DBT skills\u2009+\u2009parent training for preschool parents with emotion dysregulation and substance misuse

BackgroundDialectical Behavior Therapy’s (DBT) well established effectiveness in reducing emotion dysregulation, and the growing recognition that parental emotion regulation is critical to effective parenting has led to increasing interest in the applicability of DBT skills to parenting. Efforts to integrate DBT and parenting interventions would benefit from an empirical examination of which DBT skills are most useful to parents with emotion dysregulation.MethodsThis study used clinician-rated observational coding of skill use examples that were provided by mothers with severe emotion dysregulation (n = 16) who participated in a standard 48-week DBT Skills Training (DBT-ST) program in the context of a larger randomized controlled trial (NCT03060902). Mothers described their use of DBT skills during the homework review portion of DBT-ST sessions and video-recordings were then examined and coded to identify which DBT skills mothers most frequently described using in parenting situations (vs. non-parenting situations) and which skills were used to either increase positive parenting behaviors or to decrease negative parenting behaviors.ResultsA total of 220 skill use examples were coded and approximately one-quarter described skill use in parenting situations. Mindfulness, Distress Tolerance, and Emotion Regulation skills were the most frequently described skills used in parenting situations, while Interpersonal Effectiveness skills were rarely coded. Mindfulness and Emotion Regulation skills were most often coded when mothers’ parenting goal was to increase positive parenting, while Distress Tolerance skills were most often coded when mothers’ parenting goal was to decrease negative parenting behaviors.ConclusionsResults provide an empirical basis which clinicians and treatment developers can use when selecting DBT skills to apply towards parenting challenges.

Dialectical behavior therapy skills for transdiagnostic emotion dysregulation: A pilot randomized controlled trial

Substance misuse is an alarming issue worldwide that causes serious problems at both the individual and societal levels, placing a burden on public health systems and economies. Understanding the predictors of substance misuse may help prevent it and may be an adjunct to treatment. The present study examined the relationship among impulsivity, emotion dysregulation, generalized anxiety disorder, and substance misuse. A total of 462 participants age between 18 and 74 years (M = 33.67, SD = 12.91) from 49 cities across Türkiye, completed the measures of impulsivity, emotion dysregulation, generalized anxiety disorder, and substance misuse. Structural equation modeling indicated that impulsivity, emotion dysregulation, and generalized anxiety have a significant predictive role in substance misuse. Further, emotion dysregulation and generalized anxiety disorder mediate the relationship between impulsivity and substance misuse. These findings suggest that noticing and treating impulsivity, emotion dysregulation, and generalized anxiety may minimize the effects of substance misuse.

BackgroundDialectical behaviour therapy (DBT) is an evidence-based intervention for borderline personality disorder (BPD) but is an intensive treatment with significant health service costs. Access to DBT can sometimes be restricted due to limited resources. Positive results have been reported for the use of DBT skills training (DBT-ST), one of the four modes of standard DBT, in the treatment of individuals with BPD who self-harm. This study evaluates DBT-ST for a subgroup of individuals attending community mental health services who may have a diagnosis of BPD (or emerging BPD traits) but who are not actively self-harming.MethodsParticipants in this study were 100 adults attending community mental health services with a diagnosis of BPD, emerging BPD traits or emotion dysregulation who were not actively self-harming. The majority of participants were female (71%), aged 25–34 years (32%), single (48%) and unemployed (34%). Participants partook in a 24-week DBT-ST intervention delivered by DBT therapists. Outcome measures included the Difficulties in Emotion Regulation Scale (DERS), the DBT Ways of Coping Checklist (DBT-WCCL) and the Five Facet Mindfulness Questionnaire (FFMQ). Measures were administered at pre-intervention, at the end of each skills module, and at post-intervention.ResultsSignificant reductions in emotion dysregulation (DERS) and dysfunctional coping (DBT-WCCL) scores were reported from pre- to post-intervention (p < .001). A significant increase in mindfulness scores (FFMQ) and DBT skill use (DBT-WCCL) was also observed (p < .001). However, the drop-out rate was high (49% at post-intervention).DiscussionThe results of this uncontrolled study suggest that a standalone 24-week DBT-ST intervention may have a beneficial impact in terms of a reduction in emotion dysregulation and dysfunctional coping, and an increase in mindfulness and DBT skills use in patients with BPD/ emerging BPD traits who are not currently engaging in self-harm. Adequately powered randomised controlled trials are required to determine treatment efficacy in comparison to standard DBT for this population.

