Dialectical Behavior Therapy Research Articles

Modified dialectical behavior therapy–informed transdiagnostic intervention for emotional disorders: protocol for a randomized controlled trial

BackgroundAnxiety and depressive disorders, characterized by high incidence and functional impairments, are emotional disorders with shared etiological and maintenance mechanisms. Dialectical behavior therapy (DBT) is a promising approach for the transdiagnostic treatment of emotional disorders. Developing a brief DBT intervention can facilitate the adoption of evidence-based therapy.MethodsThis protocol is for a 3-year single-blinded, two-arm randomized controlled trial. Individuals with depressive or anxiety disorder will be randomly allocated to a modified DBT–informed transdiagnostic psychotherapy group or a treatment-as-usual group. The intervention group will receive DBT individual therapy for 15 weeks. Power analyses revealed that the cohort should include a minimum of 250 participants. Preintervention, postintervention, and follow-up (after 3 months) assessments will be conducted. Primary outcomes will be severities of depression and anxiety rated by blind assessors. Intent-to-treat and per-protocol analyses will be conducted using the hierarchical linear model. Effect sizes will be estimated using Cohen’s d.ResultTo the best of our knowledge, the proposed study will be the first randomized controlled trial to evaluate the efficacy of a modified DBT intervention in managing transdiagnostic emotional disorders in Chinese individuals.ConclusionThis intervention is expected to improve clinical outcomes, daily functioning, and quality of life. The trial will enrich the empirical evidence for transdiagnostic interventions, facilitating the implementation of evidence-based therapy and reducing the high prevalence and challenges (e.g., disability) of emotional disorders in the Chinese population.Trial registration numberNCT05989451

Prefrontal cortex engagement during an fMRI task of emotion regulation as a potential predictor of treatment response in borderline personality disorder.

Borderline personality disorder (BPD) is a severe mental illness, with high rates of co-morbid depression and suicidality. Despite the importance of optimizing treatment in BPD, little is known about how neural processes relate to individual treatment response. This study examines how baseline regional brain blood oxygen level dependent (BOLD) activation during a functional magnetic resonance imaging (fMRI) task of emotion regulation is related to treatment response following a six-month randomized clinical trial of Dialectical Behavior Therapy (DBT) or Selective Serotonin Reuptake Inhibitor (SSRI) treatment. Unmedicated females with BPD (N = 37), with recent suicidal behavior or self-injury, underwent an fMRI task in which negative personal memories were presented and they were asked to distance (i.e., downregulate their emotional response) or immerse (i.e., experience emotions freely). Patients were then randomized to DBT (N = 16) or SSRI (N = 21) treatment, with baseline and post-treatment depression and BPD severity assessed. BOLD activity in prefrontal cortex, anterior cingulate, and insula was associated with distancing. Baseline BOLD during distancing in dorsolateral, ventrolateral, and orbital prefrontal cortex (dlPFC, vlPFC, OFC) differentially predicted depression response across treatment groups, with higher activity predicting better response in the SSRI group, and lower activity predicting better response in the DBT group. All female samples. Findings indicate that greater prefrontal engagement during emotion regulation may predict more antidepressant benefit from SSRIs, whereas lower engagement may predict better response to DBT. These results suggest different mechanisms of action for SSRI and DBT treatment, and this may allow fMRI to guide individualized treatment selection.

Applications and efficacy of radically open dialectical behavior therapy (RO DBT): A systematic review of the literature.

Radically open dialectical behaviour therapy (RO DBT) is a transdiagnostic treatment, originally developed as a variant of dialectical behaviour therapy (DBT), that emerged as a novel treatment approach for those presenting with excessive or maladaptive overcontrol. Despite RO DBT's growing popularity among clinicians as a treatment for chronic depression, personality disorders and eating disorders, to date, no systematic review has been conducted to summarise the evidence on this therapy. Therefore, the aim of this study was to systematically review the literature to provide a current and comprehensive summary of the available evidence on the clinical applications and efficacy of RO DBT. Articles were included if they were original research studies that described the use of RO DBT in the treatment of any psychological disorder, condition or symptom, published in the English language in a peer-reviewed journal. Four electronic databases were searched, and screening, selection, risk of bias assessment and data extraction were all conducted by two independent reviewers. Fourteen articles were included in this review, including two qualitative articles, one case study, five case series studies, four quasi-experimental studies, and two articles describing one randomized control trial. Findings indicated there is emerging evidence for the use of RO DBT in both adolescents and adults, for disorders characterized by excessive self-control, such as anorexia nervosa and autism, as well as for treatment-resistant depression. While RO DBT shows promise as a treatment for disorders of overcontrol, further research is needed. This review outlines current gaps and identifies areas for future research.

