Dialectical Behavior Therapy (DBT)

An in-depth examination of DBT's foundations, structure, evidence base, and limitations.

What Is Dialectical Behavior Therapy?

Dialectical behavior therapy (DBT) is a comprehensive, multi-component cognitive-behavioral treatment originally developed for chronically suicidal individuals and subsequently established as the best-evidenced psychotherapy for borderline personality disorder (BPD). More than any other therapy in this series, DBT is not a style of conversation but an engineered program: a coordinated system of individual therapy, group skills training, between-session coaching, and therapist support, organized around an explicit hierarchy of treatment targets, designed for patients whose severity and crisis frequency overwhelm ordinary outpatient care.

DBT's name announces its central idea. A dialectic is the tension between two valid but opposing positions and the search for a synthesis that honors both. The fundamental dialectic in DBT is acceptance and change: the patient is fully accepted as they are, doing the best they can in this moment—and they must change, try harder, and build a different life. Marsha Linehan's founding clinical observation was that pure change-oriented therapy (classical CBT) failed with severely dysregulated, multiply traumatized patients—relentless pressure to change was experienced as one more voice saying you are the problem, and patients dropped out or escalated. Pure acceptance-oriented warmth failed equally—it left lethal behavior untouched. DBT was built to do both at once, moment to moment, and most of its technology can be read as machinery for holding that tension.

Distinguishing features at a glance:

It treats emotion dysregulation as the core problem. In DBT's model, the dramatic behaviors associated with BPD—self-injury, suicide attempts, rage, substance use, dissociation, chaotic relationships—are understood as consequences of, or desperate solutions to, pervasive difficulty regulating emotion. Treat the dysregulation and the behaviors lose their function.

It is unapologetically behavioral. Every self-harm episode is subjected to detailed chain analysis; skills are taught, rehearsed, and coached like athletic skills; contingencies are managed explicitly. The acceptance side—validation, mindfulness, radical acceptance—is woven through, but the spine is behavior therapy.

It is structured around a target hierarchy. Life-threatening behavior is always addressed first, then behavior that interferes with therapy itself, then behaviors that wreck quality of life. This ordering is non-negotiable and is one of DBT's most practical exports to general psychiatry.

It treats the therapist as part of the treatment. DBT assumes that treating chronically suicidal patients strains clinicians toward burnout, rigidity, or capitulation, and builds a mandatory therapist consultation team into the model—therapy for the therapists, in Linehan's phrase.

It is a skills technology. DBT's four skills modules—mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness—have escaped the original treatment and now circulate through psychiatry, schools, prisons, and self-help culture as a general curriculum for living with strong emotions.

Historical Development

DBT was developed by Marsha M. Linehan, a psychologist at the University of Washington, across the late 1970s and 1980s, with the canonical treatment manuals published in 1993 (Cognitive-Behavioral Treatment of Borderline Personality Disorder and the accompanying skills manual, revised 2014).

The origin story matters because the treatment's architecture records its failures. Linehan set out to apply standard behavior therapy to chronically parasuicidal women and found, in her telling, that the treatment was unworkable as designed: patients experienced the change agenda as invalidating, therapists oscillated between blaming the patient and being held hostage by crises, and sessions were consumed by the week's emergencies. Each structural element of DBT answers one of these failures. Validation strategies and the acceptance pole were imported to solve the invalidation problem—Linehan drew here on her own Zen training, making DBT the first major Western psychotherapy to incorporate mindfulness as a core component, several years before MBSR's clinical spread. The skills group was separated from individual therapy so that skill acquisition would not be perpetually displaced by crisis management. Phone coaching was added so skills could be coached in vivo, at the moment of crisis, rather than autopsied afterward. The consultation team was added to keep therapists effective and within the frame.

In 2011, Linehan publicly disclosed her own adolescent history of severe self-injury, suicidality, and prolonged hospitalization—revealing that the treatment was, in part, reverse-engineered from her own recovery, and that its founding commitment was to build a therapy for "people in hell" that she would have accepted herself.

DBT's first randomized trial appeared in 1991—the first RCT of any psychotherapy for BPD, at a time when the diagnosis was widely considered untreatable—and the treatment has since spread internationally, with adaptations for adolescents, substance use, eating disorders, PTSD, and forensic settings.