Internet-delivered dialectical behavior therapy (iDBT) represents a scalable and accessible treatment approach for individuals with substance use disorders (SUDs), yet little is known about the mechanisms of change and the role of engagement in this format. This study examined within- and between-person associations between changes in skills-based constructs (mindfulness, DBT skills use, emotion dysregulation) and two treatment outcomes (SUD severity and functional disability) across a 12-week self-guided iDBT program. The moderating role of treatment engagement was also evaluated. 72 participants with past year SUDs were randomized to immediate or delayed iDBT and completed assessments at baseline and weeks 4, 8, and 12. Multilevel models were used to assess within- and between-person associations between skills and outcomes over time. Several indices of engagement were used including treatment acceptability, usability, and hours/days spent on iDBT. Within-person increases in emotion dysregulation were associated with higher SUD severity and disability, over and above respective between-person effects. DBT skills and mindfulness were not significantly associated with outcomes after correction for multiple tests, though the latter produced a small-medium effect size at the between-persons level. There were no significant moderation effects of treatment outcomes after correction for multiple tests, but several produced small-medium effect sizes. These preliminary findings support the role of emotion dysregulation as a key correlate of treatment response and promote further research within an iDBT context. Future work should refine measurement of DBT skill acquisition and investigate longer-term functional impacts of digital DBT interventions.

AimsDysregulated behaviours are prevalent amongst young people worldwide. Emotional dysregulation plays a key role in these behaviours. Several psychiatric disorders have significant elements of emotional dysregulation, making it a potentially effective transdiagnostic therapeutic target. Dialectical behaviour therapy (DBT), mentalisation-based therapy (MBT), and schema therapy (ST) can effectively manage emotional dysregulation, however access may be limited in clinical practice.We aimed to explore whether young people with emotional dysregulation engaging in dysregulated behaviours receive support for emotion regulation. We hypothesised that those with emotionally unstable personality disorder (EUPD) will have a higher prevalence of self-harm, disordered eating, and/or substance misuse and more referrals for DBT, MBT, or ST than those with bipolar disorder, autism, attention deficit/hyperactivity disorder (ADHD), schizophrenia, or schizoaffective disorder.MethodsDe-identified clinical records from the West London NHS Trust on 2,413 16- to 25-year-olds with an ICD–10 diagnosis of EUPD, bipolar disorder, autism, ADHD, schizophrenia, and/or schizoaffective disorder were obtained through Akrivia. Chi-squared tests were performed.ResultsYoung people with bipolar disorder had the highest prevalence of self-harm, disordered eating, and substance misuse (88.35%, n = 182), χ2 (4, N = 3138) = 39.14, p &lt; 0.001, but the lowest number of references to DBT, MBT, or ST. Those with EUPD had the highest number of references to DBT, χ2 (4, N = 2585) = 886.75, p &lt; 0.001, MBT, χ2 (4, N = 2585) = 81.63, p &lt; 0.001, or ST, LR (4, N = 2585) = 21.03, p &lt; 0.001.ConclusionThere could be an unmet need for psychological interventions for young people with bipolar disorder. A more transdiagnostic approach to offering psychotherapies that target emotional dysregulation should be applied in clinical practice.

Alcohol and drug misuse are widespread and, regretfully, account for substantial proportions of the global burden of disease as well as considerable cost in social spending. Moreover, important links have been identified between substance misuse and the involvement of individuals in violent, antisocial, and criminal behavior. A burgeoning body of literature has begun to highlight the importance of biosocial factors in understanding substance misuse and criminal behavior, as well as the interconnectedness of biosocial risk, substance misuse, and crime. In this chapter, we explore the interconnections of these phenomena from various angles. First, we examine the implications of key biosocial factors in terms of the involvement of individuals in both substance misuse and crime. Next, we consider how exposure to environmental factors can influence human biology and, in turn, the propensity of individuals to misuse substances and take part in criminal behavior. Finally, we examine the ways in which substance misuse, by means of neurological dysregulation, can function as an important source of biosocial liability for crime.

