Dialectical Behavior Therapy Group Skills Research Articles

Adapting a Dialectical Behavior Therapy Skills Group Within a Jail Setting: Implementation Challenges and Considerations

Over 12 million admissions into local jails are logged each year, for charges ranging from misdemeanor traffic violations to felony homicide. Compared to people incarcerated in prisons, those held in jails face quicker community reentry, elevated reincarceration rates, overcrowding, and few opportunities to participate in programming. People caught in this cycle often experience many contextual and personal barriers, which include difficulty regulating their emotions, refraining from aggressive and impulsive behaviors, and communicating effectively. Dialectical Behavior Therapy (DBT) has been put forth as a promising evidence-based approach that is particularly well-suited to address the risks and needs of jail populations. By helping incarcerated individuals balance the “dialectic” between acceptance of the present (e.g., coping with current incarceration) and preparation for future change (e.g., planning for community reentry), DBT can help individuals gain coping skills that are directly related to preventing reoffending. This paper describes our research team’s adaptation of a DBT skills group in a jail setting, feasibility and attrition data, and challenges and lessons learned. We highlight the value of adapting treatments in underserved settings, working closely with community partners to align goals and overcome logistical challenges, and ensuring flexibility of implementation. We believe that our experiences can provide practical insights and recommendations for both scholars and practitioners within the field.

BI-REAL: A 12-session DBT skills group intervention adapted for bipolar disorder – A feasibility randomised pilot trial

International guidelines endorse psychological treatment for Bipolar Disorder (BD); however, the absence of a recognised gold-standard intervention requires further research. A Dialectical Behaviour Therapy (DBT) skills group intervention with 12 sessions was developed. This pilot randomised controlled trial (RCT) aims to evaluate the feasibility, acceptability, and outcomes variance of Bi-REAL – Respond Effectively, Assertively, and Live mindfully, tailored for individuals with BD, in preparation for a future RCT. Methods52 participants (female = 62.7 %; mean age = 43.2 ± 11.1) with BD were randomised by blocks to either the experimental group (EG; n = 26; Bi-REAL + Treatment as Usual, TAU) receiving 12 weekly 90-minutes sessions, or the control group (CG; n = 26, TAU). Feasibility and acceptability were assessed with a multimethod approach (qualitative interviews, semi-structured clinical interviews and a battery of self-report questionnaires – candidate main outcomes Bipolar Recovery Questionnaire (BRQ) and brief Quality of Life for Bipolar Disorder (QoL.BD)). All participants were evaluated at baseline (T0), post-intervention (T1) and 3-month follow-up (T2). ResultsAcceptability was supported by participants' positive feedback and ratings of the sessions and programme overall, as well as the treatment attendance (86.25 % of sessions attended). The trial overall retention rate was 74.5 %, with CG having a higher dropout rate across the 3-timepoints (42.31 %). A significant Time × Group interaction effect was found for BRQ and QoL.BD favouring the intervention group (p < .05). LimitationsThe assessors were not blind at T1 (only at T2). Recruitment plan was impacted due to COVID-19 restrictions and replication is questionable. High attrition rates in the CG. ConclusionsThe acceptability of Bi-REAL was sustained, and subsequent feasibility testing will be necessary to establish whether the retention rates of the overall trial improve and if feasibility is confirmed, before progressing to a definitive trial.

Preliminary Feasibility, Acceptability and Referral Efficacy of a Drop-In Dialectical Behavior Therapy (DBT) Skills Group to Promote Enrollment in Standard DBT Skills Group

Pretreatment interventions have been shown to increase treatment readiness, initiation, and participation in evidence-based treatments. To promote enrollment in an evidence-based Dialectical Behavior Therapy Skills Group (DBT; Linehan, 2015; Linehan et al., 2015), we developed a pretreatment Drop-In DBT Skills Group and evaluated the group’s feasibility, acceptability, and referral efficacy. Each session included a mindfulness practice and one of four introductory DBT skills. We assessed the Drop-In DBT Skill Group’s feasibility (clients attending ≥1 session), acceptability (clients attending ≥2 sessions), and referral efficacy (clients who sought referrals to the standard DBT Skills Group). In 8 months, 44 clients were referred to the Drop-In DBT Skills Group; 37 clients completed the screening process (84%). Of the 37 clients who responded to outreach, 32 attended ≥1 group or had already started the DBT Skills Group (86.5%; feasibility). Of the 32 clients who attended at least one group, 29 clients attended ≥2 Drop-In DBT Skills Groups or started the DBT Sills Group (90.6%; acceptability). Ultimately, 17 clients, including 13 DBT-ambivalent clients and 4 waitlisted clients, requested a referral to the standard DBT Skills Group. The Drop-In DBT Skills Group shows strong feasibility, acceptability, and referral efficacy in helping more ambivalent clients enroll in DBT Skills Group.