The Theoretical Model

The biosocial theory

DBT rests on a developmental account of severe emotion dysregulation: it emerges from a transaction between biological emotional vulnerability and an invalidating environment.

Emotional vulnerability has three components: high sensitivity (low threshold for emotional reaction), high reactivity (extreme responses), and slow return to baseline. Temperamental and genetic contributions are assumed, consistent with heritability findings in BPD.

An invalidating environment is one that pervasively communicates that the person's inner experiences are wrong, inappropriate, or manipulative—ranging from the catastrophic (abuse, which is reported by a large share of BPD patients, though not all) to the mundane-but-corrosive (a "good family" mismatch in which an emotionally intense child is repeatedly told to stop overreacting). Such environments fail to teach the child to label, understand, trust, or modulate emotion; intermittently reinforce escalation (only extreme displays get a response); and teach self-invalidation—the patient internalizes the environment's verdict and responds to their own emotions with shame and self-attack.

The theory is explicitly transactional: a vulnerable child evokes invalidation from an overwhelmed environment, which amplifies vulnerability, in a spiral neither party chose. Clinically this framing does double duty—it is a researchable etiology and a deliberate anti-blame device, replacing "manipulative patient" and "toxic family" alike with a tragedy of mismatch. From it follows DBT's central compassionate axiom, held simultaneously with its demand for change: patients are doing the best they can, and they must do better.

Emotion dysregulation as the engine

On this foundation, the behaviors that define BPD are reinterpreted functionally. Self-injury is, for most patients, emotion regulation by other means—it reliably (if briefly) terminates unbearable affect, and is thus negatively reinforced with every use. Suicidal communication recruits care from an environment that otherwise responds only to extremity. Dissociation, bingeing, substance use, and rage serve parallel escape functions. None of this is framed as manipulation; it is framed as the predictable behavior of a person with a maximal emotional load and a minimal skills repertoire. The treatment implication is direct: block the maladaptive solutions while building, rehearsing, and reinforcing skillful ones—and treat the skills deficit, not the patient's character, as the problem.

The dialectical philosophy

Dialectics functions in DBT at three levels. As a worldview: reality is interconnected, in flux, and composed of tensions—so rigid positions ("I'm bad," "everyone abandons me," but also therapist rigidities like "she's just attention-seeking") are inherently suspect, and truth is approached through synthesis. As a treatment strategy: the therapist constantly balances acceptance and change, warmth and irreverence, nurturing and demanding—moving between poles with speed and flexibility to keep the patient off-balance enough to move. As an antidote to the patient's own dialectical failures: black-and-white thinking, vacillation between emotional inhibition and explosion, between dependence and counterdependence. The most important synthesis taught to patients is the treatment's own: you are acceptable exactly as you are, and you need to change.

How DBT Is Structured and Used

The four modes

Standard (comprehensive) DBT delivers treatment through four coordinated modes, and the term "DBT" properly refers to all four together:

1. Individual therapy (weekly, ~60 minutes). The hub of treatment. The session agenda is set by the diary card—a daily self-monitoring form tracking urges and actions (suicidal ideation, self-harm, substance use), emotions, and skills use—reviewed at the start of every session. The week's highest-priority behavior per the target hierarchy is addressed with chain analysis: a fine-grained, moment-by-moment reconstruction of the episode (vulnerability factors → prompting event → links of thought, emotion, sensation, action → the behavior → its consequences), followed by solution analysis identifying where skills could have broken the chain, with rehearsal of those skills. Individual therapists also conduct commitment work, exposure, contingency management, and validation—and are responsible for keeping the whole treatment coherent.

2. Skills training group (weekly, ~2–2.5 hours, typically 6–12 months for the full curriculum, traditionally run twice through). Run like a class, with two leaders, teaching the four modules described below, with homework assigned and reviewed. Group process is deliberately de-emphasized; the group exists to acquire skills, the individual therapist to generalize and strengthen them.

3. Telephone coaching. Patients may contact their individual therapist between sessions for brief, skills-focused coaching at the moment of crisis—the point being in-vivo generalization, not extended support calls. Two famous rules shape its contingencies: coaching is for before harming oneself, and the 24-hour rule bars therapist contact for 24 hours after self-injury (so that self-harm does not purchase increased therapist attention).