Background: Intensive short-term dynamic Psychotherapy (ISTDP) is a structured, short-term psychotherapy that focuses on emotional processing and the resolution of internal conflicts. This randomised pilot and feasibility study evaluated the implementation of a novel 12-week group program based on ISTDP model, and compared clinical outcomes in reducing symptoms associated with personality vulnerabilities (e.g., emotion regulation, self-harm). The setting of the study was an Australian Public Hospital Service. Methods: The study design was a randomised pilot study for feasibility. Participants were consumers who were referred to a brief intervention service for personality disorders. Participants were randomly assigned to either the ISTDP group or DBT group (treatment as usual). Outcome measures included questionnaires (DASS-21, DERS-18, DES-II, DBTWCCL) assessing mood and distress, emotional dysregulation, disassociation, and DBT skill use. Feasibility outcomes, such as recruitment, attrition, and consumer experiences of the therapy, were also evaluated. Results: A total of 15 participants were recruited, with nine randomly allocated to the ISTDP group and six to the DBT group. Both groups showed improvements in clinical symptoms, including reductions in depression, emotional dysregulation, and dissociation. The ISTDP group also demonstrated a reduction in anxiety and stress. Follow-up surveys indicated that participants found both group interventions relevant, useful, and beneficial for managing their thoughts and emotions. Conclusion: Both the ISTDP and DBT interventions were well received by participants, and no adverse events were reported, further supporting their potential for implementation in public hospital settings.

Abstracts

Objective Health-risk behaviors have an unclear etiology and college students have elevated risk for engagement. Emotion dysregulation and several personality dimensions have been implicated in health-risk behaviors, but these constructs have rarely been studied together. Further, it is unknown if different types of health-risk behaviors have distinct etiologies. Participants 2077 college students completed a cross-sectional survey. Methods Latent profile analysis discerned classes of participants from emotion dysregulation and personality dimensions. Differential engagement in self-injury, suicidality, disordered eating, substance misuse, and unprotected sex was evaluated across classes. Results Three classes were identified, which were primarily distinguished by emotion dysregulation, urgency, and neuroticism. Health-risk behaviors generally increased across classes with increasing emotion-related constructs. Self-injury and suicidality demonstrated different patterns than other health-risk behaviors. Conclusions Results elucidate heterogeneity in health-risk behavior engagement. Focusing on emotional difficulties may be more important for reducing self-injury and suicidality than disordered eating, substance misuse, and risky sex.

49.1 DBT Skills + Parenting Training for Preschool Parents With Emotion Dysregulation and Substance Use

Developmental trajectories of self-injurious behavior, suicidal behavior and substance misuse and their association with adolescent borderline personality pathology

Background: Severe irritability is a common, impairing problem among youth referred for mental health services, but evidence to guide care is limited. Treatment research can be advanced by adopting a transdiagnostic perspective, leveraging existing evidence-based treatment (EBT) techniques, and situating irritability within the context of emotion dysregulation. Accordingly, this study examined treatment outcomes for youth with different levels of irritability and dysregulation who received cognitive-behavioral therapy (CBT) or behavioral parent training (BPT) in a modular EBT framework.Method: We analyzed data from a community-based implementation trial of a transdiagnostic youth psychotherapy. Two-hundred treatment-referred youths (7-15 years; 47% female; 33% White, 28% Black, 24% Latinx, 14% multiracial, 2% other) and their caregivers completed measures of clinical problems and emotion dysregulation at baseline, with repeated outcomes assessments over 18 months. First, latent profile analysis was applied to baseline irritability and emotion dysregulation data; then, latent growth curve models were used to examine outcome trajectories, controlling for covariates.Results: A two-class solution fit well, differentiating youth with high (n = 54) vs. low (n = 146) levels of dysregulation and irritability at baseline. Nearly all high-dysregulation youth received either BPT (n = 26) or CBT-Depression (n = 23). Across measures, both groups showed statistically and clinically significant improvements over time. High-dysregulation youth had greater baseline severity than low-dysregulation youth, but otherwise their longitudinal trajectories were mostly similar, with few between-group slope differences. There was virtually no evidence of differential effects for BPT vs. CBT on clinical outcomes.Conclusions: Youth with severe irritability and dysregulation, treated with a transdiagnostic, modular, EBT approach, showed significant within-person improvements over time. Their outcome trajectories did not differ according to whether they received BPT or CBT. Findings extend the literature on modular, transdiagnostic, and EBT approaches for irritability and dysregulation, suggesting comparable benefits associated with BPT and CBT when treatment selection is guided by comprehensive assessment.Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03153904.

