Dialectical Behavior Therapy Skills Training Research Articles

Effects of Dialectical Behavioral Therapy Skills Training for Emotional Problem Solving for Adolescents (DBT STEPS-A) Program of Rural Ninth-Grade Students

Effects of Dialectical Behavioral Therapy Skills Training for Emotional Problem Solving for Adolescents (DBT STEPS-A) Program of Rural Ninth-Grade Students

Group relationships during a dialectical behavior therapy skills training program for the treatment of alcohol and concurrent substance use disorders: Evidence and theoretical considerations.

Group relationships during a dialectical behavior therapy skills training program for the treatment of alcohol and concurrent substance use disorders: Evidence and theoretical considerations.

Investigating predictive factors of dialectical behavior therapy skills training efficacy for alcohol and concurrent substance use disorders: A machine learning study

BackgroundDialectical Behavior Therapy Skills Training (DBT-ST) as stand-alone treatment has demonstrated promising outcomes for the treatment of alcohol use disorder (AUD) and concurrent substance use disorders (SUDs). However, no studies have so far empirically investigated factors that might predict efficacy of this therapeutic model. Methods275 treatment-seeking individuals with AUD and other SUDs were consecutively admitted to a 3-month DBT-ST program (in- + outpatient; outpatient settings). The machine learning routine applied (i.e. penalized regression combined with a nested cross-validation procedure) was conducted in order to estimate predictive values of a wide panel of clinical variables in a single statistical framework on drop-out and substance-use behaviors, dealing with related multicollinearity, and eliminating redundant variables. ResultsThe cross-validated elastic net model significantly predicted the drop-out. The bootstrap analysis revealed that subjects who showed substance-use behaviors during the intervention and who were treated with the mixed setting (i.e., in- and outpatient) program, together with higher ASI alcohol scores were associated with an higher probability of drop-out. On the contrary, older subjects, higher levels of education, together with higher scores of DERS awareness subscale were negatively associated to drop-out. Similarly, lifetime co-diagnoses of anxiety, bipolar, and gambling disorders, together with bulimia nervosa negatively predicted the drop-out. The machine learning model did not identify predictive variables of substance-use behaviors during the treatment. ConclusionsThe DBT-ST program could be considered a valid therapeutic approach especially when AUD and other SUDs co-occur with other psychiatric conditions and, it is carried out as a full outpatient intervention.

Multilevel associations of daily skill use and effectiveness with anxiety, depression, and stress in a transdiagnostic sample undergoing dialectical behavior therapy skills training

ABSTRACT Dialectical Behavior Therapy (DBT) is effective at treating disorders of emotion dysregulation. However, it is unclear which mechanisms contribute to these effects. The aim of this study was to characterize the within-person associations of two theoretically relevant mechanisims of change, skill use and skill effectiveness, with anxiety, stress, and depression. Participants (n = 19, M age = 31.8, 68% female) with a primary anxiety or depressive disorder completed daily reports (N = 1344) of DBT skill use, perceived effectiveness, anxiety, stress, and depression during a 16-session DBT skills training group. DBT skill use increased across treatment, p < .01, but effectiveness did not, p = .64. Within persons, participants used more skills on days with greater stress and anxiety, p < .01, which predicted next-day decreases in stress and anxiety, p = .03. On days when participants reported higher effectiveness, they used more skills than their personal average when experiencing more intense negative affect, p < .01. These results suggest using more skills, especially when used more effectively, is a mechanism by which DBT skills groups address emotional dysfunction for those with transdiagnostic emotional disorders.

Effectiveness of dialectical behavior therapy skills training group for adults with borderline personality disorder.

This study evaluated the effectiveness of the Dialectical Behavior Therapy Skills Training Group (DBT-ST) component of DBT. Participants (N = 114) attended an 18-20-week DBT-ST. The study utilized a quasi-experimental design with a within-persons control group for a measure of borderline personality disorder (BPD) symptoms (at referral), and emergency department (ED) presentations, and psychiatric bed-days (both assessed for 6 months pre- and post-intervention). Primary outcomes were the number of BPD symptoms, psychological distress, depression, rate of ED presentations, and psychiatric inpatient bed-days. After completing DBT-ST, participants had reduced BPD symptoms, psychological distress, and depression (p < 0.001). The waitlist control group showed no improvement in BPD symptoms (p = 0.085). The rate of ED presentations was reduced (p = 0.001). There was no reduction in psychiatric inpatient bed-days (p = 0.160), likely due to insufficient power. DBT-ST participation in addition to treatment-as-usual is an effective treatment for people with BPD.