4. Therapist consultation team (weekly). A required meeting in which DBT therapists apply DBT to each other—monitoring adherence, problem-solving stuck cases, blocking drift toward either harshness or rescue, and treating burnout as a treatable, expectable hazard rather than a personal failing.

Stages and targets

DBT is organized in stages, preceded by a pretreatment/commitment phase in which the patient and therapist explicitly negotiate goals and the patient commits—using DBT's well-known commitment strategies (pros and cons, devil's advocate, foot-in-the-door, freedom to choose in the absence of alternatives)—to a defined treatment period (classically one year) and to working on reducing life-threatening behavior. DBT is emphatic that it is a voluntary treatment for people who want a life worth living, not a containment program.

Stage 1 targets behavioral control, in strict order: (1) life-threatening behaviors; (2) therapy-interfering behaviors (missing sessions, not doing diary cards—and the therapist's therapy-interfering behaviors are explicitly included); (3) severe quality-of-life-interfering behaviors (substance use, crises, housing, untreated illness); plus (4) increasing skills throughout. Stage 2 treats emotional experiencing—principally PTSD and trauma processing, often via the DBT-PE protocol (Harned), once behavior is stable. Stage 3 addresses ordinary problems in living and self-respect; Stage 4 (more aspirational) targets sustained meaning. The stage logic encodes a hard-won clinical sequence: you cannot process trauma in a patient who responds to distress with overdose, and you cannot build an ordinary life while weekly crises consume all capacity.

The Skills Modules

The skills curriculum (Linehan, 2014) is DBT's most widely disseminated component. The four modules, with representative skills:

Mindfulness ("core" skills, revisited between every module)

DBT secularized mindfulness into trainable micro-skills a decade before it was fashionable. The organizing concept is Wise Mind—the synthesis of "emotion mind" and "reasonable mind," a state of knowing that integrates feeling and logic. The "What" skills: observe (notice experience without reacting), describe (put words on it, factually), participate (enter fully into the activity of the moment). The "How" skills: nonjudgmentally, one-mindfully (one thing at a time), effectively (focus on what works rather than on being right). No meditation cushion is required; skills are practiced in seconds-long reps embedded in daily life—a deliberate design choice for a population for whom long silent sits can be dysregulating.

Distress tolerance

Skills for surviving crises without making them worse—explicitly not for feeling better, a distinction the module hammers. Crisis survival skills include TIPP (temperature—cold water on the face to trigger the dive reflex and rapidly downshift arousal; intense exercise; paced breathing; paired muscle relaxation), distraction (ACCEPTS), self-soothing through the senses, IMPROVE the moment, and pros-and-cons done in advance of crisis. Reality acceptance skills are the module's deeper half: radical acceptance (complete acceptance, with mind and body, of facts that cannot be changed—taught with the formula pain + non-acceptance = suffering), turning the mind (acceptance as a repeated choice, not an achievement), willingness versus willfulness, and half-smiling/willing hands. This is where DBT's Zen inheritance is most visible.

Emotion regulation

A full psychoeducational model of emotion plus change skills: identifying and labeling emotions and their functions; checking the facts (does the emotion fit the actual situation?—DBT's nearest approach to cognitive restructuring); opposite action—the module's workhorse: when an emotion does not fit the facts or acting on it is ineffective, act opposite to its urge, all the way (approach what unjustified fear says to avoid; be gentle when unjustified anger says attack; get active when depression says collapse)—essentially exposure generalized to all emotions; problem solving when the emotion does fit the facts; reducing vulnerability via ABC PLEASE (accumulate positives short- and long-term, build mastery, cope ahead; treat physical illness, balance eating, avoid mood-altering substances, sleep, exercise).

Interpersonal effectiveness

Assertiveness training adapted for people whose relationships oscillate between submission and explosion, organized by which priority leads in a given interaction: DEAR MAN for objectives (Describe, Express, Assert, Reinforce; stay Mindful, Appear confident, Negotiate), GIVE for the relationship (be Gentle, act Interested, Validate, Easy manner), FAST for self-respect (be Fair, no excessive Apologies, Stick to values, be Truthful), plus skills for ending destructive relationships and, in the revised manual, validation and dialectics skills for patients themselves.