"All the horrible emotions have passed, I still remained, and I was safe": A qualitative study of Lesbian and Gay people's lived experience of completing a full Dialectical Behaviour Therapy programme.

Lesbian and Gay people (LGP) experience higher rates of mental health difficulties, including self-harm, suicidal behaviours, as well as inequalities in health care, than their heterosexual peers. Dialectical Behaviour Therapy (DBT) is an evidence-based treatment for self-harm and suicidal behaviours, though there is little research on LGP's experiences of DBT. This research aims to explore LGP's experiences of completing a full DBT programme. A qualitative design with semi-structured individual interviews was utilised. The results were analysed using Interpretative Phenomenological Analysis. Six lesbian and two gay adults, aged between 22 and 47 years, living in the United Kingdom took part. All participants had completed a full programme of DBT within the 2 years prior to the interview. Four superordinate themes emerged from the data: (1) The DBT journey; (2) Connections and Sense of Community during DBT; (3) Sexuality both visible and invisible in DBT and (4) A Gender, Sexuality and Relationship Diverse (GSRD) affirmative future for DBT. Several clinical implications are suggested to improve DBT for LGP, for example to consider having other LGP within DBT groups, to create a more GSRD-affirming DBT (changes to the DBT manual, DBT therapists, DBT programme and physical DBT space), to adapt DBT techniques to manage sexuality-related difficulties and to adopt a GSRD-centric framework. Overall, DBT appears to be beneficial for LGP.

The Intersection of Anorexia Nervosa and Personality Disorders: A Comprehensive Review of Comorbidities, Influencing Factors, and Therapeutic Approaches

Complex eating disorders like anorexia nervosa (AN) and personality disorders (PDs), including obsessive-compulsive personality disorder (OCPD) and borderline personality disorder (BPD), often co-occur. The confluence of PDs and AN poses distinct difficulties in terms of diagnosis, prognosis, and therapy, complicating clinical management and producing less favorable results. To summarize the most recent findings on the co-occurrence of anorexia nervosa and personality disorders, this review will look at their prevalence, psychopathological relationships, effects on treatment results, and efficacy of different therapy modalities, with a thorough search conducted, concentrating on research published between 2000 and 2024, utilizing peer-reviewed publications from PubMed, PsycINFO, and Proquest. Past literature presents a substantial overlap between PDs and AN, and concomitant PDs have been linked to recurrence rates, treatment resistance, and more severe types of AN. The psychopathological relationships among these illnesses are complex, encompassing both common and unique etiological paths. Depending on the PD implicated, various therapy modalities, such as dialectical behavior therapy (DBT) and cognitive behavioral therapy (CBT), have been investigated with varying degrees of success. This review emphasizes the need for more specialized, integrated treatment approaches targeting AN and concomitant PDs and appeals that future research should concentrate on creating tailored therapies and early detection techniques to enhance therapeutic results. The results emphasize the importance of considering personality pathology while managing AN to improve treatment efficacy and promote long-term recovery.

Early remission of deliberate self-harm predicts emotion regulation capacity in adulthood: 12.4 years follow-up of a randomized controlled trial of adolescents with repeated self-harm and borderline features