Efficacy of Dialectical Behavior Therapy on Decreasing Weight in Obese Women with Emotional and Behavioral Disorders: A Quasi Experimental Study

Objective: The growing worldwide prevalence of overweight and obesity, despite treatment strategies remain the health problem. Over the past decade, increasing attention has been paid to psychological factors and a potentially comprehensive, multimodal skills-based treatment. The purpose of this study was to evaluate the efficacy of dialectical behavior therapy (DBT) on weight loss in obese women with emotional and behavioral disorders. Materials and Methods: In this quasi-experimental study, statistical population from convenience sampling consisted of 42 obese women with body mass index (BMI) more than 29.9 kg/m2 divided in 3 groups, behavioral, emotional and control. Descriptive and analytic statistics were computed according to demographic information, emotional eating scale and Dutch eating behavior questionnaire. Intervention included 13 sessions of 1.5hr group therapy, DBT-skills training from April to September 2019. Mixed-effect modeling ANOVA with repeated measurements was performed by statistical analyses, IBM SPSS version 24 to study changes in variables over time. Results: The results demonstrated that the emotional such as anger, anxiety and depression, significantly decrease during the study period. (P-value&lt;0.001) As well as behavioral eating demonstrated significant improvement in restrained eating and decrease in emotional and external eating behaviors right after the end of intervention while trial group experienced significant weight loss. Conclusion: The present study provides some evidence that DBT-skills training can be effective in decreasing problematic eating behaviors, emotion dysregulations, decreasing BMI.

Group-based DBT skills training modules are linked to independent and additive improvements in emotion regulation in a heterogeneous outpatient sample

Objective: Dialectical Behavior Therapy (DBT) was initially developed to treat symptoms of Borderline Personality Disorder (BPD), but has also been shown to improve symptoms of several other mental health conditions. Emotion regulation difficulties comprise a key target of DBT as well as a common challenge for individuals with depression, anxiety, PTSD, and other conditions. The current study investigated the impact of a DBT skills-training group on emotion regulation, and whether improvement in specific facets of emotion regulation would be linked to training in specific modules. Method: One hundred and thirty-six patients diagnosed with heterogeneous mental health conditions participated in the study. Patients were enrolled in the group on a rolling basis, and emotion regulation was assessed at the beginning and end of every six- to eight-week module. Results: Mixed model analysis revealed that each DBT skills-training module (i.e., mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation) was associated with improvements in emotion regulation (all Bonferroni corrected ps < .003). Conclusions: These findings add to the growing literature on the applicability of DBT skills-training to heterogeneous psychological conditions, particularly when patients’ challenges reflect underlying difficulties with emotion regulation.

Brief videoconference-based Dialectical Behaviour Therapy skills training for Covid-19-related stress in acute and crisis psychiatric staff

Covid-19 has increased stress for psychiatric staff. This study reports the positive impact of brief videoconference-based Dialectical Behaviour Therapy skills training for acute psychiatric staff. It was delivered by clinical psychologists as a staff support response to Covid-19-related stress.

Slow Open Dialectical Behavior Group Therapy for Adolescents and Parents: Longitudinal Study of Unconscious Orientation

Introduction: The study’s objective is to explore the existence and the evolution of common behavior of the participants to four slow open groups taking part in a Dialectical Behavior Therapy (DBT) skills training. Two groups were composed of adolescents and two of their respective parents. We analyzed their evolution via the answers to the “absurd” questionnaire. Methods: The “absurd questionnaire,” composed of 50 pairs of images, was administered to the participants who had to choose one image from each pair. In this experiment, we were able to submit a version of the questionnaire to the participants before forming the groups. We have analyzed their initial picture choices and how these evolved, considering the changes in the choices, the differences in the four groups, the flux, and the answers’ focus. Results: In the four groups, we found statistical evidence that both the pictures’ initial choices and their evolution during the training are not simply governed by randomness. The initial picture choice in each pair is highly skewed toward one of the two pictures in each pair. We compare the longitudinal evolution of the picture’s choice in the four groups. Conclusions: The results show that the answers to the questions are strongly polarized already before the groups convene, revealing an initial socio-cultural bias. The group environment causes relaxation of this strong initial bias and subsequent recovery. This relaxation could indicate the formation of a “group continuum,” coming from the entanglement of individuals’ psyches, creating a group entity having its own identity. In the slow-open groups, the participants are mainly subject to clan loyalties.