Can dialectical behavior therapy skills group treat social anxiety disorder? A brief integrative review.

The purposes of this brief integrative review are to identify and critically evaluate recent work in the area of Dialectical Behavior Therapy-Skills Group (DBT-SG) for Social Anxiety Disorder (SAD) with suicidal ideation (SI) and to suggest further how DBT-based skills may be applied to cognitive maintenance factors of SAD. Accordingly, we first evaluate the relevance of DBT in treating SI in other disorders. Second, we evaluate the relationship between SI and SAD, providing considerations for the complexity of comorbid disorders and presentations. Finally, we extend this knowledge to discuss considerations for the use of DBT-SG skills to target specific etiological and maintenance elements of SAD, with a focus on four themes (interpersonal effectiveness, mindfulness, emotion regulation, and distress tolerance). Overall, we conclude that DBT-SG may prove beneficial in reducing SI and symptoms in SAD that impact social and emotional functioning.

변증법적 행동치료 집단기술훈련이 대학운동선수의 정서조절과 대인관계 유능성에 미치는 효과

This study aims to conduct a group program that reconstructs the group skills training of dialectical behavior therapy to solve emotional dysregulation and interpersonal conflicts in college athletes and verify its effectiveness. To this end, 16 voluntary participants from among the sports journalists who are currently active as college athletes in taekwondo were wirelessly placed in an experimental group and a control group, and dialectical behavior therapy group skills training was conducted for ten sessions. The study design was operated as a quasi-experimental design of pre-post-test conduct, and the data were analyzed using a nonparametric test method. As a result of the study, it was confirmed that dialectical behavior therapy group skills training had a significant effect on improving emotional regulation and interpersonal competence.

변증법적 행동치료 집단기술훈련이 대학운동선수의 정서조절과 대인관계 유능성에 미치는 효과

This study aims to conduct a group program that reconstructs the group skills training of dialectical behavior therapy to solve emotional dysregulation and interpersonal conflicts in college athletes and verify its effectiveness. To this end, 16 voluntary participants from among the sports journalists who are currently active as college athletes in taekwondo were wirelessly placed in an experimental group and a control group, and dialectical behavior therapy group skills training was conducted for ten sessions. The study design was operated as a quasi-experimental design of pre-post-test conduct, and the data were analyzed using a nonparametric test method. As a result of the study, it was confirmed that dialectical behavior therapy group skills training had a significant effect on improving emotional regulation and interpersonal competence.

Group brief cognitive behavioral therapy for suicide prevention compared to dialectal behavior therapy skills group for military service members: a study protocol of a randomized controlled trial

BackgroundSuicide is a pressing matter for the military. Not only does it pose a health risk, but suicide also compromises operational readiness. Despite provision of suicide prevention clinical best practices, the Department of Defense suffers several challenges (e.g., clinician shortages) limiting the agency’s ability to effectively respond to service member suicide. Implementation of evidence-based suicide-specific group therapy is a possible solution to service member well-being needs and system challenges. Service members can also gain coping skills useful beyond managing suicidal thoughts and behaviors.MethodsThis 2-arm non-inferiority randomized controlled trial compares a group therapy format of Brief Cognitive Behavioral Therapy (i.e., G-BCBT) with Dialectical Behavior Therapy (DBT) Skills Group. Both therapies are delivered in-person at a United States Naval Medical Center. Participants (N = 136) are active-duty service members with recent suicidal thoughts or suicidal behavior. Evaluation features electronically delivered questionnaires at baseline, after each treatment session, and at 3- and 6-month follow-up.DiscussionThe primary outcome concerns G-BCBT impacts on suicidal ideation. Secondary outcomes of interest are suicide attempt, psychological distress (e.g., symptoms of depression, anxiety), and self-regulatory skills (e.g., emotion regulation). We also examine self-regulatory skills as treatment moderators. Clinical trial strengths and limitations are reviewed.Trial registrationThis study was registered at Clinicaltrials.gov (protocol NCT05401838).