AbstractEmotion regulation capacity, critical for adult functioning and mental health, develops strongly during adolescence in healthy individuals. Deficits in emotion regulation is often referred to as emotion dysregulation [ED] and is associated with various mental health problems, including repeated deliberate self-harm [DSH] which peaks in adolescence. Dialectical Behaviour Therapy for adolescents [DBT-A] systematically targets ED through strategies such as changing coping behaviours and has previously been shown to effectively induce DSH remission in adolescents. However, whether such remission is associated with improved emotion regulation capacity in adulthood, and whether this effect is mediated by changes in use of coping strategies has not been previously studied. Prospective long-term follow-up study of an RCT comparing DBT-A with enhanced usual care [EUC] for adolescents presenting to community child and adolescent psychiatric outpatient clinics with borderline personality features and repeated self-harm. Assessments included both structured interviews and self-report at baseline and 1.6, 3.1 and 12.4 years follow-up. In the final follow-up, adult ED was measured and data were collected for 61 (80%) of the original 77 participants. DSH remission was assessed at 1.6 years follow-up, and use of coping strategies at 3.1 and 12.4 years follow-ups. A mediation analysis was conducted within a causal inference framework. Both treatment groups increased their use of functional coping skills from adolescence to adulthood, while only DBT-A was associated with decreases in dysfunctional coping. There was a direct effect of DSH remission 1 year after treatment on adult ED, particularly for participants who did not receive DBT-A. There was a negative association between reductions in dysfunctional coping and adult ED, however this did not mediate the effect of DSH remission. This is the first study to report that early DSH remission in adolescence predicted lower ED in adulthood. These results highlight the importance of early DSH remission and provides new insight into the long-term relationship between DSH and ED. Clinical trial registration information: “Treatment for Adolescents with Deliberate Self-harm”; http://ClinicalTrials.gov/;NCT00675129

A thematic analysis of the subjective experiences of mothers with borderline personality disorder who completed Mother-Infant Dialectical Behaviour Therapy: a 3-year follow-up

BackgroundPerinatal borderline personality disorder (BPD) is a common condition in perinatal mental health settings with few specialised treatment options, and little is known about the enduring effects of available treatment programs. This study explored the follow-up experiences of women with BPD after completing Mother-Infant Dialectical Behaviour Therapy (MI-DBT).MethodsSemi-structured interviews were conducted with eight women who had completed MI-DBT 3 years prior. Reflexive Thematic Analysis was used to analyse the interviews to gain a richer understanding of these mothers’ lived experience.ResultsA thematic analysis generated four main themes which indicated that participants found that MI-DBT improved their ability to hold their child in mind, be aware of their own internal state and behaviours, manage their own emotional reactions and stay calm, and manage interpersonal interactions within adult relationships. Mothers with perinatal borderline personality disorder also highlighted the need for ongoing support in the context of parenting.ConclusionsThis study is the first of its kind to explore the longer-term experiences of mothers following such an intervention, giving voice to this vulnerable group of women. The findings of this study provide a greater understanding of the complex challenges experienced as part of parenting for mothers with borderline personality disorder, and provides both insight into mothers’ experiences of life after MI-DBT and the impact of the program on their lives. The clinical and research implications of the study’s findings are discussed.Trial registrationThis research was retrospectively registered on 07/03/2024, ACTRN12624000225516.

Online dialectical behavior therapy for binge eating disorder: an open trial.

The purpose of the present study was to examine the efficacy of online Dialectical Behavior Therapy for Binge Eating Disorder (DBT-BED) in reducing eating psychopathology and investigate the factors that influence the severity and frequency of binge eating. Seventy-three individuals seeking treatment for BED participated in 20 two-hour group sessions. Participants completed the Emotional Eating Scale (EES), Binge Eating Scale (BES), and Eating Disorder Examination Questionnaire (EDE-Q) before and after the treatment and at three- and six-month follow-ups. Results from 58 participants were analyzed. The study results indicated a significant decrease in objective binge eating (OBE) days, as well as in all EES, BES, and EDE-Q subscales (except the Restraint subscale), and global EDE-Q score at the end of treatment and follow-ups. Moreover, the Body Mass Index (BMI) reduced at the end of treatment and during the follow-up period. Except for the Restraint subscale, more OBE days were linked with higher EES, BES, and EDE-Q scores. Overall, the study suggests that online DBT-BED is an effective approach to treating Binge Eating Disorder (BED) for individuals who cannot receive in-person therapy. Further research is necessary to compare the efficacy of online DBT-BED with other interventions.

The Dialectical Difference: Evaluation of a Modified-Dialectical Behavior Therapy Group for Incarcerated Women in South Australia

Women in custody commonly report high rates of trauma, increased contact with mental health services, and have a significant history of mental illness. Over a 2-year period, we ran seven groups using a modified Dialectical Behavior Therapy (DBT) program at the Adelaide Women’s Prison, South Australia. Participants completed pre- and post-group measures to explore their DBT skills use, coping behaviors, and depression, anxiety and stress symptoms. We also completed post-group interviews. Quantitative and qualitative findings support the use of this modified DBT program to improve women’s coping skills, emotion regulation, mental health symptoms and self-reported behavior whilst in custody.

