Dialectical Behavior Therapy Skills Research Articles

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.

Contextual-compassion training for borderline personality disorder with long lasting symptoms: a randomized clinical trial

Long-term follow-up studies have shown that the symptoms of borderline personality disorder (BPD) tend to remit over time. However, many patients present long lasting symptoms (LLS), including low mood, emptiness, and persistent impairment in psychosocial adjustment. Given the high rate of LLS in BPD patients, new treatment strategies are needed. We conducted a randomized clinical trial (RCT) to evaluate the efficacy of a novel intervention that combines self-compassion and contextual-based skills for patients with persistent symptoms. Sixty BPD individuals with LLS who had received dialectical behavior therapy skills training (DBT-ST) in the previous six months were recruited and randomized to receive the experimental intervention or treatment as usual (TAU) for 12 weeks. All participants were evaluated pre- and post-intervention and at 3-months follow-up. The primary outcome measure was self-reported well-being. Other clinical variables were also evaluated, including depressive symptoms, BPD symptoms, functionality, self-compassion, and self-criticism. Participants in the experimental arm showed a significant increase in indicators of well-being (e.g., happiness and quality of life) and a significant decrease in depressive symptoms. These results were sustained—and even continued to improve—at the three-month follow-up. No significant changes were observed in BPD severity, self-criticism, or self-compassion. More RCTs are needed to test the efficacy of new interventions targeting this population with persistent symptoms, not only to reduce symptoms but also to promote well-being and personal recovery.

Adlerian Play Therapy and Dialectical Behavior Therapy Skills: An Integrated Approach

ABSTRACT The prevalence of youth mental illness in the United States is on the rise, and this increases the need for effective counseling interventions for children. This article introduces the integration of Adlerian play therapy (AdPT) and dialectical behavior therapy (DBT) skills with children who struggle with emotion dysregulation. We include an overview of both theoretical approaches, justification for integration, and a case study illustrating this dual approach in session. Finally, counseling implications and suggestions for future research are discussed.

Providing LGBTQIA+ affirming mental health services in schools: A cultural adaptation of dialectical behavior therapy Skills Training for Emotional Problem Solving for Adolescents (DBT STEPS-A).

Despite growing concerns related to the youth mental health crisis and the well-being of sexual and gender minority youth, specifically, most mental health interventions fail to meet the unique needs of this population. Research and clinical guidance have recommended that approaching mental health treatments through a lens of minority stress and intersectionality can be particularly helpful in addressing the mental health concerns of LGBTQIA+ (lesbian, gay, bisexual, transgender, questioning/queer, intersex, and asexual, with the '+' capturing other identities within the gender and sexually diverse population) youth. Because many adolescents do not have access to mental health care, schools have an important role to play in meeting the mental health needs of LGBTQIA+ youth. To address these issues, we propose LGBTQIA+ affirming adaptations to the dialectical behavior therapy (DBT) Skills Training for Emotional Problem Solving for Adolescents (STEPS-A) curriculum using Pachankis et al.'s (2023) Adaptation Model to provide practitioners with a culturally affirming model of this social-emotional curriculum, while highlighting the utility of this framework in adapting other evidence-based interventions in schools. We walk readers through each module of DBT STEPS-A and provide rationale for adapting these skills for LGBTQIA+ youth. We offer specific adaptations that facilitators can make through psychoeducation and skills training. For example, we provide sample dialectics that mirror the experience of minority stress and propose examples of coping skills that are relevant for LGBTQIA+ youth (e.g., distracting and self-soothing to tolerate distress). Finally, the role of school psychologists in meeting the mental health needs of LGBTQIA+ youth is discussed along with implications for practice and future research. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Be curious, not judgmental: A DBT emotion regulation handout for changing unwanted emotions