Implementation of a brief online skills group of dialectical behaviour therapy for emotional dysregulation in Latinx: a withdrawal experimental single-case design.

Dialectical behaviour therapy (DBT) skills groups have shown promise as an effective treatment for clients with emotional dysregulation, especially when combined with individual DBT. However, their efficacy is not well established as an online therapy, or in the Latinx population. This study aimed to explore satisfaction, retention and effects of an internet-based DBT group added to individual online sessions. An ABAB withdrawal experimental single-case design was conducted to evaluate the effect of a brief online DBT skills group on emotional dysregulation, anxiety and depression for five Latinx participants. DBT skills group (phase B) were compared with placebo group sessions (phase A) and fortnightly individual DBT sessions were offered throughout to manage risk. Visual inspection showed a decrease in level of emotional dysregulation and a large effect size according to the Nonoverlap of All Pairs when comparing group DBT and placebo phases. Although depression symptoms decreased after introducing group DBT, anxiety indicators decreased most during the second round of group placebo sessions. Whilst only a pilot, this study suggests that online group DBT in Latinx populations is feasible and effective for changing emotional regulation processes but may not effectively target anxiety. Future research might increase the number of DBT sessions in order to enhance learning opportunities and generalization. Replication with larger sample sizes and diverse modalities is needed.

Dialectical behaviour therapy skills training: A feasibility study with active duty military

LAY SUMMARYThis study looked at the use of dialectical behaviour therapy (DBT) skills group training with military personnel. DBT skills group training teaches coping skills to manage emotions; it has been well researched and used effectively with civilians and Veterans, but less is known about its use with military personnel. The General Mental Health (GMH) clinic receives a large volume of referrals for military personnel who have difficulty with coping skills and managing emotions. On the basis of previous research, a modified DBT skills group therapy program was developed for the clinic to offer an efficient, effective treatment program for these clients in this busy clinic. Military personnel may be a particularly good fit for this type of group-based treatment because they are familiar with working in small group settings. This treatment can also allow for a timelier return to work, minimizing interruptions to military deployments and operations. Study results showed that program participants had lower levels of depression and a greater ability to manage emotions and cope more effectively after the program. Treatment gains were largely maintained at six-month follow-up. This research suggests that DBT skills group training may be an effective treatment for military personnel.

Madde Kullanım Bozukluğu olan Hastalarda Diyalektik Davranış Terapisi Grup Becerileri Eğitimi Pilot Çalışması: Madde Kullanım Şiddeti, Duygudurum ve İlişki Becerilerindeki Değişiklikler

Objective: This pilot study aimed to investigate effects of Dialectical Behavior Therapy Group Skills Training (DBT-ST) on patients’ severity of substance use status, mood and other psychological symptoms, difficulties in emotion regulation, interpersonal problem solving skills, and social competence. Method: Nine outpatient males with substance use disorders were administered the DBT-ST for 20 weeks. Age ranged between 17 and 34. Average years of substance use was 1.61 (SD=.29). DBT-ST modules (mindfulness, emotion regulation, interpersonal skills, and distress tolerance) were administered for 20 weeks. Urine toxicology screenings, the Addiction Profile Index (API), the Symptom Check List-90-Revised (SCL-90-R), the Beck Depression Inventory (BDI), the Difficulties in Emotion Regulation Scale (DERS), the Interpersonal Problem Solving Inventory, and the Perceived Social Competence Scale were administered at pre and post-treatment. Results: There were significant decreases in the severity of substance use with decreased number of positive drug screening test results and an increase in emotion regulation; decreases in the API total score, dependency diagnosis, and the effects of substance use on the user sub-scale scores; depression, hostility, and phobic anxiety sub-scale scores on the SCL-90-R; the BDI total score; and nonacceptance, strategies, clarity and impulsivity sub-scale scores of the DERS. Conclusion: The findings indicated a 20 week DBT-ST helped participants increase their days of abstinence, regulate emotional regulation, decrease depressive and anxiety symptoms, and substance related difficulties.

Dialectical behaviour therapy 'Skills for Living' for young people leaving care: A qualitative exploration of participants' experiences.