Assessing the implementation of suicide-focused treatments delivered in hybrid telemental health format in a real-world setting

Objective The purpose of this study was to assess the implementation of suicide-focused treatments delivered via a hybrid telemental health (TMH) and in-person format. Method This study was conducted at four university counseling centers (UCCs) across the United States. Treatment-seeking clients were recruited from their local UCCs and participated in adaptive treatment strategies (ATSs) involving Treatment as Usual (TAU), Collaborative Assessment and Management of Suicidality (CAMS), and Dialectical Behavior Therapy (DBT). Implementation outcomes, including appropriateness, acceptability, feasibility, fidelity, safety, and client satisfaction, were assessed. UCC clinicians participated in qualitative interviews focused on implementation of TMH for clients presenting with suicidal ideation (SI). Results Overall, treatments delivered via hybrid format were reported to be appropriate, acceptable, feasible, and satisfactory by clinicians and clients. Implementation of TMH was reported to be equivalent to in-person treatment across multiple measurement methods. Conclusion Results from this study demonstrate that TMH is an implementable treatment modality for addressing suicidality, particularly for college students presenting to UCCs with SI. This study has implications for real-world clinical settings planning to offer hybrid treatment modalities to address SI. Trial registration: ClinicalTrials.gov identifier: NCT04728815.

62 Outcomes from a randomized controlled trial of a brief virtual group intervention for adolescents with mild to moderate suicidal ideation and their caregivers: The BRAVA study

Abstract Background Building Resilience and Attachment in Vulnerable Adolescents (BRAVA) is a brief virtual group intervention designed for adolescents with mild to moderate suicidal ideation (SI) and their caregivers. The goal of BRAVA is to reduce SI in adolescents and increase family connection. The intervention consists of six independent, 90 minute modules that are delivered in a group setting on a weekly basis. Independent modules allow for rolling admission thereby reducing wait time to start the intervention. The modules include components of Dialectical Behaviour Therapy. Attachment Based Family Therapy, Cognitive Behavioral Therapy, Collaborative Problem Solving and psychoeducation. Adolescents and their parents attend separate groups. Adolescents focus on emotional regulation, coping skills, managing crisis situations and caregivers focus on connecting with their teen, validation and crisis management Objectives This randomized controlled trial (RCT) assessed the efficacy of BRAVA in reducing symptoms of SI, depression and anxiety in adolescents, and improving life stress and competency in caregivers. Design/Methods Ninety-nine eligible youth (13-17.5 years) presenting with mild to moderate SI (rated 1 on the suicide item of HEADS-ED MH screening tool) and their caregivers were recruited from hospital and community services. Families were randomized to BRAVA (n=50) or the control group (n=49). The control group intervention consisted of weekly text messages and the opportunity to join the BRAVA group post-exit assessment). Outcome measures were administered at intake and exit for adolescents (Suicidal Ideation Questionnaire-Junior, SIQ-JR; Revised Children’s Anxiety and Depression Scale, RCADS) and caregivers (Perceived Stress Scale, PSS; Parent Sense of Competency Scale, PSOC). Outcomes were analyzed using repeated measures of multivariable analysis of variance (MANOVA). Results Preliminary analyses showed no significant differences between groups at intake for any demographic or clinical variables. Most adolescents and caregivers completed their exit assessment (nBRAVA=37; nControl=39). Adolescents and caregivers attended a median of six and five groups, respectively. Comparing to the control group, BRAVA was superior in reducing SI (p = 0.05) and depression (p = 0.005) in adolescents and caregiver life stress (p = 0.026). Preliminary MANOVA of adolescent outcomes were significant for time [p <0.01, Effect size (ES) = 0.98] and between groups (p = 0.03, ES = 0.11). Caregiver outcomes were significant for time (p=0.051, ES=0.70). Conclusion This study demonstrates that a brief virtual group intervention can have a significant impact on adolescent SI and depression compared to an enhanced treatment as usual control group. In addition, BRAVA can reduce caregiver perceived stress, helping them view their lives as less unpredictable, uncontrollable and overloaded.

Family Systems Dialectical Behavioral Therapy: A Proposed Clinical Synthesis

Dialectical behavioral therapy (DBT) has been well documented as an effective treatment for individuals with intense emotions. A comprehensive family model that addresses family systems utilizing DBT has yet to be developed. This article presents a model for DBT for a family system that goes beyond serving the individual and utilizing the family system for support. The theoretical concepts of DBT named “family systems (FS)DBT” are reviewed. The author reviews the current literature of DBT, how (FS)DBT addresses the dialectic of acceptance and change, how the complex model of individualized therapy such as DBT could be systematically applied to a complex and changing family system through psychoeducation, and the remaining phases of (FS)DBT. This proposed comprehensive model for doing (FS)DBT will have significant implications for clinicians working directly with complex FS that have multiple family members with intense emotions.

