Suicidal Ideation as a Maladaptive Emotion Regulation Strategy: Implications for Treatment in Dialectical Behavior Therapy

Dialectical behavior therapy (DBT) is a leading psychotherapy for the reduction of suicidal and self-injurious behaviors (SIBs). However, evidence shows that DBT may be comparably less effective at reducing suicidal ideation (SI) than SIBs. Improving the effectiveness of DBT for SI is critical, given that SI poses risk for SIBs and presents a substantial clinical burden. In the following theoretical paper, we first review evidence surrounding the effectiveness of DBT for SI reduction and explore why DBT may be comparably less effective at reducing SI than SIBs. We argue that DBT’s effectiveness for treating SI may be enhanced by a functional understanding of SI as a maladaptive form of affect regulation, as put forth by recent empirical research. Finally, we discuss implications of this model for treatment in DBT and provide clinical recommendations for how to target SI more effectively using DBT’s existing repertoire for behavior change.