Dialectical Behavior Therapy Research Articles

Brief, pragmatic measure of emotion dysregulation in young people – a preliminary validation of the BER-5

BackgroundEmotion dysregulation is a transdiagnostic construct associated with mental health problems, including self-harm and borderline personality disorder (BPD). Although often targeted in clinical practice, the majority of psychometric assessment instruments of emotion dysregulation are developed for research purposes, and there is a need for an adapted version to be used in a clinical screening setting. The main aim of this study was to examine psychometric properties of a brief, pragmatic measure of emotion dysregulation, the Brief Emotion Regulation Scale − 5 items (BER-5).MethodsThe sample consisted of 60 young adults (mean age 28.1 years) who participated in a 12.4 years follow-up study of an RCT of Dialectical Behaviour Therapy’s long-term effect. Cronbach’s alpha was used to calculate internal consistency. Concurrent and convergent validity were examined using Spearman’s correlation in comparison with other measures, and logistic regression as well as area under the curve to examine its ability in terms of differentiating between BPD diagnosis and trait levels. Optimal cut-off points were explored using Receiver Operating Curves.ResultsOur results indicated adequate internal consistency both in adolescence and in young adulthood, as well as high convergence with a gold-standard measure of emotion dysregulation, and moderate convergence with symptom measures of anxiety and depression. BER-5 was able to differentiate between participants with no BPD from subthreshold or full BPD diagnosis in adulthood, and a cut-off score of 5 was found optimal in terms of sensitivity and specificity in identifying individuals with BPD.ConclusionsThe BER-5 is a brief, pragmatic measure of emotion dysregulation with good psychometric properties and is potentially a useful screening tool for clinicians working in specialized health care settings.

Dialectical behaviour therapy in the treatment of borderline personality disorder: a commentary

Dialectical behaviour therapy in the treatment of borderline personality disorder: a commentary

Dialectical Behavior Therapy in Autism.

Recent research indicates that Dialectical Behavior Therapy (DBT) is feasible, acceptable, and effective for autistic adults. This review aims to provide conceptual arguments and empirical evidence to support DBT as a relevant therapeutic alternative for autistic individuals experiencing emotion dysregulation (ED). ED is frequent in autism whereby it is associated with severe mental health challenges. However, appropriate therapeutic options are limited. Currently, DBT has amassed the most evidence for treatment of ED across a range of clinical conditions, although it was originally developed for borderline personality disorder (BPD). In the context of autism, there is evidence supporting the efficacy of DBT for ED, life-threatening behaviors and depression, but adaptations are likely to improve its dissemination and acceptability. While similar biosocial factors seem to be involved in ED in BPD and autism, alexithymia is prominent in autism and autistic features such as sensory sensitivity and social overload also contribute to ED in autistic adults. Given the significant impact of ED on the well-being of autistic adults, there is an urgent need to enhance our understanding of the mechanisms involved in ED in autism and the adaptations likely to improve the acceptability and dissemination of DBT for autistic people.

Trait dissociation in borderline personality disorder: influence on immediate therapy outcomes, follow-up assessments, and self-harm patterns

ABSTRACT Background: Dissociative symptoms are suggested to compete with the effectiveness of psychotherapeutic treatment and frequently co-occur with early life trauma and self-harm patterns, including self-injury, suicidal ideation, and suicide attempts, which are characteristic for borderline personality disorder (BPD). Objective: We explore the connections between dissociation and other BPD features like self-harm and childhood traumatization and examine the impact of trait dissociation on both immediate and follow-up psychotherapy outcomes. Method: In this naturalistic prospective evaluation study, we investigated psychopathology including general psychological distress (SCL-90), depression (BDI-II), and borderline-specific pathology (BSL) in 131 patients with BPD pre and post of a certified 8-week inpatient Dialectical Behaviour Therapy (DBT), as well as 3- and 6-month post inpatient treatment. Prior to therapy, we evaluated trait dissociation (Dissociative Experience Scale), early life trauma (Childhood Trauma Questionnaire), and self-harm patterns (clinical interview). We performed a network analysis to explore the interplay between dissociation, self-harm, and childhood traumatization. To analyse the influence of dissociation on treatment outcomes, we employed linear mixed models. Results: Psychopathology (SCL-90, BDI-II and BSL) exhibited significant reductions at post-treatment and follow-up assessments when compared to baseline measurements. Higher levels of trait dissociation were consistently related to higher psychopathology but did not suggest poorer symptom reduction during DBT. However, trait dissociation predicted reduced 6-month follow-up benefits from DBT, regardless of the baseline symptom burden. The network analysis revealed a close association between self-injury and derealization/depersonalization, while the frequency of suicide attempts was more closely connected to childhood emotional abuse, which was identified as a central node of the network. Conclusions: Dissociation was not related to poorer outcomes regarding inpatient DBT. However, trait dissociation predicted reduced follow-up benefits, highlighting the need to address dissociation during psychotherapeutic interventions. Based on the estimated network structure, treating dissociative symptoms could potentially mitigate self-injury while especially childhood emotional abuse was linked with suicide attempts.

