Thread by @tylerblack32

A disappointing (unfortunately not unexpected) result but good science; care management OR DBT skills did not decrease self harm (severe or broader definition), and in fact, DBT skills resulted in worse outcomes.

https://twitter.com/GregSimonKPWHRI/status/1493758284599152642

DBT is an important therapy for many reasons, but it is not magic. It is being hyped beyond its abilities in the management of suicidal patients, and most modern interpretations of its effect size are vanishingly small (0.15-0.25).

I still recommend DBT (not skills training, the full meal deal) for people who need gigantic containing therapies (multiple times per week, nighttime coaching, etc), and believe that many benefit from it.

But it is not a first-line intervention nor is it a particularly well evidenced one.

"DBT Skills," what most people have tried to do with DBT, is of very little benefit to anyone.

The authors were obviously hopeful of a positive effect, but credit to good science: these negative findings crucially important.

For those of us who have been cautious about dbt's effectiveness, it's less surprising.

because it has a claim to fame in borderline personality style/disorder use, people have unfortunately assumed that there was something about the (errr.... questionable) interpretation of eastern philosophy or idea of looking at patterns that was somehow unique under DBT.

In fact, I would put good money in the idea that it is DBT's intensity: multiple times per week, in the moment coaching, significant pressure on the patient to follow the program without necessarily coddling that provides all of the benefit...

... and the specific skills themselves almost none of the benefit.

I really hope this study becomes well known, because people who did great science to test this thing they thought would work had a negative study, and that IS amazing science at work.