (2023) · Psychological Services · doi:10.1037/ser0000825 · Cited by 9
Symptom reduction in DBT-informed partial hospital, intensive outpatient, and step-down programs: Mindfulness matters
Swearingen, K. M. V., & Lothes, J. E., II (2021) · Psychotherapy Research · doi:10.1080/10503307.2021.2001602 · Cited by 7
“Incorporating DBT into partial hospital (PH) and intensive outpatient (IOP) programs may help to reduce healthcare costs while providing patients with more skills to regulate their emotions and decrease symptoms (Pasieczny & Connor, 2011).”
Background
Terapia dialéctico conductual para el trastorno de personalidad límite [Dialectical behavioral therapy in borderline personality disorder]
la Vega-Rodríguez, I. D., & Sánchez-Quintero, S. (2013) · Acción Psicológica · doi:10.5944/ap.10.1.7032 · Cited by 8
Traditional Gender Roles and Emotion Dysregulation as Risk Factors for Intimate Partner Violence Perpetration Among College Men
Conzemius, D. J., Brem, M. J., Wettersten, K. B., & Stuart, G. L. (2021) · Partner Abuse · doi:10.1891/pa-2020-0033 · Cited by 6
Efficacy of dialectical behavior therapy in the treatment of suicidal behavior
DeCou, C. R., & Carmel, A. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-816384-9.00005-1 · Cited by 5
Tagesklinische dialektisch-behaviorale Therapie: Eine Verlaufsuntersuchung nach Entlassung. Gibt es Prädiktoren für eine Verschlechterung?
Richter, C. (2018) · Verhaltenstherapie · doi:10.1159/000488360 · Cited by 4
Dialectical behaviour therapy for younger adults: evaluation of 22 weeks of community delivered dialectical behaviour therapy for females 18–25 years
Lyng, J., Swales, M. A., & Hastings, R. P. (2015) · Irish Journal of Psychological Medicine · doi:10.1017/ipm.2014.69 · Cited by 4
“Pasieczny & Connor (2011) found DBT led to reductions in self-injury and crisis service utilisation in routine practice when * Address for correspondence: J. L. Lyng, Department of Psychology, Cluain Mhuire Family Centre, Newtownpark Avenue, Blackrock, Dublin, Ireland.”
Background
Dialectical behavior therapy for mood disorders
Chesin, M. S., & Stanley, B. (2013) · Cambridge University Press eBooks · doi:10.1017/cbo9781139175869.021 · Cited by 4
La thérapie comportementale dialectique
Jomphe, J. (2014) · Santé mentale au Québec · doi:10.7202/1023991ar · Cited by 6
Current state of the evidence on community treatments for people with complex emotional needs: a scoping reviewPreprint
Ledden, S., Rains, L. S., Schlief, M., Barnett, P., Ching, B. C. F., Hallam, B., Günak, M. M., Steare, T., Parker, J., Labovitch, S., et al. (2021) · medRxiv · doi:10.1101/2021.12.07.21267399 · Cited by 4
Hva er dialektisk atferdsterapi? En kort oversikt
Mehlum, L. I., & Tørmoen, A. J. (2015) · Suicidologi/Nytt i suicidologi · doi:10.5617/suicidologi.2266 · Cited by 6
A Feasibility Study Investigating Mechanisms of Change in Public Mental Health Dialectical Behaviour Therapy Programmes
Frost, G., Strodl, E. S., Swannell, S., Macdonald, K., & Madson, K. (2023) · Behaviour Change · doi:10.1017/bec.2023.1 · Cited by 3
“It must be noted, however, that the effectiveness of DBT may be impacted by the level of therapist training, and by extension, adherence to the standard DBT protocol (Pasieczny & Connor, 2011).”
BackgroundMethodInfluential
[Retracted] Analysis of the Correlation between College Music Education and Public Mental Health Based on Deep Learning
Huang, J. (2022) · Journal of Environmental and Public Health · doi:10.1155/2022/6593850 · Cited by 3
“It is a very good approach to provide DBT therapy to patients [12].”
Background
Retracted
Terapia Dialéctica Conductual: aplicaciones clínicas y evidencia empírica
Soler, J., Eliges, M., & Carmona, C. (2016) · Análisis y Modificación de Conducta · doi:10.33776/amc.v42i165-66.2793 · Cited by 3
“…TDC versus el TH (Carter, Willcox, Lewin, Conrad, & Bendit, 2010; Koons et al., 2001; Linehan et al., 1991; Linehan, Schmidt, Dimeff, & Comtois, 1999; Linehan et al., 2002; Linehan et al., 2006; McMain et al., 2009; Pasieczny & Connor, 2011; Soler et al., 2009; Turner, 2000; Verheul et al., 2003).”
Implementation of a brief online skills group of dialectical behaviour therapy for emotional dysregulation in Latinx: a withdrawal experimental single-case design
Muñoz-Martínez, A., Gómez, Y., Naismith, I., & González-Rodríguez, D. (2023) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465823000085 · Cited by 1
“Whilst DBT was originally designed as a 12-month program combining the multiple therapy modes, more recent studies have demonstrated its efficacy as a 6-month program (Pasieczny and Connor, 2011; Stanley et al., 2007).”
Method
Emotion regulation and impulsivity evolution during transdiagnostic DBT implementation in addictology – a 3-year naturalistic study
Durpoix, A., Weiner, L., Porche, C., Walter, M., Séverac, F., Weibel, S., D’USSEL, L.-M., & Lalanne, L. (2026) · Substance Abuse Treatment Prevention and Policy · doi:10.1186/s13011-025-00698-y · Cited by 2
“With the exception of Pasciezny and Connor [63], we did not find other studies investigating the effects of DBT therapist levels on patient outcomes.”
Comparison of the effectiveness of integrative transdiagnostic treatment and dialectical behavior therapy on hope and pain perception among cancer patients in Isfahan
Kazemi, E., Ghazanfari, A., Mashhadizadeh, S., & Ahmadi, R. (2022) · فصلنامه علوم پزشکی دانشگاه آزاد اسلامی واحد پزشکی تهران · doi:10.52547/iau.32.3.311 · Cited by 2
Brief Therapeutic Approaches for Personality Disorders
Dixon–Gordon, K. L., Conkey, L. C., & Woods, S. E. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108333931.083 · Cited by 2
Subjektive Nebenwirkungsklagen von Borderline-Patienten – zwei Jahre nach einer tagesklinischen Behandlung
Richter, C. (2020) · Verhaltenstherapie · doi:10.1159/000511619 · Cited by 2
The role of skills use, common and extratherapeutic factors in dialectical behaviour therapy for borderline personality disorder
Barnicot, K. (2013) · Cited by 2
Personality Disorders
Black, D. W., Paris, J., & Schulz, C. S. (2017) · Wiley eBooks · doi:10.1002/9781119152606.ch7 · Cited by 2
Effectiveness of Cognitive Therapy in Treatment of Borderline Personality Disorders
Hadadi, A. H. A., Qahtani, H. A., Abdelgadir, H., Ayidh, F. A. N., al Hassani, A., & Ayed, A. (2018) · The Egyptian Journal of Hospital Medicine · doi:10.12816/0045034 · Cited by 1
Adding dialectical behaviour therapy to multidisciplinary rehabilitation does not change quality of life but can improve emotional regulation and personal goals attainment after acquired brain injury
Kuppelin, M., Goetsch, T., Elbel, M., Laugel, M., Isner-Horobeti, M.-È., & Krasny‐Pacini, A. (2026) · Disability and Rehabilitation · doi:10.1080/09638288.2026.2655107 · Cited by 1
“This underlines the need for further research, including cost-effectiveness studies, to provide data-driven arguments such as those in borderline personality disorder [88] for securing the training and resources required to deliver such an intensive intervention.”
An implementation “Field Trial” of DBT for adolescents with bipolar disorder: Training procedures and therapist outcomes
Goldstein, T. R., Dimick, M. K., Hotkowski, N. J., Chugani, C. D., Curcio, D., Roane, J. L., Timmins, V. H., Mitchell, R. H. B., Rode, N., Khoubaeva, D., et al. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2026.122211 · Cited by 1
Accreditation, adherence, and training in dialectical behavior therapy: data review and practical applications
Miga, E. M., LoTempio, E. R., Michonski, J. D., & Hunter, D. A. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-816384-9.00004-x · Cited by 1
Schema therapy for borderline personality disorder: Patients' and therapists' perceptions
Tan, Y. M. (2015) · Murdoch University Research Portal
Erfaringar med dialektisk åtferdsterapi i Molde
Bjørnerem, H., & Jonsbu, E. (2015) · Suicidologi/Nytt i suicidologi · doi:10.5617/suicidologi.2267
The assessment and treatment of emotional dysregulation in adolescents who self-harm
Geddes, K. (2016) · Murdoch University Research Portal