It is acknowledged that care leavers experience an accelerated transition into adulthood, despite often having complex psychosocial needs with limited support networks. The 'Skills for Living' programme was designed to improve the psychological wellbeing of care leavers and offers an adapted Dialectical Behaviour Therapy skills group as its primary intervention. This paper provides a qualitative evaluation of the programme. Semi-structured interviews were undertaken with 10 participants, and the data were analysed using thematic analysis (Braun & Clarke, 2006). Four key themes emerged: 'Initial Apprehension and Reluctance to Participate', 'Connection, Understanding and Validation', 'Confidence with Social Skills', and 'Emotional Acceptance and Self-Soothing'. Clinical implications and recommendations are discussed.

Implementation of brief dialectical behavior therapy skills training among borderline personality disorder patients in Malaysia: feasibility, acceptability, and preliminary outcomes

Aim/backgroundEven though dialectical behavior therapy (DBT) has received substantial empirical support in treating patients with borderline personality disorder (BPD), fewer studies have evaluated whether a brief DBT skills group may be effective in improving clinical outcomes in this population. Further, less is known regarding the feasibility and outcomes of DBT beyond Euro-American contexts. This paper describes outcomes from a pilot study examining the feasibility, acceptability, and clinical outcomes following completion of a shortened, 14-week DBT skills group in a sample of Muslim-majority BPD patients in Malaysia.MethodsTwenty patients were recruited from a public hospital and attended DBT skills groups in an outpatient clinic. Participants completed measures assessing psychological symptoms, self-harm behaviors, suicidal ideation, emotion regulation difficulties, self-compassion, and well-being pre- and post-intervention.ResultsThere were significant reductions in depressive symptoms, stress, and emotion regulation difficulties, as well as increases in self-compassion and well-being from pre- to post-intervention. A trend was found for decreases in frequency and types of non-suicidal self-harm behaviors, suicidal ideation, and anxiety symptoms. Qualitative content analyses of participants’ feedback indicated that the vast majority of participants perceived a positive impact from the skills group, with mindfulness and distress tolerance being rated frequently as skills that were beneficial.ConclusionThese preliminary findings suggest that DBT skills training is feasible and acceptable in a Muslim-majority, low resource clinical setting, and holds promise in improving clinical outcomes among BPD patients in Malaysia.

Effects of a modified DBT Skills Group for military personnel and Veterans with OSIs and borderline personality disorder or traits

LAY SUMMARY This study looked at the use of a group treatment known as Dialectical Behaviour Therapy Skills Group (DBT-SG) to see if it was helpful for military personnel and Veterans who had a variety of mental health disorders related to their service. The results of the study showed improvements in symptoms of borderline personality disorder, reductions in negative thoughts and feelings, and reductions in unhelpful behaviours. Results also showed improvements in all examined areas of functioning among participants, with the largest change occurring in the area of social functioning. The presence of posttraumatic stress disorder (PTSD), depression, or chronic pain did not impact results, but the presence of a substance abuse disorder did. Overall, the results provide preliminary support for DBT-SG as an intervention for borderline personality disorder symptoms among military and Veterans, and perhaps particularly for persons who also have other mental health challenges, or persons for whom other treatment may be considered inappropriate.

Adapted dialectical behaviour therapy skills group service evaluation

Purpose The purpose of this paper is to determine the effectiveness of an adapted dialectical behaviour therapy (DBT) treatment programme for individuals with an intellectual disability, via completion of a service evaluation. Design/methodology/approach Outcome measurements were competed at pre-, post- and 12 months follow-up, and the effectiveness of the intervention was assessed using a Friedman analysis. Findings Findings demonstrated that the treatment group showed significant differences in their “psychological distress” scores, but no significant differences were found in their “psychological well-being”, “anxiety” or “quality of life” (WHO-QOL) scores over time. Originality/value Overall, the current study adds to the small but growing literature that supports using the skills training group part of DBT as a stand-alone psychological intervention when working with people with an intellectual disability.

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.

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.

Exploring Undergraduate Nursing Students' Experiences of Engaging With a Dialectical Behavior Therapy-Skills Group Intervention: Findings of a Thematic Analysis.

