Veterans' Service Utilization and Associated Costs Following Participation in Dialectical Behavior Therapy: A Preliminary Investigation
Abstract
CONTEXT: Dialectical Behavior Therapy (DBT) is an evidence-based therapy developed for the treatment of suicidal behaviors and disorders characterized by emotional and behavioral dyscontrol that is effective in veteran populations. The impact of DBT on veterans' Veterans Affairs (VA) service utilization and cost is unknown. EVIDENCE ACQUISITION: This study evaluated the impact of DBT in a VA outpatient mental health setting on VA service utilization and cost of services. Veterans treated for symptoms of Borderline Personality Disorder, who had completed at least 6 months of the DBT program were sampled (N = 41). Use of physical and mental health services during the years prior and following DBT was assessed using medical record information. RESULTS: There was a significant decrease in mental health service utilization. Psychiatric hospitalization dropped in half, and for those with a hospitalization, length of stay decreased significantly. Direct costs associated with all health care were significantly reduced. CONCLUSION: Changes in service utilization resulted in a significant reduction in direct costs of providing care to veterans with symptoms of Borderline Personality Disorder. Additional research is needed to compare the reduction in overall costs to the cost of implementing DBT and to compare these changes to a control group.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Cites
Statistical power analysis for the behavioral sciences
Cohen, J. (1990) · Computers Environment and Urban Systems · doi:10.1016/0198-9715(90)90050-4 · Cited by 65,415 · see citing works
(1993) · Cited by 7,136 · see citing works
Cognitive Therapy for the Prevention of Suicide Attempts: A Randomized Controlled Trial
Brown, G. K., Ten Have, T., Henriques, G. R., Xie, S. X., Hollander, J. E., & Beck, A. T. (2005) · JAMA · doi:10.1001/jama.294.5.563 · Cited by 1,045 · see citing works
Efficacy of dialectical behavior therapy in women veterans with borderline personality disorder
Koons, C. R., Robins, C. J., Lindsey Tweed, J., Lynch, T. R., Gonzalez, A. M., Morse, J. Q., Bishop, G. K., Butterfield, M. I., & Bastian, L. A. (2001) · Behavior Therapy · doi:10.1016/s0005-7894(01)80009-5 · Cited by 700 · see citing works
(2006) · Cited by 392 · see citing works
Karlin, B. E., & Cross, G. (2014) · American Psychologist · doi:10.1037/a0033888 · Cited by 283 · see citing works
Priebe, S., Bhatti, N., Barnicot, K., Bremner, S. A., Gaglia, A., Katsakou, C., Mosweu, I., McCrone, P., & Zinkler, M. (2012) · Psychotherapy and Psychosomatics · doi:10.1159/000338897 · Cited by 150 · see citing works
Jobes, D. A., Wong, S. A., Conrad, A. K., Drozd, J. F., & Neal‐Walden, T. A. (2005) · Suicide and Life-Threatening Behavior · doi:10.1521/suli.2005.35.5.483 · Cited by 148 · see citing works
Health service utilization before and after evidence-based treatment for PTSD.
Tuerk, P. W., Wangelin, B. C., Rauch, S. A. M., Dismuke, C. E., Yoder, M. S., Myrick, H., Eftekhari, A., & Acierno, R. E. (2012) · Psychological Services · doi:10.1037/a0030549 · Cited by 120 · see citing works
Treating complex trauma among veterans: three stage-based treatment models
Landes, S. J., Garovoy, N. D., & Burkman, K. M. (2013) · Journal of Clinical Psychology · doi:10.1002/jclp.21988 · Cited by 60 · see citing works
Self-citationBartak, A., Soeteman, D., Verheul, R., & Busschbach, J. (2007) · Canadian journal of psychiatry. Revue canadienne de psychiatrie · doi:10.1177/070674370705201208 · Cited by 36 · see citing works
Ben‐Porath, D. D. (2004) · Journal of Contemporary Psychotherapy · doi:10.1023/b:jocp.0000036633.76742.0b · Cited by 35 · see citing works
The Effect of DBT Provision in Reducing the Cost of Adults Displaying the Symptoms of BPD
Amner, K. (2012) · British Journal of Psychotherapy · doi:10.1111/j.1752-0118.2012.01286.x · Cited by 21 · see citing works
Practical Psychotherapy: Adaptation of Dialectical Behavior Therapy by a VA Medical Center
