About
Adapted from standard dialectical behavior therapy (DBT), DBT-ACES (Accepting the Challenges of Employment and Self-Sufficiency) is an expansion and adaptation of standard DBT featuring a second year of treatment designed for DBT graduates who want to increase self-sufficiency and maintain living wage employment. It has been evaluated in a series of pre-post observational studies in the United State and in three routine care outpatient settings in the United States and Germany.
Outcomes
Pre-post program evaluations of DBT-ACES have demonstrated suicide-related outcomes comparable to those of clinical trials as well as promising findings for increasing school and work activities and meaningful cost benefits.
- The results of a feasibility trial found that clients in DBT–ACES were three times more likely to be working or in school and five times more likely to be working 20 hours a week or more in the year of DBT–ACES than their SDBT year.
- A three-site evaluation including programs in Germany and California have replicated and exceeded these pre–post results and included a cost-benefit analysis yielding substantial savings. While the majority of the over $17,000 per DBT-ACES client cost-offset compared to the year prior to SDBT was primarily driven by the decrease in inpatient care, evidence of significant school and workplace benefits were also observed in both the SDBT and DBT-ACES years compared to the year prior to SDBT.
Citations
- Comtois, K.A., Carmel, A., McFarr, L., Hoschel, K., Huh, D., Murphy, S.M., Benson, L., Pfluegler, S. (2020). Dialectical behavior therapy-Accepting the challenges of employment and self-sufficiency (DBT-ACES) effectiveness: A re-evaluation in three settings. DBT Bulletin. 3(1).
- Comtois, K. A., Kerbrat, A. H., Atkins, D. C., Harned, M. S., & Elwood, L. (2010). Recovery from disability for individuals with borderline personality disorder: a feasibility trial of DBT-ACES. Psychiatric services (Washington, D.C.), 61(11), 1106–1111. https://doi.org/10.1176/ps.2010.61.11.1106
In addition to these effectiveness studies, several articles have been published on the clinical application of DBT-ACES. These articles include a case study of the progression from SDBT through DBT-ACES (Comtois et al. 2020), considerations for integrating DBT-ACES components into CBT (Carmel & Comtois, 2023), and examining cultural dialectics while providing DBT-ACES in multicultural community mental health settings (Bolden et al, 2020).
- Carmel, A., & Comtois, K. A. (2023). Integrating Dialectical Behavior Therapy-Accepting the Challenges of Employment and Self-Sufficiency (DBT-ACES) Strategies into Cognitive Behavioral Therapy. Journal of Contemporary Psychotherapy. https://doi.org/10.1007/s10879-023-09580-z
- Bolden, L. S., Gaona, L., McFarr, L., & Comtois, K. (2020). Chapter 14 – DBT–ACES in a multicultural community mental health setting: Implications for clinical practice. In J. Bedics (Ed.), The Handbook of Dialectical Behavior Therapy (pp. 307–324). Academic Press. https://doi.org/10.1016/B978-0-12-816384-9.00014-2