Dialectical behavior therapy (DBT) and its adaptation for adolescents (DBT‐A) provide evidence‐based tools for individuals with chronic emotion dysregulation and their families (Linehan, 2015; Miller et al., 2007). Teens with emotion dysregulation struggle to understand, label, and accept their emotions; they are frequently unable to modulate the intensity of their emotions to match the goals of the present context. No matter how much emotionally‐dysregulated teens and their families may wish it were so, emotion regulation does not include getting rid of emotions. Why not? We need emotions for survival, as emotions serve essential functions: to motivate us for action and to communicate to ourselves and others. Rather than eliminating emotions, emotion regulation aims to help individuals understand their own emotions, decrease emotional vulnerability and suffering, and change unwanted emotions. This article presents “Check the Facts,” a DBT skill for helping individuals with emotion dysregulation effectively change unwanted emotions. We share a handout that we adapted from DBT with step‐by‐step tips based on our experience treating adolescents with chronic emotion dysregulation co‐occurring with obsessive‐compulsive disorder (OCD)/anxiety disorders.

Mapping Dialectical Behavior Therapy Skills to Clinical Domains Implicated in Contemporary Addiction Research: A Conceptual Synthesis and Promise for Precision Medicine

Recent addiction research has identified clinical domains that are central to the development and maintenance of alcohol use disorder (AUD). Yet existing psychotherapy approaches are not typically organized around these clinical domains and are often limited in scope. Dialectical behavior therapy (DBT) is an intensive, multicomponent cognitive behavioral treatment that includes individual psychotherapy, group-based skills training, phone coaching, and consultation team for DBT therapists. Despite its efficacy on various mental health conditions, access to full DBT is often a challenge. In this paper, we describe how the skills training component of DBT can be flexibly applied to target clinical domains that underlie the three stages of the addiction cycle or impair quality of life during recovery from AUD. Using three clinical case vignettes, we illustrate how DBT skills can be mapped onto addiction clinical domains (e.g., Dialectical Abstinence and Clear Mind on executive function, STOP and TIP skills on incentive salience, Check the Facts and Opposite Action on negative emotionality, and ABC PLEASE skill on quality of life). Based on this integrated framework, we offer practical recommendations for case conceptualization, stigma reduction, and implementation through multiple delivery options. Implications on precision medicine were also discussed. Together, this conceptual synthesis serves as a bridge for practitioners to learn about contemporary addiction theories and for addiction researchers to appreciate the value of DBT in substance use treatment. The promotion of DBT skills training as a standalone or adjunctive intervention may help address the significant treatment gap in alcohol and substance use behaviors.

Efficacy of Dialectical Behavioral Therapy Skills in Addressing Emotional Dysregulation Among Adolescents: A Systematic Literature Review

Adolescence is marked by significant emotional challenges, with mood disorders becoming increasingly prevalent, necessitating effective interventions. Dialectical Behavioral Therapy (DBT) skills have emerged as promising tools for addressing emotional dysregulation in adolescents. This systematic literature review aims to evaluate the effectiveness of DBT skills in managing emotional dysregulation and reducing mood disorder symptoms among adolescents. Through meticulous analysis of existing research, this review highlights the substantial impact of DBT interventions in decreasing the frequency and intensity of maladaptive behaviors associated with emotional dysregulation. Drawing from studies involving 908 adolescents aged 12 to 18, compelling evidence suggests notable improvements in mood and related symptoms following participation in DBT skills programs. These findings underscore the potential of DBT interventions as valuable resources in supporting adolescents through their emotional challenges. Furthermore, this review emphasizes the urgent need to integrate DBT approaches into mental health interventions tailored to the unique needs of this vulnerable population. Overall, this review contributes to the growing body of literature on adolescent mental health, providing insights into the efficacy of DBT skills in promoting emotional regulation and enhancing overall well-being during this critical developmental phase.