Spoont, M. R., Sayer, N. A., Thuras, P., Erbes, C., & Winston, E. (2003) · Psychiatric Services · doi:10.1176/appi.ps.54.5.627 · Cited by 19 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Meuldijk, D., McCarthy, A., Bourke, M. E., & Grenyer, B. (2017) · PLoS ONE · doi:10.1371/journal.pone.0171592 · Cited by 99 · see citing works
Lewis, C. C., Darnell, D. A., Kerns, S. E. U., Monroe‐DeVita, M., Landes, S. J., Lyon, A. R., Stanick, C., Dorsey, S., Locke, J. J., Marriott, B. R., et al. (2016) · Implementation Science · doi:10.1186/s13012-016-0428-0 · Cited by 43 · see citing works
Self-citationLandes, S. J., Rodriguez, A. L., Smith, B. N., Matthieu, M. M., Trent, L. R., Kemp, J. E., & Thompson, C. (2017) · Translational Behavioral Medicine · doi:10.1007/s13142-017-0465-5 · Cited by 41 · see citing works
Self-citationLandes, S. J., Matthieu, M. M., Smith, B. N., Trent, L. R., Rodriguez, A. L., Kemp, J. E., & Thompson, C. (2016) · Military Medicine · doi:10.7205/milmed-d-15-00267 · Cited by 21 · see citing works
Self-citationIvanoff, A. M., & Marotta, P. L. (2018) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780198758723.013.14 · Cited by 15 · see citing works
Challenges and Potential Solutions to Implementing Phone Coaching in Dialectical Behavior Therapy
Landes, S. J., Matthieu, M. M., Smith, B. N., McBain, S. A., & Ray, E. S. (2019) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2019.10.005 · Cited by 13 · see citing works
Self-citationO’Hayer, C. V. (2021) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2020.12.005 · Cited by 13 · see citing works
Skerven, K., Mirabito, L. A., Kirkman, M., & Shaw, B. (2021) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x21000295 · Cited by 12 · see citing works
“Additionally, these DBT programmes have decreased serviceutilization, resulting in lower treatment costs (Meyers et al., 2014).”
BackgroundScheiderer, E. M., Carlile, J. A., Aosved, A. C., & Barlow, A. S. (2017) · Clinical Case Studies · doi:10.1177/1534650116688557 · Cited by 12 · see citing works
“Moreover, Meyers et al. (2014) extended previous service utilization and cost-effectiveness findings (e.g., Amner, 2012; Priebe et al., 2012), providing evidence for long-term service-utilization reductions among high-service-utilizing VA patients with clinically significant BPD features.”
BackgroundAccuracy of Anxiety Disorder Not Otherwise Specified Diagnosis in Older Veterans
Fletcher, T. L., Hundt, N. E., Kunik, M. E., Singh, H., & Stanley, M. A. (2019) · Journal of Psychiatric Practice · doi:10.1097/pra.0000000000000408 · Cited by 8 · see citing works
Rasolkhani-Kalhorn, T., & Sheppard, C. W. (2021) · Military Behavioral Health · doi:10.1080/21635781.2020.1864532 · Cited by 3 · see citing works
“Use of DBT to treat BPD symptoms among veteran populations was associated with a decrease in mental health utilization, to include reduction hospitalizations in general, as well as reduction in hospitalization length of stay (Meyers et al., 2014).”
BackgroundSchreiber, A., & Cawood, C. D. (2023) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2023.05.065 · Cited by 5 · see citing works
Description of a Dialectical Behavior Therapy program in a Veterans Affairs Health Care System
Phalen, P. L., Grossmann, J. L., Bruder, T., Jeong, J. Y., Calmes, C. A., McGrath, K., Malouf, E. T., James, A., Romero, E. G., & Bennett, M. E. (2022) · Evaluation and Program Planning · doi:10.1016/j.evalprogplan.2022.102098 · Cited by 3 · see citing works
“Psychosis is a common exclusion criteria for DBT programs (cf., Goodman et al., 2016; Meyers et al., 2014; Neacsiu et al., 2014; Valentine et al., 2015) and suicide-focused clinical trials in general (Villa et al., 2020), despite the fact that psychosis is associated with much higher rates of…”
Decker, S. E., Matthieu, M. M., Smith, B. N., & Landes, S. J. (2023) · Military Medicine · doi:10.1093/milmed/usad123 · Cited by 3 · see citing works
Self-citationCha, Y., Links, P. S., Ba, D., & Kazi, A. (2024) · American Journal of Men s Health · doi:10.1177/15579883241271894 · Cited by 3 · see citing works
“In addition, DBT was reported to decrease utilization of mental health services, admission rates, and length of stay (Meyers et al., 2014).”