Authors: Pasieczny, N., & Connor, J.
Affiliations: Queensland Health (AU)
The University of Queensland (AU)
Corresponding author: Pasieczny, Nathan
ORCID: Pasieczny, Nathan
Connor, Jason
Venue: Behaviour Research and Therapy
Publisher: Elsevier BV
Published: 2011-01
Volume: 49
Issue: 1
Pages: 4-10
ISSN: 0005-7967 (ISSN-L)
DOI: 10.1016/j.brat.2010.09.006
OpenAlex: W2090458554
Cited by: 116
References: 49
Citations by year: 2026: 9 · 2025: 1 · 2024: 3 · 2023: 3 · 2022: 8 · 2021: 10 · 2020: 12 · 2019: 4 · 2018: 13 · 2017: 9 · 2016: 7 · 2015: 7 · 2014: 7 · 2013: 10 · 2012: 12
FWCI: 8.06
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Behaviour Research and Therapy (publishedVersion)
PubMed (publishedVersion)
Funders: Queensland Health
Newcastle University
Department of Biotechnology, Ministry of Science and Technology, India
University of Queensland
Topics: Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
Keywords: dialectical behavior therapy, borderline personality disorder, suicidal behavior, non-suicidal self-injury, public mental health services, outpatient care, cost-effectiveness, therapist training, waitlist control, anxiety and depression, emergency department visits, psychiatric hospital admissions
MeSH terms: Adolescent, Adult, Australia, Mental Disorders, Borderline Personality Disorder, Female, Humans, Male, Mental Health Services, Middle Aged, Psychiatric Status Rating Scales, Severity of Illness Index, Cognitive Behavioral Therapy, Self-Injurious Behavior, Health Care Costs, Self Report

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The effectiveness of dialectical behaviour therapy in routine public mental health settings: An Australian controlled trial

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