Change is the Only Constant: How Dialectical Behavior Therapy (DBT) Can Be Made More Culturally Responsive Across Treatment Settings

This program design demonstrates how Dialectical Behavior Therapy (DBT), a well-regarded, existing evidence-based practice (EBP) used to treat many transdiagnostic and complex mental health disorders around the world, can be made more culturally responsive across treatment settings. An overview of the literature regarding global access to mental health treatment reveals that much effort has been made to close the mental health treatment gap by promoting EBPs. However, most EBP research is conducted in Western countries using majority white populations, which calls into question the generalizability and effectiveness of EBPs among U.S. cultural and racial minority and international populations. Despite the increasing global demand for DBT because of its flexible, principle-driven approach that has broad appeal for complex and transdiagnostic conditions, it is no exception. While several international studies demonstrate DBT’s effectiveness in other countries, virtually no studies have examined what parts of DBT make it effective for non-white populations both in the U.S. and globally. Despite its growing international popularity, there are also no published studies that investigate the overall cultural responsiveness of DBT, how cultural factors of the participants or the therapists impact treatment outcomes, or how it can be implemented in cross-cultural contexts while still adhering to treatment adherence and fidelity. Nonetheless, DBT’s unique dialectical philosophy, combining Western cognitive science with Eastern meditation practices, makes it an EBP with vast potential for global effectiveness and application. This project examines how DBT can be implemented, disseminated, and sustained in both U.S. minority populations as well as in international (especially non-Western) settings. Although not intended to be a panacea, questions about DBT’s cultural responsiveness have opened new directions consistent with one of its fundamental dialectical principles: change is the only constant