Overview: This paper proposes a theoretical rationale for the application of dialectical behavior therapy to individuals with bipolar disorders.Proposal text: Theoretical Rationale for Applying Dialectical Behavior Therapy to Individuals with Bipolar Disorders This paper proposes a theoretical rationale for the application of dialectical behavior therapy to individuals with bipolar disorders. Among all psychiatric disorders, substance use and medical disorders, both youth and adults with bipolar disorders are at greatest risk for suicide attempts and death by suicide. Bipolar disorders are a leading cause of disability worldwide. Emotion dysregulation has been found to be a core feature of bipolar disorders. In bipolar disorders periodic life events or changes in the social environment precipitate or exacerbate mood symptoms triggering episodic emotional dysregulation in the form of a mood episode. Whereas, in borderline personality disorder a perpetually invalidating social environment interacting with biological vulnerabilities produces pervasive emotional dysregulation. This episodic versus pervasive emotional dysregulation is essential in differential diagnosis, yet highlight the same core feature of emotional dysregulation and a need to target this in treatments for both disorders. Current psychotherapies for bipolar disorders remain inadequate with the majority of individuals who reach remission reporting a recurrence within a year. Furthermore, most treatments for bipolar disorders do not explicitly target suicidality, functional recovery and quality of life. Dialectical Behavior Therapy (DBT), originally developed to treat adults with borderline personality disorder, is a skills-based intervention targeting suicidality, emotional dysregulation, and psychosocial functioning. Biosocial Theory, the theoretical rationale for DBT, was originally developed to explain pervasive emotional dysregulation experienced by individuals with borderline personality disorder. We propose the synthesis of existing biopsychosocial theories of the etiology and course of bipolar disorders under the biosocial theory of borderline personality disorder. Leading theories include Kindling Theory, Social Rhythms Disruption Theory, and Behavioral Approach System Dysregulation (BAS) Theory. Each theory discusses the interplay between biological vulnerabilities and social/environmental contributing factors yet have major gaps, which are addressed by their integration under the framework of Biosocial Theory. A cohesive synthesis of the existing biopsychosocial theories of bipolar disorders under Biosocial Theory further justifies the adaptation of DBT to individuals with bipolar disorder. This paper provides theoretical rationale for previous pilot studies of DBT for bipolar disorders, which found initial feasibility, acceptability, and improvement in mood symptoms, emotion dysregulation, and suicidality in adolescents and adults with bipolar disorders. DBT holds promise as an intervention able to uniquely fit the treatment needs of individuals with bipolar disorders and directly targets suicidality, functional recovery and enhanced quality of life. This theoretical rationale provides support for future research examining the efficacy of DBT with individuals with bipolar disorders. Implications for social work include access to effective treatment for a high risk and marginalized population, thus promoting mental health as a human right. Educating social workers in this integrated theory is integral to bridging the gap between research and best clinical practice.
