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When someone you love is at risk of suicide, you find them a therapist. Which therapist, and which treatment, gets far less attention than it deserves, and the trials say it changes what happens next. This page sets out what “evidence-based treatment for suicide” means, what the research found when good therapists using other approaches were tested against DBT, what the full DBT program is, how it differs from DBT-informed therapy, and what to ask a provider before you commit.

Contact North Texas DBT Associates

The short answers

Evidence-based treatment for suicide means a treatment tested in controlled trials with suicidal behavior as the measured outcome. DBT has been tested that way since 1991.
Experience alone was not enough. Against experienced expert therapists using other approaches, people in DBT were half as likely to attempt suicide.
Comprehensive DBT is four parts at once: individual therapy, a skills group, phone coaching, and a therapist consultation team. That is the version the trials tested.
The full program keeps people in treatment: 24 percent dropped out against 48 percent from individual DBT alone.
How closely the therapist follows the model predicts the outcome. Higher adherence meant fewer subsequent suicide attempts and less dropout across 83 therapists and 288 patients.
The DBT-Linehan Board of Certification independently assesses whether a clinician delivers DBT as it was researched.

What does “evidence-based treatment for suicide” mean?

A treatment that was tested in controlled trials where the outcome being measured was suicidal behavior itself, meaning attempts, self-harm and the use of emergency care, rather than mood or general wellbeing. Plenty of therapies are evidence-based for depression or anxiety. A much smaller number were built for people at risk of suicide and tested on that risk.

DBT is one of them. Marsha Linehan’s first randomized trial, published in 1991, enrolled women who were repeatedly harming themselves and attempting suicide, and it measured what happened to that behavior over a year. The DBT-Linehan Board of Certification, the body that certifies DBT clinicians, describes its purpose as certifying providers “who treat suicidal behavior using the gold standard, evidence-based treatment: Dialectical Behavior Therapy.” The full run of trials, with what each measured, is in the second post in this series.

Does the specific treatment matter if the therapist is experienced?

Yes. This is the question Linehan’s team set out to answer in the 2006 trial published in Archives of General Psychiatry. The 101 women in the study, all with recent suicidal and self-injurious behavior, were randomized either to a year of DBT or to a year of treatment by experienced non-behavioral therapists chosen for their reputation. The two sets of therapists were matched on sex, availability, expertise, belief in their own approach, training and experience, access to consultation, and the standing of their institution.

Over the two years of treatment and follow-up, the women who received DBT were half as likely to make a suicide attempt, required less hospitalization for suicidal ideation, had lower medical risk across their attempts and self-injuries combined, were less likely to drop out, and had fewer psychiatric hospitalizations and psychiatric emergency department visits. The authors concluded that the effectiveness of DBT “cannot reasonably be attributed to general factors associated with expert psychotherapy.”

Skilled, well-regarded therapists sat on both sides of that trial. The treatment made the difference.

What is Comprehensive DBT?

Comprehensive DBT, also called standard DBT, is the version of the treatment that was tested in the trials, and it has four parts that run at the same time:

Weekly individual therapy with a DBT-trained therapist.
A weekly skills training group.
Phone coaching between sessions, so a skill gets used in the moment it’s needed rather than discussed the following week.
A weekly consultation team, where the therapists review their cases together and keep one another to the model.

The 2015 component trial describes DBT as consisting of exactly these components, and our own Comprehensive DBT page sets out how each one runs in our program.

Does the full program work better than parts of it?

On keeping people in treatment and out of the emergency room, yes. Linehan’s team ran a randomized component trial, published in JAMA Psychiatry in 2015, with 99 women at high risk of suicide. It compared standard DBT with two stripped-down versions: skills training with case management, and individual DBT therapy with an activities group instead of skills training. Every therapist used the DBT protocol for assessing and managing suicide risk, and all three versions produced similar reductions in suicide attempts.

The differences showed up elsewhere. The versions with skills training did better on non-suicidal self-injury and on depression, and anxiety improved in those two arms but not in individual therapy alone. Standard DBT had the lowest dropout: 24 percent, against 48 percent for individual therapy alone. In the follow-up year, 3 percent of the standard DBT group visited an emergency department for a crisis and 3 percent were hospitalized, against 13 percent and 13 percent for individual therapy alone.