Adaptations and Spread

• DBT for adolescents (DBT-A) (Miller, Rathus): adds family members to skills training and a fifth module ("walking the middle path" on validation and behavior principles for families); supported by randomized trials for self-harming adolescents, including Mehlum's Norwegian trials.
• DBT for substance use disorders (DBT-SUD): adds attachment strategies and dialectical abstinence (full commitment to abstinence + non-catastrophic handling of lapses).
• DBT-PE: integrates prolonged exposure for PTSD into Stage 2 for patients with recent self-harm—a population historically excluded from trauma treatment—with trials supporting feasibility and benefit.
• Eating disorders: DBT-informed treatments for binge eating and bulimia (Safer, Telch) where emotion-driven eating is prominent; and intensive programs for multi-diagnostic, suicidal eating-disorder patients.
• Skills-only DBT: standalone skills groups, now tested in their own right (see below), and widely used where comprehensive programs are unavailable.
• Settings: inpatient, residential, forensic and correctional adaptations, college counseling, and school-based curricula (DBT STEPS-A).

The Research Evidence

The core trials

Linehan's 1991 trial randomized chronically parasuicidal women with BPD to one year of DBT versus community treatment-as-usual: DBT produced fewer and less severe parasuicide episodes, dramatically lower dropout (~17% vs ~58%), and fewer inpatient days. It was a landmark twice over—first RCT for BPD, and proof that the diagnosis was treatable.

The more demanding test came with Linehan's 2006 trial against community treatment by experts—therapists nominated for their skill with difficult patients, controlling for therapist allegiance and availability rather than straw-man TAU. DBT halved suicide attempts (hazard ratio ≈ 0.5), reduced emergency and inpatient utilization, and retained more patients. Independent replications followed in the Netherlands (Verheul), Canada, Germany, and elsewhere, including trials run by non-originator teams—an important credibility marker many therapies lack.

Meta-analytic picture

Across systematic reviews and the Cochrane review of psychotherapies for BPD (Storebø et al., 2020), DBT is the most-studied treatment and shows moderate effects on self-harm, suicidality (ideation/attempts), anger, and BPD severity, with reduced service utilization. Several honest qualifications:

• Effects concentrate on behavioral outcomes. DBT reliably reduces self-harm and crisis utilization; effects on depression, hopelessness, and global functioning are smaller and less consistent, and full recovery—stable work, relationships, subjective well-being—remains elusive for many patients even when behavior stabilizes. Zanarini's longitudinal data show diagnostic remission of BPD is common over time, but functional recovery lags badly; no therapy, DBT included, has solved this.
• No demonstrated mortality advantage. Trials are not powered for death by suicide; claims should stay at the level of attempts and self-harm.
• Comparator-dependent effect sizes. Against strong, structured comparators DBT's margin narrows or vanishes—the central finding of the next section.
• Trial quality is middling on average (small samples, allegiance, limited blinding), per Cochrane—typical for psychotherapy research but worth saying.

What part of the package works?

Linehan's own 2015 component trial randomized high-risk women to standard DBT, DBT skills training plus case management, or DBT individual therapy without skills. All three reduced suicide attempts comparably; the skills-containing conditions outperformed on self-harm frequency and depression/anxiety improvement. Combined with positive trials of standalone skills groups (e.g., McMain's brief skills trial) and mediation work showing that increased skills use statistically mediates outcomes, the evidence points to skills acquisition as the engine—simultaneously a validation of the curriculum and a challenge to the necessity of the full, expensive apparatus for every patient.

Guideline status

DBT holds first-line or strongly recommended status for BPD and for repeated self-harm in major guidance (NICE recommends DBT for women with BPD for whom reducing self-harm is a priority; APA and international guidelines list it among structured evidence-based options), and DBT-A is among the best-supported treatments for adolescent self-harm.

Criticisms and Controversies

The generalist challenge: is the brand necessary?