BackgroundMethodInfluentialDialectical behavior therapy research and program evaluation in the Department of Veterans Affairs
Landes, S. J., Decker, S. E., McBain, S. A., Goodman, M. S., Smith, B. N., Sullivan, S. R., Spears, A. P., & Meyers, L. L. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-816384-9.00012-9 · Cited by 3 · see citing works
Self-citationDialectical behaviour therapy skills training: A feasibility study with active duty military.
Jewer, C., & Forsyth, A. (2022) · Journal of Military Veteran and Family Health · doi:10.3138/jmvfh-2022-0010 · Cited by 2 · see citing works
Townsend, A. N., Christie, I. C., Sansgiry, S., Hundt, N. E., Escamilla, M., Singh, H., Kunik, M. E., Stanley, M. A., & Fletcher, T. L. (2024) · Psychiatry Research Communications · doi:10.1016/j.psycom.2024.100184 · Cited by 2 · see citing works
Adolescent Dialectical Behavior Therapy Intensive Outpatient Programs
Clarke, S. B., Atasuntseva, A. A., Thordarson, M. A., & Berk, M. S. (2022) · Issues in clinical child psychology · doi:10.1007/978-3-031-14567-4_16 · Cited by 2 · see citing works
Schreiber, A., Davis, M. T., & Cawood, C. D. (2025) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2025.2572480 · Cited by 2 · see citing works
“Although a growing literature supports the use of DBT in treating Veterans with BPD (Goodman et al., 2016; Koons et al., 2001; Meyers et al., 2014), less is known about how co-occurring PTSD symptoms affect DBT outcomes in Veterans.”
Top-Down (Cognitive) Therapies That Treat Trauma
Zaleski, K. L. (2018) · Focus on sexuality research · doi:10.1007/978-3-319-73724-9_7
Comparison of Different Therapies on Reducing Self-Injury Behaviors in PTSD Veterans
Eyni, S. (2023) · مجله طب جانباز · doi:10.58209/ijwph.15.3.271
Cawood, C. D., Schreiber, A., & Duraney, E. J. (2025) · Psychotherapy Research · doi:10.1080/10503307.2025.2556843
“Elucidating these relationships is important given research suggesting that DBT is associated with reduced direct costs for providing care to veter - ans with BPD-related symptoms (Meyers et al., 2014).”
Harned, M. S., Sears, M. S., & Landes, S. J. (2025) · American Journal of Psychiatry · doi:10.1176/appi.ajp.20250780
Self-citationMaxwell, C. A., Holland, K. E., Young, L., Chen, E. Y., Olino, T. M., & Kendall, P. C. (2026) · Journal of Clinical Psychology · doi:10.1002/jclp.70195
- Authors
- Meyers, L. L., Landes, S. J., & Thuras, P.
- Affiliations
- University of Minnesota (US)
- VA Palo Alto Health Care System (US)
- Venue
- Military Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-11
- Volume
- 179
- Issue
- 11
- Pages
- 1368-1373
- ISSN
- 0026-4075 (ISSN-L)
- 1930-613X
- OpenAlex
- W2735533608
- Cited by
- 25
- References
- 14
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 2 · 2023: 3 · 2022: 3 · 2021: 3 · 2020: 1 · 2019: 2 · 2018: 2 · 2017: 3 · 2016: 2
- FWCI
- 1.97
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Military Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- dialectical behavior therapy, veterans, borderline personality disorder, mental health service utilization, health care costs, psychiatric hospitalization, length of hospital stay, cost reduction
- MeSH terms
- Suicide Prevention, Adult, Ambulatory Care, Behavior Therapy, Borderline Personality Disorder, Depression, Direct Service Costs, Female, Follow-Up Studies, Health Services, Hospitalization, Hospitals, Psychiatric, Humans, Length of Stay, Male, Mental Health Services, Middle Aged, Retrospective Studies, Stress Disorders, Post-Traumatic, Suicide, United States, United States Department of Veterans Affairs, Veterans, Health Care Costs, Dysthymic Disorder, Substance-Related Disorders, Evidence-Based Practice
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