Treatment as a moderator and executive function as a mediator of the effect of a mindfulness ecological momentary intervention for generalized anxiety disorder.

Theory and research indicated that executive functioning (EF) correlated with, preceded, and stemmed from worry in generalized anxiety disorder (GAD). The present secondary analysis (Zainal & Newman, 2023b) thus determined whether EF domains mediated the effect of a 14-day (5 prompts/day) mindfulness ecological momentary intervention (MEMI) against a self-monitoring control (SM) for GAD. Participants (N = 110) diagnosed with GAD completed self-reported (Attentional Control Scale, GAD Questionnaire, Perseverative Cognitions Questionnaire) and performance-based tests (Letter-Number Sequencing, Stroop, Trail Making Test-B, Verbal Fluency) at baseline, post-treatment, and one-month follow-up (1MFU). Causal mediation analyses determined if pre-post changes in EF domains preceded and mediated the effect of MEMI against SM on pre-1MFU changes in GAD severity and trait repetitive negative thinking (RNT). MEMI was more efficacious than SM in improving pre-post inhibition (β = -2.075, 95% [-3.388, -0.762], p = .002), working memory (β = 0.512, 95% [0.012, 1.011], p = .045), and set-shifting (β = -2.916, 95% [-5.142, -0.691], p = .010) but not verbal fluency and attentional control. Within groups, MEMI but not SM produced improvements in all examined pre-post EF outcomes except attentional control. Only pre-post improvements in inhibition mediated the effect of MEMI against SM on pre-1MFU reductions in GAD severity (β = -0.605, 95% [-1.357, -0.044], p = .030; proportion mediated = 7.1%) and trait RNT (β = -0.024, 95% [-0.054, -0.001], p = .040; proportion mediated = 7.4%). These patterns remained after conducting sensitivity analyses with non-linear mediator-outcome relations. Optimizing MEMI for GAD might entail specifically boosting inhibition plausibly by augmenting it with dialectical behavioral therapy, encouraging high-intensity physical exercises, and targeting negative emotional contrast avoidance.

Dialectical Behavior Therapy for Adolescents: Examining Preliminary Pretreatment Expectations and Preferences.

Dialectical behavior therapy for adolescents (DBT-A) is an evidence-based treatment for adolescents with multiple emotional and behavioral problems. Research has demonstrated the posttreatment acceptability of DBT-A by parents and adolescents. However, no study has systematically explored the expectations and preferences of adolescents before beginning DBT-A treatment. The goals of this study were to investigate adolescents' pretreatment expectations for DBT-A by developing the Adolescent Expectancies for Therapy Scale (AETS), adapted from the Parent Expectancies for Therapy Scale, and to explore their preferences regarding treatment delivery format. Participants were 21 adolescents (ages 13-18) with varying race-ethnicities who were referred for DBT-A in either a group private practice or a community mental health clinic. Participants completed the AETS and the Preferences Rating Form, which examined the extent to which participants preferred each of seven treatment modifications or preferred to keep DBT-A as is. Findings indicated that, before beginning DBT-A, adolescents had moderate expectations for the outcome and process of the therapy, and approximately half reported that they preferred to be separate from their parents during multifamily skills group sessions (for at least part of the time) and to add weekly teen-only support groups to DBT-A. The AETS had adequate internal consistency (Cronbach's α=0.88). Understanding adolescents' pretreatment expectations and preferences for the format in which DBT-A is delivered can help clinicians better engage adolescents during the intake and orientation process.

Sertraline medications plus dialectical behavior therapy for depressed adolescents with nonsuicidal self-injury behaviors.