Multidisciplinary Perspectives on Eating Disorders: From Socio - psychological Roots to Cutting - edge Treatments and Future Prospects

This study takes a multidisciplinary approach, drawing from sociology, psychology, and psychiatry to explore binge eating disorder (BED) and related eating disorders, such as anorexia nervosa and bulimia nervosa. It highlights how the sociocultural ideal of thinness increases body image dissatisfaction, particularly in lower socioeconomic groups, leading to maladaptive eating behaviors like binge-eating episodes and purging. The study also examines the psychodynamic factors of BED, including neuroendocrine dysregulation, body image distortions, and compulsive dieting, which may serve as coping strategies for socioeconomic stress. Therapeutic approaches such as Cognitive Behavioral Therapy (CBT), Integrative Cognitive-Affective Therapy (ICAT), and Dialectical Behavior Therapy (DBT) are reviewed, alongside pharmacological treatments and emerging neuromodulatory techniques like Transcranial Magnetic Stimulation (TMS). Despite these advances, the underlying mechanisms of BED remain unclear, necessitating further research in novel treatments and precision medicine. The paper emphasizes the potential of AI-driven algorithms and multimodal data fusion in improving diagnostics and individualized treatments, while stressing the importance of ethical frameworks for data security. These innovations promise significant advancements in managing eating disorders.

Effectiveness of Dialectical Behavior Therapy (DBT) on Aggression, Anxiety, and Attention in Girls with Obsessive-Compulsive Disorder: A Quasi-Experimental Study

Effectiveness of Dialectical Behavior Therapy (DBT) on Aggression, Anxiety, and Attention in Girls with Obsessive-Compulsive Disorder: A Quasi-Experimental Study

Eye Movement Desensitisation and Reprocessing with and without Dialectical Behaviour Therapy for Posttraumatic Stress Disorder and Comorbid Borderline Personality Disorder Symptoms: A Randomised Controlled Trial.

Comorbidity between posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD) is prevalent. Despite evidence-based therapies, high rates of non-response and dropout persist. This study therefore aimed to examine whether the concurrent application of eye movement desensitization and reprocessing (EMDR) for PTSD and dialectical behavior therapy (DBT) for BPD yields better results than EMDR alone. Patients with a PTSD diagnosis and at least four BPD symptoms were randomly assigned to EMDR (n = 63) or concurrent EMDR-DBT (n = 61). Over one year, changes in PTSD symptoms were measured using the Clinician-Administered PTSD Scale for DSM-5. Secondary outcomes included BPD symptoms, global functioning and quality of life. Both treatments led to large reductions in PTSD symptoms, without significant differences after one year (p = .312, d = -0.23, 95% CI = -0.6, 0.1). Both treatments also yielded large and comparable reductions in BPD symptoms and improved quality of life. Global functioning improved only in the EMDR condition according to one measure (WHODAS 2.0), while the other measure (OQ-45) showed improvements in both groups. Additionally, patients in the EMDR-DBT condition were twice as likely to drop out from EMDR treatment compared to those in the EMDR-only condition. Stand-alone EMDR demonstrated safety and efficacy in alleviating PTSD and BPD symptoms, as well as enhancing quality of life. These findings support the use of EMDR as a strong therapeutic option for patients with PTSD and comorbid BPD symptoms. Further research is needed to assess longer-term outcomes beyond one year.

Mind Matters: Mental Health and Diabetes Management.