Nursing students often have high levels of stress leading to negative consequences for academic performance and overall well-being. Novel strategies are needed to help students manage stress. To explore students' experiences with an evidence-based intervention-Dialectical Behavior Therapy-Skills Group (DBT-SG). We conducted a mixed-methods study to pilot test a DBT-SG intervention, modified for use with undergraduate nursing students. Qualitative data collected as part of this study included focus groups and written responses on a study questionnaire. Thematic analysis of these data was undertaken to explore how students experienced the intervention. The results of this analysis are reported here. Five themes were uncovered: experiencing stress and de-stressing, feeling accepted and validated, acquiring skills, shifting perspectives, and enhanced well-being. Our findings suggest that by engaging with DBT-SG, nursing students felt accepted and validated, acquired a variety of skills to cope with stress, as well as developed new perspectives, such as the value of practicing self-care, which contributed to enhanced well-being. Future research could build on these results by further exploring how to best create accepting and validating learning environments where students are encouraged to develop interpersonal relationship skills and enact self-care to further support their well-being and professional development.

A Dialectical Behavior Therapy Skills Group in a Psychoanalytic Community Service: A Pilot Study.

This exploratory study reports on the implementation and effectiveness of a 20-week Dialectical Behavior Therapy (DBT) skills group provided to 8 outpatients (7 women, average age 33 years old) within a psychoanalytic community clinic. We report on the practical implementation of this DBT skills group, and describe how the theoretical/technical differences between DBT and psychoanalysis were negotiated by the two co-therapists. The effectiveness of the skills group was evaluated on standardized measures of borderline personality symptoms, depression, anxiety, interpersonal problems, quality of life, and mindfulness skills that patients completed before and after treatment. At post-treatment, patients evaluated the DBT skills group on a satisfaction questionnaire and therapists completed a countertransference measure. Pre-post outcome data indicated reduced symptom levels of anxiety, depression, and improved quality of life. Both therapists reported moderate therapist responses typically associated with borderline personality disorder psychopathology. Their therapist responses were not associated with symptom levels or change but were related to patient satisfaction. Accumulative pilot studies like these add to the practice-based evidence of DBT components offered within psychoanalytically-oriented community clinics. However, given the exploratory nature of this study, strong conclusions are precluded until further effectiveness research is conducted.

Decreasing stress and supporting emotional well-being among senior nursing students: A pilot test of an evidence-based intervention

BackgroundNursing students can experience stress related to their academic and practice experiences, which can have deleterious effects on physical and emotional well-being. ObjectivesTo pilot test an evidence-based intervention, Dialectical Behavior Therapy-Skills Group, designed to promote emotional well-being among nursing students. DesignA single group, pre-posttest design, mixed-method approach. SettingA large university situated in a multicultural urban setting. ParticipantsSenior undergraduate nursing students (n = 31). MethodsStudents participated in an 8-week modified Dialectical Behavior Therapy-Skills Group (DBT-SG) intervention. Quantitative and qualitative data were collected to explore the interventions' feasibility, acceptability, and students' perceptions of its applicability to practice. Students also completed standardized outcome measures of psychological distress and emotional well-being pre- and post-intervention to evaluate preliminary effectiveness. ResultsOverall feedback was positive, with participants describing how skill modules helped them establish relationships and manage stress in clinical, academic, and personal settings. Significant reductions in stress and improvements in well-being were also reported. ConclusionResults suggest that DBT-SG offers a promising approach for mitigating nursing students' stress by helping them acquire practice-relevant strengths and self-care strategies. Further research is required to examine the effectiveness of DBT-SG among other nursing student groups, as well as to explore optimal approaches to delivering this intervention in conjunction with nursing curricula.

Implementing a condensed dialectical behavior therapy skills group for binge-eating behaviors in adolescents.

Subthreshold binge-eating disorder (BED) symptoms can lead to additive physical and psychological health challenges and may put youth at risk for developing BED during the early adulthood. We examined the implementation of a condensed dialectical behavior therapy (DBT) skills intervention for subthreshold binge-eating behaviors in adolescents. Fifteen 14-18years old participated in a 10-week DBT skills group, which experientially introduced mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness skills in the context of emotionally driven overeating behaviors. Adolescents and caregivers completed measures of emotional eating and binge-eating behaviors at baseline and post-intervention, including the Eating Disorder Examination Questionnaire and Emotional Eating Scale for Children and Adolescents. Eleven participants were retained at 3-month follow-up. Descriptive statistics were compared at all three time points. Results suggested a reduction in emotional eating and binge-eating behaviors based on youth self-report and caregiver report. Acceptability ratings of the treatment were high among participants completing the intervention. Using DBT skills to target emotionally driven overeating behaviors in youth may be useful in the treatment of subthreshold BED behaviors and potentially deter future development of full-criteria BED. Level IV, uncontrolled pilot trial.