Intervensi Pencegahan Perilaku Bunuh Diri pada Remaja Berbasis Aplikasi dalam Meningkatkan Efektivitas Penanganan Kesehatan Mental

This research aims to develop a suicide prevention intervention for adolescents by utilizing technology to reach adolescents with suicidal behavior effectively and efficiently. The method used was a literature review with articles originating from the Scopus, Web of Science, Wiley Online, and Science Direct databases, to search for keywords using the Medical Subject Headings (MeSH) system related to relevant articles in this research. The research results resulted in an initial 354 articles. Articles were selected based on publications in the last 5 years and did not include literature reviews or systematic reviews, screening 187 articles. The final results of the 15 articles synthesized showed that there was effectiveness of screening interventions, education, DBT (dialectical behavioral therapy) skills, and help seeking in adolescents with suicidal behavior. The conclusion of this research is that suicide prevention interventions for teenagers by utilizing application technology on smartphones have proven to be effective and efficient in reaching and helping teenagers with suicidal ideation. Keywords: Application, Suicide Prevention, Suicide Intervention, Teenagers

Resilience eDBT: Development and Usability Evaluation of a Dialectical Behavior Therapy Skills Training App for Eating Disorders.

Dialectical behavior therapy (DBT) is an evidence-based treatment for disorders characterized by recurrent binge eating. Yet, access to specialized treatment like DBT remains limited. To increase the accessibility of DBT, we developed a DBT skills training app (Resilience: eDBT) for the management of eating disorder (ED) symptoms. This paper delineates the developmental process of Resilience and tests its usability. Descriptive information on the development and features of Resilience is provided, including its framework, content structure and delivery formats, functionality, data storage procedure, and privacy protocols. Usability was assessed via a mixed methods approach in 10 symptomatic individuals. Qualitative data were organized based on an existing framework, which included six themes: usability, visual design, user engagement, content, therapeutic persuasiveness, and therapeutic alliance. Resilience demonstrated good usability via a Systems Usability Scale score of 85.5, which exceeded the recommended cutoff of 68. Positive aspects of the app, according to interview data, were the ease of use and the visual design, while the addition of peer support was suggested as an opportunity for improvement. A novel DBT-based app may serve as an acceptable, low-intensity option or adjunct to traditional treatment for targeting ED symptoms that emerge in daily life. However, notable limitations include the small sample size and the single time point at which the usability assessment was conducted.

Effects of Dialectical Behavior Therapy (DBT) Skills Training on Depression and Anxiety Disorders - A Pilot Study under Routine Care Conditions

Skills training as an integral part of dialectical behavioral therapy (DBT) is highly effective in the treatment of borderline personality disorder. Research interest is increasingly focused on the transdiagnostic effects of the skills training on depression and anxiety disorders. The present study examined the extent to which the findings of high-quality randomized controlled studies can be transferred to everyday treatment under routine care conditions. N=26 patients without personality disorders were treated in a day clinic over a period of eight weeks. In the control group, 11 patients received routine care treatment and in the experimental group 15 patients additionally received weekly skills training. Symptom distress, as well as emotion regulation and mindfulness were assessed longitudinally at three time points. Multilevel analyzes were used to examine whether there was an additive effect of the skills training. The experimental group was superior to the control group in all endpoints. The effect sizes were comparable to those from experimental research. Improvements in mindfulness were significantly correlated with reductions in symptom distress. The findings fit into previous research efforts and complement them with a naturalistic research perspective. The advantages and disadvantages of an experimental and naturalistic research perspective are discussed, and relevant limitations of the present study are highlighted. Skills training is an established, flexible, modular therapy program that is ideal for improving the adaptability of patients with different psychological diagnoses.

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.

Randomized effectiveness-implementation trial of dialectical behavior therapy interventions for young people with borderline personality disorder symptoms.

