"In general, results have largely replicated the initial randomized controlled trial," said Linehan. She said that current research is underway by 10 groups of investigators to adapt DBT to other disorders and for other difficult-to-treat patient populations including opiate-dependent individuals with HIV, opiate- and methamphetamine-dependent women with BPD, inmates with antisocial personality disorder and binge-eaters.
Linehan said her own group is now halfway through a replication trial comparing DBT to community-provided "treatment by experts." This trial is funded by the National Institute of Mental Health. For this study, control-condition therapists were nominated by local therapists for their expertise in treating suicidal and/or BPD patients and asked to apply the best standard of care, including any medications viewed as appropriate and necessary. "This treatment-by-experts condition rigorously controls for many aspects of the DBT treatment, making it a robust condition in which to evaluate DBT," said Linehan. "We are also interested in what factors besides treatment orientation are important for outcome. Results are not yet available."
She and her colleagues have also been looking at DBT for the treatment of drug abuse. "In a first study [Linehan, 1997] of 28 substance abusers, we compared an adaptation of DBT to TAU and found that subjects assigned to DBT had greater reductions in illicit substance use both during treatment and at follow-up, and greater improvements in global functioning and social adjustment at follow-up," she reported.
If behavioral treatments change behaviors correlated with biological systems, then they may also be changing the associated biological systems. "Change the behavior, and you'll change the brain," Linehan said.