Managing diabetes is an intensive, lifelong responsibility that significantly impacts a person's mental health and diabetes outcomes such as glycemic stability and complications. This mini-review examines the research leading to this conclusion as well as the implications for screening and treatment of mental health issues in people with diabetes within an interdisciplinary care model. We searched the literature for the past 10 years, including original articles, reviews, and meta-analyses from PubMed and OVID using the search terms diabetes and mental health. Diabetes is a lifelong burden, and people with the disease grapple with intensive management, financial burden, fear of hypoglycemia, chronic hyperglycemia complications, and diabetes stigma. These stressors have a debilitating emotional impact, making it difficult to carry out diabetes care tasks, which in turn is associated with poorer short-term glycemic stability and greater mental health symptoms. Psychological syndromes related to a diabetes diagnosis, management, or coping with the disease include major depressive disorder, diabetes distress, anxiety, and eating disorders. Providers managing people with diabetes can leverage 4 validated screening instruments to assess for these syndromes. The main psychological interventions studied to treat these mental health conditions include cognitive behavioral therapy, cognitive conceptualization, dialectical behavioral therapy, relational therapy, and psychoeducation. It is pertinent to address the mental health of people with diabetes as rates of psychological syndromes are significantly higher than among those without diabetes. Interdisciplinary care involving endocrinologists, mental health providers, diabetes educators, and medical nutritionists could improve diabetes self-care and glycemic control.

TextSavvy: Exploring the Effectiveness of a Text Messaging Adjunct to a Dialectical Behavior Therapy (DBT) Skills Training Intervention

Abstract Dialectical behavioral therapy (DBT) is an evidence-based treatment for adolescent mental health concerns with potential as a preventative approach for at-risk youth. Automated text messaging, a low-cost and widely accessible technology, may enhance treatment engagement and further support youth mental health outcomes. However, the effectiveness of automated text messaging as a delivery format for DBT-informed content has not been extensively studied. This quasi-experimental study evaluated a six-week DBT-based skills training program with one group receiving twice-daily psychoeducational and supportive text messages (n = 37) and a historical control group receiving the intervention only (n = 39). Psychoeducational messages included DBT skill explanations aligned with session content. Supportive messages provided reminders, connection to local resources, and encouragement. Measures of attendance, perceived learning, DBT skill usage, and clinical outcomes (e.g., anxiety, depression, emotion regulation) were collected. Text messaging was associated with improved session attendance (p < .01) and perceived learning mid-intervention (ps < .05), although no significant differences were observed in DBT skill use or clinical outcomes. Effect sizes for attendance and perceived learning were moderate (Cohen’s d = .57–.61). Qualitative feedback indicated that participants found the text messages helpful, particularly for enhancing attendance, reinforcing DBT skills, and boosting motivation and mood. While text messaging shows promise for increasing engagement in adolescent mental health interventions, its impact on clinical outcomes and skill use remains unclear. Further research is needed to optimize the use of text messaging as a supportive tool in youth DBT interventions, utilizing more rigorous experimental designs.

To Adopt or Adapt: A Scoping Review of Dialectical Behaviour Therapy With Patients With Minoritised Identity Constructs

To Adopt or Adapt: A Scoping Review of Dialectical Behaviour Therapy With Patients With Minoritised Identity Constructs

Imagining Futures: Evaluation of a blended programme of dialectical behaviour therapy and the creative arts for young women with a history of self-harm.

To evaluate an arts-enhanced dialectical behavioural therapy skills group for managing emotions and self-harm, implemented via an innovative public sector/third sector partnership to increase access to care. This is a pilot mixed-methods study. To assess participant experience in the 'Imagining Futures' programme, we examined self-report questionnaires and qualitative focus group interviews using framework analysis. We collected recruitment, session attendance and programme completion rates. To explore impact, we also report on quantitative psychological outcome measures, including self-harm frequency and overall well-being. We recruited 45 young women (mean age: 15.9, s.d. = 1.24, range 13.9-18.0 years) with a history of emotional dysregulation, self-harm and other contextual risks who were not receiving support from statutory child and adolescent mental health services in the United Kingdom. Participants were 22% not in education, employment or training and 77% were from United Kingdom racially minoritized backgrounds. The overall completion rate was 62% (n = 28/45). Qualitative data analysed from respondents (n = 25/28 young people and n = 12 parents) suggested high levels of satisfaction with the project. Thirteen themes were identified which described service elements perceived to support engagement and observed impact. There was an important role for relationships and the creative components. Quantitative clinical data indicated reductions in the frequency of self-harming, significant reductions in the perceived impact of difficulties and increased perceived social support. This novel delivery of a DBT skills group, incorporating blended psychology arts activities, has the potential to support engagement with psychological supports that improve mental well-being.