The study aims to investigate the efficacy of sertraline medication plus dialectical behavior therapy (DBT) in reducing nonsuicidal self-injury (NSSI) behavior and depression among adolescents. Participants were 100 adolescents with depression and NSSI behaviors, 50 of whom received sertraline medication plus DBT and 50 of whom received sertraline medication plus cognitive behavioral therapy (CBT) for 12 weeks. During 6 months post intervention, 26 (57.8%) participants did not report having engaged in any form of NSSI in the sertraline + DBT group and 15 (32.6%) in the sertraline + CBT group, showing significant difference. The sertraline + DBT group and the sertraline + CBT group exhibited significant difference regarding the proportions of cutting skin and biting self. The scores of anxiety, depression, aggression against self in four modified overt aggression scale categories, and Personal and Social Performance were notably lower in the sertraline + DBT group than those in the sertraline + CBT group at 6 months post intervention. Sertraline medication plus DBT could decrease NSSI episodes and improve symptoms of anxiety and depression for adolescents, and these changes were comparable to those of CBT. More importantly, DBT was demonstrated better clinical improvements at 6-month follow-up.

Experimental Testing of a Short Model of Integrative Psychotherapeutic Intervention to Reduce Suicidal Behavior and Ideation in Depressed Patients Admitted to the Psychiatric Ward

<p>This study investigates the efficacy of a short-term integrative psychotherapeutic intervention designed to reduce suicidal behavior and ideation in depressed patients admitted to a psychiatric ward. Suicidal risk, influenced by mental health disorders, personal crises, social isolation, substance abuse, and trauma, is typically treated with pharmacotherapy and psychotherapy. The study focuses on combining various psychotherapeutic techniques including Cognitive-Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Mindfulness-Based Cognitive Therapy (MBCT) into a cohesive intervention program.</p><p>The intervention, delivered over four weeks, included six modules encompassing psychoeducation, behavioral activation, cognitive restructuring, mindfulness practices, and personal development strategies. Participants were divided into an experimental group receiving both the psychotherapeutic intervention and medication and a control group receiving only medication.</p><p>The study measured changes in hopelessness and depression using the Beck Hopelessness Scale (BHS), Montgomery-Åsberg Depression Rating Scale (MADRS), and the DASS-21R depression scale. The study concludes that integrative psychotherapeutic intervention significantly improves psychological outcomes for depressed patients at risk of suicide, offering a viable complement to pharmacological treatments. These findings support the potential of combining cognitive-behavioral and mindfulness techniques for the holistic management of depression and suicidal ideation in clinical settings.</p>Results indicated significant reductions in hopelessness and depression among the experimental group. Specifically, the BHS and MADRS scores showed substantial decreases post-intervention, highlighting the immediate efficacy of the integrated psychotherapeutic approach. However, the DASS-21R results did not demonstrate statistically significant differences.

Using Biosensor Devices and Ecological Momentary Assessment to Measure Emotion Regulation Processes: Pilot Observational Study With Dialectical Behavior Therapy.

Novel technologies, such as ecological momentary assessment (EMA) and wearable biosensor wristwatches, are increasingly being used to assess outcomes and mechanisms of change in psychological treatments. However, there is still a dearth of information on the feasibility and acceptability of these technologies and whether they can be reliably used to measure variables of interest. Our objectives were to assess the feasibility and acceptability of incorporating these technologies into dialectical behavior therapy and conduct a pilot evaluation of whether these technologies can be used to assess emotion regulation processes and associated problems over the course of treatment. A total of 20 adults with borderline personality disorder were enrolled in a 6-month course of dialectical behavior therapy. For 1 week out of every treatment month, participants were asked to complete EMA 6 times a day and to wear a biosensor watch. Each EMA assessment included measures of several negative affect and suicidal thinking, among other items. We used multilevel correlations to assess the contemporaneous association between electrodermal activity and 11 negative emotional states reported via EMA. A multilevel regression was conducted in which changes in composite ratings of suicidal thinking were regressed onto changes in negative affect. On average, participants completed 54.39% (SD 33.1%) of all EMA (range 4.7%-92.4%). They also wore the device for an average of 9.52 (SD 6.47) hours per day and for 92.6% of all days. Importantly, no associations were found between emotional state and electrodermal activity, whether examining a composite of all high-arousal negative emotions or individual emotional states (within-person r ranged from -0.026 to -0.109). Smaller changes in negative affect composite scores were associated with greater suicidal thinking ratings at the subsequent timepoint, beyond the effect of suicidal thinking at the initial timepoint. Results indicated moderate overall compliance with EMA and wearing the watch; however, there was no concurrence between EMA and wristwatch data on emotions. This pilot study raises questions about the reliability and validity of these technologies incorporated into treatment studies to evaluate emotion regulation mechanisms.