Dialectical behaviour therapy skills group including stigma management: a pilot with sexual and gender minority veterans

AbstractAs a principle-driven treatment, dialectical behaviour therapy (DBT) offers concepts and strategies that can be flexibly applied to address unique types of invalidation, such as stigma experienced by marginalized groups. A pilot DBT skills training group that included material on using skills to dialectically manage the effects of stigma was conducted with four sexual and gender minority (SGM) veterans. The group included standard DBT skills along with explicitly teaching about stigma commonly faced by SGM individuals and ways to apply DBT skills to the experiences of stigma. This pilot group was conducted to determine the acceptability of such a group as well as its effects on symptoms (depression, emotion regulation), use of DBT skills in daily living, and the psychological burden of stigma-related experiences. The group was well-received by participants; outcomes suggest promising trends in reducing psychological distress and increasing use of DBT skills to cope. Implications for clinical practice using a dialectical approach to stigma management and future directions are provided.Key learning aims(1)Readers will learn about how dialectical behaviour therapy can be used to help sexual and gender minority clients effectively manage the effects of minority stress.(2)Readers will learn how taking a dialectical perspective on managing minority stress can be effective.(3)Readers will learn how delivering dialectical behaviour therapy in a manner contextualized within the clients’ experience can be effective in managing mental health symptoms.

Dialectical behavior therapy skills training for generalized anxiety disorder: Considering the value of adapting something new versus improving what works.

Dialectical behavior therapy skills training for generalized anxiety disorder: Considering the value of adapting something new versus improving what works.

Exploring DBT skills training as a treatment avenue for generalized anxiety disorder.

Exploring DBT skills training as a treatment avenue for generalized anxiety disorder.

CALMA, a Mobile Health Application, as an Accessory to Therapy for Reduction of Suicidal and Non-Suicidal Self-Injured Behaviors: A Pilot Cluster Randomized Controlled Trial

The present study was aim to evaluate the acceptability and preliminary effectiveness of a mobile-health application, CALMA, based on dialectical behavioral therapy skills. CALMA was proposed as an adjunct to therapy for the reduction of non-suicidal and suicidal self-injury behaviors. A parallel design was used to compare the intervention group (DBT + CALMA) and the comparison group (DBT). Patients were randomized based on their groups following a randomized cluster design. After treatment, patients completed a follow-up assessment four weeks later. Each cluster was represented by a different DBT Skills Training Group offered weekly at FORO Foundation for Mental Health. Six DBT Skills Training groups were randomized to the intervention or comparison group. Twenty-one individuals met inclusion criteria and eighteen were included in the analysis. Acceptability was measured with the User Experience Questionnaire short version (UEQ-s) and preliminary efficacy with the Self-injurious thoughts and behaviors interview (SITBI). CALMA shows good acceptability to be used as an adjunct to therapy specific to the reduction of suicidal and non-suicidal self-directed violence. Evidence for preliminary efficacy included a high probability of decreased in more behaviors evaluated with the SITBI pre- and post-intervention for the group that received CALMA as compared to the comparison group. Our study provides initial evidence for the effectiveness and acceptability of CALMA. Future studies scaling up this intervention in a larger number of participants are necessary. CALMA may be especially useful in low and middle-income Latin American countries to improve access to evidence-based interventions openly available in Spanish and free to download. Highlights CALMA is a DBT-based app aimed to reduce non-suicidal and suicidal self-directed violence. The app showed good acceptability by users A high probability of decrease in suicidal ideation, suicidal plan, suicidal gesture, thoughts about NSSI and NSSI pre- and post-intervention was observed

Feasibility trial of the dialectical behavior therapy skills training group as add-on treatment for adults with attention-deficit/hyperactivity disorder.