Dialectical behavior therapy (DBT) is an evidence-based treatment for people with emerging borderline personality disorder (BPD). In "real world" clinical settings, standard DBT is resource intensive. Emerging evidence suggests that group-based DBT skills training alone can lead to promising outcomes. This hybrid type 1 effectiveness-implementation trial directly compared the effectiveness of an 8-week group DBT-skills training program and a 16-week DBT-informed program including individual treatment and group-based skills training. This pragmatic trial employed a staggered, parallel-groups design. We recruited 104 participants, aged 16-25 years, with emotion dysregulation or emerging BPD symptoms. Participants were randomized to receive either program at a youth mental health service located in the Gold Coast, Australia. Data was collected via online surveys at baseline, 8-week, 16-week, and 24-week follow-up. Mixed effect linear models compared groups on the primary outcomes of emotion dysregulation and BPD symptoms, and secondary outcomes of suicidal ideation, coping skills, depression, anxiety, and stress. Across groups there were significant and sustained improvements relating to emotion dysregulation, BPD symptoms, stress, depression, and emotion-focused coping; but not suicide risk, anxiety, or task-focused coping. There was no significant time by group differences between the 8-week and 16-week interventions on any primary or secondary outcome. The more intensive mode of delivering DBT was not more effective than the brief group-based skills training. Both interventions resulted in significant improvements across both primary and most secondary outcomes. These results have implications for clinical practice regarding length and intensity of DBT treatment in young people.

Feasibility and acceptability of an online group dialectical behavioural therapy skills training in a Transdiagnostic group with Anxiety and Depression

Transdiagnostic approaches offers a paradigm shift in managing psychiatric disorders. Emotion regulation difficulties are a transdiagnostic prevalent across various mood and personality disorders. Dialectical Behavioural Therapy Skills Training (DBT-ST), initially designed as part of treatment for borderline personality disorder, targets emotion regulation and has shown promise in diverse psychiatric conditions. In lower middle-income countries with resource-constrained settings, online delivery of evidence-based interventions holds potential to bridge treatment gaps. This study assesses the feasibility and acceptability of online group DBT skills training for individuals with depression or anxiety disorders in India. Mental health professionals practising in India referred twenty-four eligible participants currently not engaged in psychotherapy. Of these, 18 initiated the 8-week virtual group DBT-ST program, with 12 completing it (66 % female, 18-35 years of age, 5 on concurrent medication). They provided feedback on therapy content's usefulness. Baseline, post-intervention, and one-month follow-up assessments measured changes in emotion regulation difficulties, depression, and anxiety symptoms. Treatment retained 66.7 % of participants, all participants found the intervention beneficial. Repeated measures ANOVA indicates significant reductions in self-reported difficulties in emotion regulation, depression, and anxiety symptoms post-intervention. These findings highlight the promise of transdiagnostic interventions like DBT-ST that merit further evaluations using RCTs with larger sample sizes.

Effects of brief dialectical behavior therapy skills training on Malay‐speaking school teachers: A controlled study

Effects of brief dialectical behavior therapy skills training on Malay‐speaking school teachers: A controlled study

Effectiveness of Dialectical Behavior Therapy (DBT) in a Forensic Psychiatric Hospital.

Dialectical behavior therapy (DBT) has strong evidence in support of its effectiveness in reducing suicide attempts, anger, impulsivity, and substance abuse. It has been implemented in a variety of forensic settings to help with these challenges, despite limited research on the efficacy of DBT within this population. The current study presents treatment outcomes from an established DBT program in a maximum-security forensic facility. Outcomes included self-reported functioning, behavioral outcomes, and assessment of DBT skills knowledge among inpatients who participated in either comprehensive DBT or DBT skills training. Behaviorally, the study found a significant decrease in rates of patient assaults and reduced use of "Pro re nata" (PRN) medication for anxiety or agitation over the course of DBT treatment. During the first six months of treatment, self-reported symptoms of depression, emotional and behavioral dysregulation, and psychological inflexibility significantly decreased. Within this time frame, patients also displayed a significant decrease in the use of dysfunctional coping skills and a significant increase in knowledge pertaining to emotion regulation and interpersonal effectiveness. The results of this study largely support the use of DBT in forensic settings.

Exploring Preclinical Medical Students' Experience Facilitating Group Dialectical Behavior Therapy (DBT) for a Student-Run Mental Health Clinic: A Qualitative Study.