The most consequential finding in modern BPD research is that well-structured generalist treatments perform comparably to DBT. McMain's 2009 trial—one of the largest BPD trials conducted—found general psychiatric management (GPM), a coherent but far simpler treatment, equivalent to a year of full DBT on suicidal/self-harm episodes and most outcomes, with gains maintained at follow-up. Parallel findings hold for other specialized therapies versus structured comparators (e.g., mentalization-based treatment, transference-focused psychotherapy, schema therapy each beat unstructured care but rarely each other). The emerging consensus—articulated by Gunderson, Bateman, and others—is that the active ingredients may be largely common structural factors: a coherent model offered with conviction, an active therapist, a crisis frame, attention to the therapy relationship, and team support. The health-system implication is uncomfortable for the DBT brand: most patients with BPD may do well with good generalist care, with resource-intensive DBT reserved for the most severe and recurrent self-harm—where its evidence remains strongest.

Resource intensity and the dilution problem

Comprehensive DBT requires four modes, trained teams, and roughly a year—expensive to mount and staff, and accessible mainly in well-resourced systems, with long waitlists where it exists at all. The market's response has been dilution: clinics and clinicians advertising "DBT-informed" therapy—often a skills handout grafted onto ordinary treatment—without the structure that carried the trial results. Because "DBT" is not a protected term, patients cannot easily tell the difference; the DBT-Linehan Board certification effort addresses this but covers a small fraction of self-described providers. The skills-component evidence partially redeems lighter formats, but the gap between trial DBT and community "DBT" is among the largest brand-to-practice gaps in psychiatry.

Demandingness, dropout, and the contingency critiques

DBT asks an enormous amount—weekly individual and group sessions, daily diary cards, homework, a year's commitment—from patients whose disorder includes instability of motivation. Roughly a quarter to a third drop out even in trials, more in routine care, and the treatment's structure can select for the already-more-functional. Specific design elements draw recurring criticism: the 24-hour rule and target hierarchy can be experienced (or clumsily applied) as punitive; phone coaching boundaries vary in practice; and some service users describe the relentless skills focus as invalidating in a new key—being handed a worksheet for what they experience as a life built on trauma. DBT's Stage 2 answers this in principle, but in practice many programs deliver only Stage 1, and patients can graduate behaviorally contained but emotionally unprocessed.

Theory and diagnosis questions

The biosocial theory, while heuristically powerful and destigmatizing, remains only partially tested as an etiological account; "invalidating environment" is hard to operationalize prospectively, and the theory sits awkwardly with cases lacking adversity. More broadly, DBT inherits every controversy attached to the BPD construct itself—its heterogeneity (256 criterion combinations), gendered application, contested overlap with complex PTSD, and stigma within services. Some critics argue DBT's success quietly reinforces a diagnosis that should be reconceptualized; defenders reply that DBT is, in practice, a treatment for severe emotion dysregulation and self-harm across diagnoses—which is also where its trial evidence actually lives.

What outcome counts?

DBT's trials excel on the outcomes the model targets—self-harm, hospitalization, retention. Critics from psychodynamic and service-user perspectives note that a treatment can reduce incidents while leaving identity disturbance, emptiness, and relational capacity comparatively untouched, and that cost-effectiveness analyses driven by reduced hospitalization may satisfy payers while undershooting patients' own definitions of recovery. The fairest reading of the longitudinal data: DBT is the best-proven way to get a person with severe BPD out of behavioral hell; what builds the rest of a life worth living afterward is less settled, and Linehan herself framed the unfinished agenda exactly that way.

What Patients Can Expect, and Practical Considerations

What treatment feels like. Expect structure: diary cards every day, agendas built from them, detailed chain analyses after any target behavior, skills homework, and a therapist who is warm, direct, occasionally irreverent, and immovable about the hierarchy. Expect the group to feel like a class, not group therapy. Expect a commitment conversation before treatment proper begins—and expect to be asked, repeatedly, to choose the treatment rather than be processed by it.

Duration and dose. Standard adult DBT runs about 12 months; adolescent programs are often ~6 months; meaningful change in self-harm frequently appears within the first 4–6 months. Skills-only groups typically run 20–30 weeks.

Medication. No medication is approved for BPD; pharmacotherapy targets comorbid conditions and acute symptoms, ideally minimized and time-limited, while psychotherapy carries the disorder-level treatment. DBT programs commonly coordinate closely with prescribers; polypharmacy reduction is itself a frequent treatment goal.

Who else benefits. Beyond BPD: adolescents with repeated self-harm, emotion-driven binge eating, substance use with dysregulation, and—via the skills curriculum—a much broader population for whom emotion regulation is the transdiagnostic problem.