A Suicide Attempt Multicomponent Intervention Treatment (SAMIT Program): study protocol for a multicentric randomised controlled trial.

Suicide has become a first-order public health concern, especially following the negative impact of COVID-19 on the mental health of the general population. Few studies have analysed the effects of early psychotherapeutic interventions on subjects who have attempted suicide, and even fewer have focused on those hospitalized in non-psychiatric units after a Medically Serious Suicide Attempt (MSSA). The main aim of this study is to describe the protocol designed to evaluate the effectiveness of individual psychological treatment for patients hospitalized after an MSSA. The secondary objectives of the study are: (1) to evaluate the impact on quality of life and other psychosocial variables of patients with a recent MSSA who receive early psychological intervention; (2) to analyse the biological, psychological, and clinical impact of early psychotherapeutic treatment on subjects hospitalized after an MSSA. A longitudinal randomised controlled trial will be conducted with patients over 16 years of age admitted to two general hospitals. The case intervention group will enrol for 8-sessions of individual psychotherapy, Suicide Attempts Multi-component Intervention Treatment (SAMIT), combining Dialectical Behaviour Therapy (DBT), Mentalization-Based Therapy (MBT), and Narrative approaches, while the control group will receive a treatment-as-usual intervention (TAU). Longitudinal assessment will be conducted at baseline (before treatment), post-treatment, and 3, 6, and 12 months after. The main outcome variable will be re-attempting suicide during follow-up. Some psychotherapeutic interventions, usually implemented in outpatient, have proven to be effective in preventing suicidal behaviours. The combination of some of these may be a powerful treatment for preventing future SA in patients hospitalised after an MSSA, which is the most severely suicidal subgroup. Moreover, assessment of the biological, clinical and psychometric impact of this new intervention on patients during the first year after the attempt may help understand some of the multi-level factors associated with the effectiveness of psychotherapeutic interventions in MSSAs. The prevalence of high suicide rates requires the design of effective psychological interventions for their prevention, and also in order to design new pharmacological and psychological treatments. ClinicalTrials.gov ID: NCT06238414. Date of registration: 1st February 2024, final update is protocol version 3.0, 19th March 2024.

Emptiness and negative affect changes related to binge eating and borderline personality traits.

Borderline personality disorder (BPD) is characterized by unstable self-image, conflictual interpersonal relationships, emotional dysregulation, and marked impulsivity. One form of impulsivity commonly seen in BPD is binge eating; however, little is known about this maladaptive behavior in the context of BPD. In the eating disorder (ED) literature, multiple theories suggest binge eating occurs as a result of heightened levels of negative affect. Given that BPD and EDs share emotional dysregulation and impulsivity as maintaining mechanisms of each respective disorder, these theories of binge eating may provide a model for binge eating in BPD. Existing literature suggests feelings of emotional emptiness may precede binge episodes in those with EDs. The current study sought to explore feelings of emptiness as antecedents to binge eating behaviors in those with BPD traits. Using ecological momentary assessment, binge episodes, affect, and feelings of emptiness were tracked throughout the day for 14 days in undergraduate students with BPD traits (n = 55). The current study found momentary feelings of emptiness at the time of the binge eating episode significantly predicted increased odds of a binge episode occurring. Additionally, momentary feelings of emptiness, as well as other negative affects, increase following a binge episode. Results suggest treatment of binge eating within BPD should include elements of acceptance of negative affects including emptiness, such as in dialectical behavior therapy distress tolerance skills training. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Suicidal Ideation as a Maladaptive Emotion Regulation Strategy: Implications for Treatment in Dialectical Behavior Therapy

Dialectical behavior therapy (DBT) is a leading psychotherapy for the reduction of suicidal and self-injurious behaviors (SIBs). However, evidence shows that DBT may be comparably less effective at reducing suicidal ideation (SI) than SIBs. Improving the effectiveness of DBT for SI is critical, given that SI poses risk for SIBs and presents a substantial clinical burden. In the following theoretical paper, we first review evidence surrounding the effectiveness of DBT for SI reduction and explore why DBT may be comparably less effective at reducing SI than SIBs. We argue that DBT’s effectiveness for treating SI may be enhanced by a functional understanding of SI as a maladaptive form of affect regulation, as put forth by recent empirical research. Finally, we discuss implications of this model for treatment in DBT and provide clinical recommendations for how to target SI more effectively using DBT’s existing repertoire for behavior change.