For someone at risk, staying in treatment is most of the work, and the full program is what kept people in it.

Does it matter how closely a therapist follows the model?

Yes, and there is now direct evidence on it. A 2022 study in the Journal of Consulting and Clinical Psychology pooled data from six clinical trials run in research and community settings. Trained observers rated 83 therapists for adherence to the DBT manual across 1,262 individual therapy sessions with 288 patients. Higher therapist adherence predicted fewer subsequent suicide attempts and a lower risk of the patient dropping out. Among community therapists, and among patients whose problems went beyond suicidal behavior, higher adherence also predicted fewer subsequent hospitalizations.

We wrote about this from the clinician’s side in why adherence and fidelity matter in Comprehensive DBT. This study is the research underneath it.

What is DBT-informed therapy, and how is it different?

DBT-informed therapy uses some of DBT’s ideas or skills inside another kind of treatment. In practice that usually means individual sessions with DBT language and worksheets, or a skills group on its own, without phone coaching and without a consultation team. There is no standard definition, which is part of the difficulty: two providers can both say they do DBT and mean quite different things.

The distinction matters because of what was tested. The 1991, 2006 and 2015 trials, the 18-trial meta-analysis and the Cochrane review measured the full program, or specific parts of it in the component trial. Those are the results that apply when a provider offers all four parts. A provider offering some DBT techniques inside another approach is offering something the trials didn’t measure. For the people at the highest risk, the ones the treatment was built for, the version with the evidence is the one to ask for.

What is DBT-LBC certification?

The DBT-Linehan Board of Certification is a non-profit that certifies individual clinicians and whole programs, and it is the credential to look for when searching for a DBT certified therapist. For clinicians, its site states that certification gives a client and their family “confidence that the clinician has been independently evaluated and has demonstrated efficiency in delivering the treatment as researched,” and that the board assesses whether a clinician has the knowledge and skills to deliver DBT “with adherence to the model as it has been researched.” For programs, it checks that the necessary components and organizational structure are in place to run DBT with fidelity. Courtney Hicks at our practice is a DBT-Linehan Board of Certification Certified Clinician.

What should I ask a provider?

Four questions. A good clinic will answer them without hesitating.

Do you offer all four components, individual therapy, a skills group, phone coaching and a consultation team, or only some of them?
Is phone coaching available between sessions, at what hours, and who answers?
Does your team meet as a DBT consultation team, and how often?
Is anyone on the team certified by the DBT-Linehan Board of Certification?

If the answer to the first question is “we use DBT techniques,” that answers a different question. Ask it again.

Why this matters in Texas

Because getting into treatment at all is already harder here. SAMHSA’s 2023 and 2024 state estimates put Texas adults level with the rest of the country on serious thoughts of suicide, 5.17 percent against 5.22 percent, and behind on treatment: 19.56 percent of Texas adults received any mental health treatment in the past year against 22.90 percent nationally, and the confidence intervals around those two figures don’t overlap. When fewer people make it to treatment, the treatment they reach has to count. The full picture for Texas is in the first post in this series.

Treatment for adults in Texas

North Texas DBT Associates provides Comprehensive Dialectical Behavior Therapy for adults, by telehealth across Texas. Our program has all four parts: weekly individual therapy, a weekly skills group, 24/7 phone coaching, and clinicians who sit on a weekly DBT consultation team. Courtney Hicks is a DBT-Linehan Board of Certification Certified Clinician. Ask us the four questions above. We’d rather you did.

You can read about how Comprehensive DBT works, see the program, meet our clinicians, check where we work, and read our fees, including the sliding scale.

Contact North Texas DBT Associates, call (817) 214-7200, or email info@ntxdbt.com. If it’s urgent, call or text 988.

The rest of this series

Three companion posts, written for Suicide Prevention Month 2026:

Suicide statistics for the United States and Texas: rates by sex, age and race, with sources.
Does DBT work for suicidal behavior?: what the randomized trials found.
Suicide crisis resources for Texas: who to call, what to text, and what happens next.

Sources:

Every source above was opened and checked on 8 September 2026, apart from the 1991 trial, which was added on 23 September, and each figure was checked against its page or published abstract on 23 September 2026.