Conclusion

DBT changed psychiatry's relationship to its most feared diagnosis. It demonstrated in randomized trials that chronically suicidal patients with BPD could be retained in treatment and could stop harming themselves; it built the first systematic technology of validation and the most widely adopted emotion-skills curriculum in mental health; and it engineered, in the consultation team, a rare structural answer to clinician burnout. Its limits are equally instructive: its advantage narrows against any well-structured comparator, its full package is expensive and widely diluted in practice, its effects are strongest on behavior and weakest on the slow work of building a life, and its own component data suggest the skills—not the brand—may carry much of the effect.

For a psychiatric practice, the synthesis: reserve comprehensive DBT for severe, recurrent self-harm and suicidality, where its evidence is unmatched; use skills groups and DBT principles (target hierarchies, chain analysis, validation, opposite action) far more broadly; demand structural fidelity from anything labeled DBT; and hold the treatment to the standard Linehan set for it—not fewer incidents only, but a life experienced as worth living.

Selected References and Further Reading

1. Linehan, M.M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. Guilford Press.
2. Linehan, M.M. (2014). DBT Skills Training Manual (2nd ed.). Guilford Press.
3. Linehan, M.M., et al. (1991). Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48(12), 1060–1064.
4. Linehan, M.M., et al. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63(7), 757–766.
5. Linehan, M.M., et al. (2015). Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: A randomized clinical trial and component analysis. JAMA Psychiatry, 72(5), 475–482.
6. McMain, S.F., et al. (2009). A randomized trial of dialectical behavior therapy versus general psychiatric management for borderline personality disorder. American Journal of Psychiatry, 166(12), 1365–1374.
7. Storebø, O.J., et al. (2020). Psychological therapies for people with borderline personality disorder. Cochrane Database of Systematic Reviews, Issue 5, CD012955.
8. Verheul, R., et al. (2003). Dialectical behaviour therapy for women with borderline personality disorder: 12-month randomised clinical trial in the Netherlands. British Journal of Psychiatry, 182, 135–140.
9. Mehlum, L., et al. (2014). Dialectical behavior therapy for adolescents with repeated suicidal and self-harming behavior: A randomized trial. Journal of the American Academy of Child & Adolescent Psychiatry, 53(10), 1082–1091.
10. Harned, M.S., Korslund, K.E., & Linehan, M.M. (2014). A pilot randomized controlled trial of DBT with and without the DBT prolonged exposure protocol for suicidal and self-injuring women with borderline personality disorder and PTSD. Behaviour Research and Therapy, 55, 7–17.
11. Neacsiu, A.D., Rizvi, S.L., & Linehan, M.M. (2010). Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder. Behaviour Research and Therapy, 48(9), 832–839.
12. Crowell, S.E., Beauchaine, T.P., & Linehan, M.M. (2009). A biosocial developmental model of borderline personality: Elaborating and extending Linehan's theory. Psychological Bulletin, 135(3), 495–510.
13. Zanarini, M.C., et al. (2012). Attainment and stability of sustained symptomatic remission and recovery among patients with borderline personality disorder and Axis II comparison subjects: A 16-year prospective follow-up study. American Journal of Psychiatry, 169(5), 476–483.
14. Gunderson, J.G. (2016). The emergence of a generalist model to meet public health needs for patients with borderline personality disorder. American Journal of Psychiatry, 173(5), 452–458.
15. Cristea, I.A., et al. (2017). Efficacy of psychotherapies for borderline personality disorder: A systematic review and meta-analysis. JAMA Psychiatry, 74(4), 319–328.
16. DeCou, C.R., Comtois, K.A., & Landes, S.J. (2019). Dialectical behavior therapy is effective for the treatment of suicidal behavior: A meta-analysis. Behavior Therapy, 50(1), 60–72.
17. Miller, A.L., Rathus, J.H., & Linehan, M.M. (2007). Dialectical Behavior Therapy with Suicidal Adolescents. Guilford Press.
18. Carey, B. (2011, June 23). Expert on mental illness reveals her own fight. The New York Times.
19. Swales, M.A. (Ed.) (2018). The Oxford Handbook of Dialectical Behaviour Therapy. Oxford University Press.
20. Linehan, M.M. (2020). Building a Life Worth Living: A Memoir. Random House.