This report explores the experiences of preclinical medical students who led group dialectical behavior therapy (DBT) for a student-run LGBTQ + mental health clinic. In the clinic, experienced clinicians trained and supervised preclinical medical students to facilitate DBT groups. The authors conducted a qualitative study to understand the impact of the DBT groups on the student facilitators via semi-structured interviews, which were evaluated using thematic analysis. The clinic hosted nine iterations of group DBT facilitated by preclinical medical students, involving 18 student leaders and 30 patients. Twelve student facilitators were interviewed. Participants had a diverse array of specialty interests and were primarily motivated by the opportunity for early clinical experience. They reported improved clinical skills, increased appreciation of psychotherapy as a treatment modality, and increased interest in incorporating psychotherapy in their future practice. Furthermore, participants reported using DBT skills to cultivate wellbeing during clerkship year and in their personal lives. Offering preclinical medical students the opportunity to lead group DBT therapy is a novel educational model providing early training in psychotherapy techniques. This opportunity for early direct patient experience in a supervised group setting attracted medical students with a diverse range of specialty interests. This model provided medical students specific DBT skills to implement in future patient care interactions and to maintain their personal wellbeing throughout medical training. The broad appeal and lasting effects of this program may prove beneficial at other institutions.

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.

Animal-Assisted Dialectical Behavior Therapy Skills Groups for Those who are Incarcerated: A Pre-Post-test Study

Incidents of self-harm present significant concerns in correctional facilities. Purpose: Developing interventions to address self-injury is beneficial to individuals who are incarcerated as well as the security personnel in charge of their care and custody. Method: Four 6-week animal-assisted dialectical behavior therapy (DBT) skills groups were provided to men and women incarcerated in a jail. Each group integrated two therapy dogs while participants utilized a workbook to assist in the application of DBT skills. A total of 23 participants completed the program. Results: Participants demonstrated a statistically significant decrease in self-harming behaviors. Discussion: All participants indicated that the presence of therapy dogs was helpful as they provided comfort/support, calming/coping, and focus. The receptivity to groups and the results offer support for enhancing treatment in correctional facilities.

A Randomized Controlled Pilot Trial of a Brief Dialectical Behavior Therapy Skills Training-Informed Intervention for Test Anxiety

ABSTRACT Data testing the effectiveness of third-wave interventions to decrease college students’ test anxiety is sparse. We conducted a randomized controlled trial with college students to examine whether an intervention using several DBT skills (DBT; Linehan, 2015a, 2015b) would decrease test anxiety. Participants (N = 48) were randomly assigned to one of two conditions, the brief DBT condition (n = 26) or the control condition (n = 22), a brain-training activity group. Participants in both conditions met for a single, two-hour session. After the intervention, participants completed an exam in their psychology course. Results indicated that individuals in the DBT intervention group had greater reductions in levels of test anxiety and state anxiety, and greater increases in mindfulness, than individuals in the control group. This study provides data supporting DBT skills training as a promising treatment for students with test anxiety.

The acceptability and feasibility of a cognitive behavioural therapy managing emotions group on a male psychiatric intensive care unit: a mixed methods evaluation

Research suggests that the provision of psychological interventions within acute inpatient settings is effective and important for improving clinical outcomes. There remains limited research on the application of such interventions for individuals admitted to psychiatric intensive care units (PICU), and notably none for male-only PICU environments specifically. Two published protocols have been evaluated in female and mixed gender PICU settings, one a cognitive behavioural therapy (CBT) anger management group and one dialectical behaviour therapy (DBT) skills group. No studies have reported on a general CBT-based group in a male PICU. This study aimed to assess the acceptability and feasibility of a CBT-based managing emotions skills group, delivered in brief 30-minute sessions, within a 7-bed male PICU. All individuals admitted to the PICU during the study period were invited to attend a five-session group. A mixed methods design was used incorporating measuring attendance and retention, a pre–post quasi-experimental design and a qualitative component. Pre- and post-group self-report outcome measures of calmness, anxiety, recovery, and qualitative feedback were gathered and analysed. Pre- and post-outcome measures demonstrate significant improvements in calmness and reduction in anxiety following attendance. Attendance, retention and qualitative feedback data suggests that the group was acceptable and feasible for the participants. Initial findings suggest that adapted CBT skills group-based interventions tailored to the male PICU population are acceptable, feasible, and beneficial to participants. The clinical and research implications are discussed.