Dialectical Behavior Therapy: What Payers Can Learn

Clinicians use multiple modalities to address different patients’ needs, including dialectical behavior therapy (DBT), which is evidence-based and useful for managing personality disorders and interpersonal conflicts. Evidence suggests that DBT can be helpful in treating mood disorders and suicidal ideation, as well as for changing behavioral patterns such as self-harm and substance use.

DBT includes several core techniques aimed at redirecting the patient away from self-destructive behaviors—promoting mindfulness, self-esteem, and good relationships with others—as well as helping patients move toward life goals.

DBT can help treat post traumatic stress disorder (PTSD), including complex PTSD that may involve prolonged or complex trauma where the patient experienced trauma for a long time,
often for years.

What Does DBT Do?

DBT was originally founded in the late 1970s by Marsha Linehan, PhD. It was originally developed from early efforts to apply standard behavior therapy to treat individuals who were highly suicidal. Today, it is used by behavioral health practices, and even within schools, to treat self-harm and suicidal behavior.

DBT includes elements of analysis and behavioral change. DBT can be provided in individual one-on-one sessions, but may also be provided in a group setting with multiple patients or via phone or zoom.

DBT provides practices with another avenue for offering an evidence-based, flexible therapy method that can be adapted to specific patients and conditions. Some therapists have found success in using DBT to treat other conditions such as bipolar disorder, eating disorders, suicidal behavior, certain types of depression, and even attention-deficit/hyperactivity disorder. Some providers consider DBT for patients who are not responding positively to medication or other forms of therapy.

Additionally, behavioral health practices that offer DBT benefit from the collaborative approach that allows the therapist and patient to work together for the patient to accept themselves while also embracing change. DBT equips patients with a very structured set of skills that helps them navigate their emotions most effectively. Giving them tangible tools for approaching various situations.

Getting Started With DBT

Adding DBT as a treatment option can be time-intensive, however, the evidence based approach can increase the likelihood for positive patient outcomes. For clinicians to implement DBT at their practice they must invest time in training clinicians or find providers with this specific skill set.

Various training options exist for clinicians who want to become DBT-certified. Behavioral Tech, founded by Dr Linehan, trains behavioral health care providers who work with patients to use scientifically valid treatments and to implement and evaluate these treatments in their practice setting.

Behavioral health providers are encouraged to first learn standard DBT, then pursue advanced training on how to thoughtfully adapt it for a specific population.

For DBT to be most effective, clinics must adhere to the specific guidelines and not cut corners. For example, you must have a DBT consultation team and there must be therapy for the therapist once a week to avoid burnout.

All guidelines must be followed for optimal patient results.

Operational Considerations for DBT

With DBT, it is critical to ensure a team is in place—whether that be other providers within a clinic or partnering with another provider in the community so that group therapy can be offered. In addition to one-on-one sessions, group therapy plays an important role in DBT, presenting a very effective way of learning DBT skills. During groups, individuals can focus on weekly lessons, learn from other members, and get more opportunities to practice DBT skills like being aware of emotions and respecting others.

Developing DBT treatment plans requires clinicians to document detailed notes including capturing goals, patient history, and other records. Working with an electronic health record designed specifically for the unique workflows and clinical documentation needs of behavioral health can help make implementing DBT a smooth process.

On the billing side, technology solutions can help providers demonstrate to payers the efficacy of the treatment being provided by offering tools that assess the severity of patient symptoms and then demonstrating how those symptoms decrease over time. This can be reported back in graphical form and presented to payers who are in or out of network, helping providers increase reimbursement rates.

Final Thoughts

Although DBT requires a larger commitment of time and resources, meta-analyses of numerous studies have supported its use for borderline personality disorder, along with a smaller number of research studies for other disorders.

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