Dialectical behaviour therapy skills reconsidered: applying skills training to emotionally dysregulated individuals who do not engage in suicidal and self-harming behaviours

Mary Kells,Mary Joyce,Aoife Hayes,Daniel Flynn,Ailbhe Spillane

doi:10.1186/s40479-020-0119-y

Abstract

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.

Highlights

Dialectical behaviour therapy (DBT) is an evidence-based intervention for borderline personality disorder (BPD) but is an intensive treatment with significant health service costs
Given the absence of ongoing behavioural dysregulation for this group of individuals, we considered the potential benefit of offering a DBT skills training (DBT-ST) programme, rather than the standard DBT programme with all four modes of treatment, to individuals with lower risk emotion dysregulation
Fifty-nine participants had borderline personality traits only while the remaining 41 participants had a diagnosis of BPD

Summary

Introduction

Dialectical behaviour therapy (DBT) is an evidence-based intervention for borderline personality disorder (BPD) but is an intensive treatment with significant health service costs. 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. Borderline personality disorder (BPD) is a complex and challenging mental health diagnosis, characterised by a pervasive instability in affect, identity, interpersonal relationships and dysregulated behaviour [1, 2]. Not all individuals with BPD or severe emotion dysregulation actively engage in self-harm or other suicidal behaviours [9]. Access to standard DBT is often restricted due to limited resources and a shortage of DBT trained clinicians, in public health services [9, 14]

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