Our aim was to explore the feasibility, and efficacy of a Dialectical Behavior Therapy Skill Training Group (DBT-ST) as an add-on treatment for adult attention-deficit/hyperactivity disorder (ADHD) in Latin America. Adults with ADHD (n = 31) with stable medication treatment for ADHD and residual symptoms (ASRS > 20) were randomly assigned to DBT-ST (n = 16) or treatment as usual (TaU; n = 15) for 12 weeks. Feasibility was accessed by attendance and completion rates at 12 weeks. Efficacy outcomes were measured with the ASRS, and performed at 0, 6, 12, and 16 weeks. The DBT-ST protocol had 81.25% completion rate, with a mean attendance of 87.25% of the sessions. No significant interactions between group and time were detected for outcome measures. The DBT-ST was feasible as add-on treatment for adult patients with ADHD in Latin America. Replicating previous findings, DBT-ST has shown no significantly higher improvement in ADHD symptoms in comparison with TaU. Registered at the Clinical Trials database (NCT03326427).

Affirmative Dialectical Behavior Therapy Skills Training With Sexual Minority Veterans

Minority stress theory posits that unique stressors create an invalidating environment, which places sexual minority individuals at increased risk for psychiatric morbidity. Sexual minority veterans’ experience of minority stressors results in elevated levels of emotion dysregulation, anxiety, depression, and suicidality. Clinical interventions designed to address minority stress and treat emotional dysregulation and related disorders among sexual minority veterans are warranted. Professional guidelines recommend the adaptation of evidence-based treatments to address the unique features of sexual minority and veteran mental health. Dialectical Behavior Therapy (DBT) is a treatment for emotion dysregulation and related problems that addresses an invalidating environment, which is an appropriate framework for sexual minorities. The current research adapts the Emotion Regulation module of DBT Skills Training. This adaptation highlights minority stress as part of the invalidating environment and adds new teaching points to address the unique features of sexual minority mental health to create Affirmative DBT Skills Training. Six sexual minority veterans completed Affirmative DBT Skills Training meeting on a weekly basis for 10 consecutive weeks. Before and after treatment, participants completed measures of emotion regulation, anxiety, and depression as well as assessments of minority stress processes. Affirmative DBT Skills Training was well received in this sample. Results suggest that the intervention was effective in decreasing emotion dysregulation and symptoms of depression. These findings suggest Affirmative DBT Skills Training is a promising treatment, although more research is warranted, particularly given the small sample size and lack of a control group.

The effectiveness of dialectical behaviour therapy for treating women with obesity suffering from BED: A feasibility and pilot study

ObjectiveThis study aimed to examine the effects of dialectical behaviour therapy skills training intervention on emotional eating, body image, and weight management in women with obesity suffering from binge eating disorder.MethodForty women with obesity were selected based on inclusion and exclusion criteria from three outpatient nutrition clinics in Tehran, Iran, and were assigned into the dialectical behaviour therapy (n = 20) or control groups (n = 20) randomly. The dialectical behaviour therapy group participated in 20 group therapy sessions, while there was no intervention for the control group. All participants completed the Multidimensional Body Self‐Relations Questionnaire‐Appearance Scale, Emotional Eating Scale, and body mass index at the baseline and post‐treatment.ResultsCurrent results indicated that dialectical behaviour therapy has significant effects on the reduction of body mass index and emotional eating subscales (except for depression; F [1, 35] = 0.05, p = .94). Moreover, dialectical behaviour therapy resulted in an improvement in the body image of women with obesity at the end of the treatment.ConclusionsThis study suggests that dialectical behaviour therapy‐based skills training is efficacious not only in reducing weight and emotional eating but also in improving the body image of females with binge eating disorder.

A qualitative research of adolescents with behavioral problems about their experience in a dialectical behavior therapy skills training group

BackgroundSeveral quantitative studies support the effectiveness of the Dialectical Behavior Therapy (DBT) psychosocial skills training group component for adolescents with impulse-control disorder and/or emotional dysregulation. However, qualitative research to assess this psychotherapeutic tool in the adolescent population is sparse. This study aims to examine the subjective experience of adolescents with behavioral issues who have completed DBT skills training group, as well as using this experience to extract hypotheses regarding its usefulness which can then be verified at a later time by means of quantitative instruments.MethodsWe developed a qualitative study by using focus groups with adolescents (N = 20) whose diagnosis includes symptoms such as behavior disorder, impulse-control disorder and/or emotional dysregulation, and good informants, who have completed DBT skills training. Three focus groups were created.ResultsThe subjective experience of adolescents who have completed a DBT skills training group is collected in four main categories: experience of illness, motivation for therapy, experience of therapy and results of the therapy.ConclusionsAdolescents with behavioral problems assess their participation in the DBT skills training group positively, even recommending its usefulness to healthy population. Beyond learning skills, they emphasize the intrapsychic changes (as improvement in reflective activity) that they objectify after the group experience.