IntroductionDialectical Behavior Therapy (DBT) has assembled a large body of evidence for the treatment of emotional dysregulation in borderline personality disorder (BPD), but also in other disorders characterized by emotional dysregulation (e.g., bipolar disorder (BD) and ADHD). Standalone skills learning groups address the problem of limited resources in several clinical settings. Furthermore, transdiagnostic skills groups facilitate the recruitment and decrease the scattering of resources in psychiatric settings. However, few studies have focused on the pertinence of transdiagnostic standalone skills groups in naturalistic settings as well as their long-term outcomes. The goal of this study is to assess the impact of participation in a transdiagnostic DBT skills group one year after its completion.MethodTransdiagnostic DBT skills training groups were provided for BPD, BD and ADHD patients in a University Psychiatric Department (Strasbourg, France), between 2019 and 2020. They consisted of 16 group sessions of 2.5 h and 3 individual sessions. At 1-year follow-up, ad-hoc questionnaires were proposed to all participants to assess the perceived impacts, the changes in symptomatology, and the maintenance of skills learned.Result22 of the 31 participants were interviewed at the one-year post-group session (64% BPD, 41% ADHD and 27% BD). 73% participants estimated that group impact was important or very important, 64% stated using the skills learned often or very often, mainly emotion regulation skills. An improvement in emotional instability, substance use, impulsivity and suicidal thoughts was reported by respectively 100%, 91%, 86% and 85% of participants. Quality of life improved according to 90% participants. All patients reported an improvement in suicidality during the post-group year, especially in suicide attempts. Psychotropic medication decreased in 59% of participants.DiscussionOur one-year naturalistic study suggests that transdiagnostic DBT skills training groups are promising for the treatment of emotional dysregulation in people with BPD, BD and/or ADHD. The observational design and the lack of control group are the main limitations. Randomized controlled studies are required to confirm the long-term efficacy of transdiagnostic skills learning groups in naturalistic settings.

IntroductionDialectical behavioural therapy (DBT) developed by Linehan has been shown to be widely effective in improving emotional regulation capacity in patients diagnosed with borderline personality disorder in adults and adolescents, but also for other profiles of emotional dysregulation, even in the general non-clinical population through emotional regulation skills training programs in schools.ObjectivesThe objective was to describe psychopathological characteristics and to evaluate clinical outcome variables (self-harm, suicide attempts, admissions and emotional regulation difficulties) in young patients who participated in the DBT skills training group carried out by the child and adolescent psychiatry team of Hospital del Mar (Barcelona) between February 2020 and April 2022.MethodsProspective longitudinal study with two evaluations (before starting the group and after finishing it). The clinical variables were evaluated by reviewing the medical records, and the improvement in emotional regulation difficulties was evaluated through the Difficulties in Emotion Regulation Scale (DERS) adaptation to adolescents before and after the intervention.ResultsA total of 36 participants have been referred and assessed to participate in the previously mentioned emotional regulation program. The mean age was 15.6 years (14-17 years old). 100% of the participants were female. All of them met criteria for BPD according to the SCID-II questionnaire; but only 23 patients (63.9%) had BPD as their main diagnosis. 63.9% (n=23) presented psychiatric comorbidities, being 27.8% (n= 10) ADHD, 30.6% (n= 11) substance use disorder and 47.2% (n= 17) eating disorders,77.8% (n=28) had presented self-injurious behaviour, 52% (n=18) had committed a suicide attempt, requiring hospital admission in 36.2% (n=13) at some point in their lives before the therapy group. In the three months after the end of the group, admissions were reduced to 17% (n=6), suicide attempts to 14.8% (n=5) and non-suicidal self-injurious behaviours to 27.8% (n=10).The mean score of all participants on the DERS scale was 129.91 points before participating in the DBT skills group and 105 points right after the group finished. Higher scores translate into greater emotional regulation difficulties.ConclusionsThe reduction in DERS scores, self-injurious behaviours, suicide attempts, and admissions was notable for all participants. It remains to add the results of the groups currently in operation and perform the statistical analysis of all the results. It is necessary to continue studying and testing the benefits of DBT both in the clinical adolescent population and in the general child and adolescent population in order to generalize the promising results observed in our sample. At Hospital del Mar, we will continue to expand the DBT program so that more children and adolescents with emotional dysregulation can benefit.Disclosure of InterestNone Declared