The independent roles of mindfulness and distress tolerance in treatment outcomes in dialectical behavior therapy skills training.

Despite research supporting the effectiveness of dialectical behavior therapy (DBT) for borderline personality disorder (BPD), few studies have examined how DBT leads to clinical change. DBT is theorized to lead to improved clinical outcomes by enhancing the capacity for emotion regulation, including improvement in skills (e.g., mindfulness and distress tolerance) for managing emotional distress and impulsive behaviors. Therefore, the aim of this study was to test whether improvements in mindfulness and distress tolerance indirectly affect the relationship between DBT skills training and clinical outcomes. The sample consists of 84 patients diagnosed with BPD who were enrolled in a randomized controlled trial comparing 20 weeks of DBT-skills group (DBT-S) to an active waitlist control. Mindfulness and distress tolerance were assessed at baseline and at the end of the 20 weeks. BPD symptoms, general psychiatric symptoms, and social adjustment were assessed at the end of 20 weeks and combined into a latent variable representing a broad assessment of general psychopathology. Relative to the waitlist control group, improvements in mindfulness and distress tolerance each independently indirectly affected the relationship between DBT-S and posttreatment general psychopathology. Findings suggest that DBT-S exerts its effects on outcomes through improvements in mindfulness and distress tolerance. These findings support the significance of mindfulness and distress tolerance in DBT-S for BPD. Limitations, future directions, and clinical implications are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Effectiveness of Zhong-Yong thinking based dialectical behavior therapy group skills training versus supportive group therapy for lowering suicidal risks in Chinese young adults: A randomized controlled trial with a 6-month follow-up.

BackgroundDialectical behavior therapy (DBT) is a first‐line treatment for the prevention of suicide. Zhong‐Yong thinking could be viewed as a Chinese way of dialectical thinking, has long been a culturally dictating thinking style in China. To enhance cultural adaptability, we integrated Zhong‐Yong thinking into DBT group skills training and examined its efficacy in suicidal prevention compared with a supportive group therapy and a wait‐list group in high‐risk suicidal Chinese college students.MethodsA total of 97 suicidal participants were randomized to either Zhong‐Yong thinking based DBT group skills training (DBTZYT, n = 33), or supportive group therapy (SGT; n = 32), or wait‐list group (WL; n = 32). DBTZYT was a 12‐week program based on Zhong‐Yong thinking instead of dialectical thinking, coaching participants mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. Supportive group therapy was a 12‐week program aiming at improving interpersonal effectiveness and emotion regulation skills. Outcome measures were assessed at pre‐ and post‐treatment and 6‐month follow‐up.ResultsAt post‐treatment measures, the levels of suicidal ideation, hopelessness, psychache symptoms, and general psychopathology had significantly decreased in both intervention groups; at the 6‐month follow‐up measures, the intervention effects were better maintained in the DBTZYT group rather than in the SGT group. Specifically, DBTZYT was more effective in relieving participants’ long‐term obsessive‐compulsive, anxiety, hostility, phobic, psychotic, and additional symptoms.ConclusionsZhong‐Yong thinking not only could integrate with DBT skills training in Chinese young adult population, but also has special strength in enhancing DBT’s efficacy.

The Effects of Dialectical Behavior Therapy(DBT) Skill Training on Depression and Alcohol Abstinence Self-efficacy of Patients with Alcohol Use Disorder

Background/Objectives: This study is an experimental study to investigate the effect of Dialectical Behavior Therapy (DBT) skills training on depression and abstinence self-efficacy of people with alcohol use disorder..Methods/Statistical analysis: The study was conducted on patients with alcohol use disorder diagnosed in one mental health department hospital, and 10 subjects were included in the control group receiving medication and 10 subjects were in the experimental group receiving additional dialectical behavior therapy skills training. Data collection was conducted from July 17, 2017 to September 4, 2017, once a week for a total of 8 sessions. The collected data were analyzed by Mann-Whitney U test, Friedman and repeated measure ANOVA.Findings: The results showed that there was a significant effect on the viewpoint and interaction of the experimental group and the control group on depression, and the abstinence self-efficacy showed a significant difference in the pre-post-follow up period.Improvements/Applications: It is expected that this program will continue to be used in education for the treatment and rehabilitation of patients with alcohol use disorders.