First do no harm: Client and staff experiences of negative effects from dialectical behaviour therapy.

Research has shown that dialectical behaviour therapy (DBT) is effective in reducing self-harm and suicidal ideation, but there is also some evidence of negative effects with differences in the reports from clients and staff. However, no research has focused on both groups' understandings of negative effects. This study aimed to explore client and staff experiences of the negative effects from DBT, investigate how their understandings compare, and how staff address any negative effects that arise. Eight client participants and seven staff participants, who had experienced or witnessed negative experiences from DBT, engaged in semi-structured interviews, the transcripts of which were analysed using reflexive thematic analysis. Four themes relating to client experiences were generated: 'I'm the problem', 'DBT can do no wrong', 'No understanding of trauma' and 'An unhealthy "blueprint for relationships"'. Five themes relating to staff experiences were generated: 'It's not me, it's the client', 'DBT or nothing', 'We don't do 'why' in DBT', 'We did make some changes' and 'Organisational "restrictions"'. Both staff and clients understood negative effects from DBT to include pathologisation and re-traumatisation. However, whilst clients related negative effects to the therapeutic relationship, staff highlighted the impact of organisational restrictions. The findings support a number of changes to practice, particularly the need to recognise potential negative effects and provide meaningful informed consent procedures.

변증법적 행동치료 집단프로그램이 여자 중학생의 정서조절곤란, 마음챙김, 고통감내력에 미치는 영향

Objectives The purpose of this study was to evaluate the effectiveness of a Dialectical Behavior Therapy (DBT) group program on mindfulness, emotional dysregulation, and distress tolerance in female middle school students experiencing difficulties with emotion regulation. Methods A group program consisting of 10 sessions was conducted, and to assess the program's effectiveness, 24 female students from OO Middle School in D Metropolitan City, who experienced emotion regulation difficulties, were assigned to either an experimental group (12 people) or a control group (12 people). The measurement tools used were the Emotion Regulation Difficulties Scale, the Mindfulness Scale, and the Pain Tolerance Scale. Assessments were conducted at pre-test, post-test, and follow-up points. Results The results showed that, in the experimental group, levels of mindfulness and pain tolerance increased post-test compared to pre-test, and emotion regulation difficulties decreased. This indicates that the program was effective, and these effects were maintained at the follow-up point. In contrast, no significant differences were found in the pre-test, post-test, or follow-up scores of the control group. Conclusions The DBT group program reduced emotion regulation difficulties and increased mindfulness and pain tolerance levels in middle school girls with emotion regulation difficulties. These effects were maintained even at the follow-up point.

Evaluating the Efficacy of Group-Based Dialectical Behaviour Therapy for Binge Eating Disorder: A Systematic Review

Evaluating the Efficacy of Group-Based Dialectical Behaviour Therapy for Binge Eating Disorder: A Systematic Review

Study protocol of a hybrid type 1 effectiveness-implementation multisite trial: Dialectical behavior therapy skills group for Veterans at high-risk for suicide attempt.

Study protocol of a hybrid type 1 effectiveness-implementation multisite trial: Dialectical behavior therapy skills group for Veterans at high-risk for suicide attempt.

Hypnosis applications to the treatment of posttraumatic stress disorder

ABSTRACT Current evidence-based therapies considered efficacious for posttraumatic stress disorder (PTSD) include Prolonged Exposure Therapy (PE), Cognitive Processing Therapy (CPT), Eye Movement Desensitization Reprocessing (EMDR), and medication treatments. Hypnosis, one of the first mind-body therapies known to Western medicine, has been used for mind-body problems such as conversion reactions, medication-less anesthesia, and wound healing. Because PTSD is a mind-body problem, hypnosis seems especially suited for its treatment. Hypnosis is a state-based treatment that can move PTSD patients into a state of calm, downregulate their emotional reactivity, and facilitate altering maladaptive beliefs. Combined with cognitive behavioral therapy (CBT) approaches, hypnosis may magnify their effects. In this article, we present hypnotic techniques applicable to PTSD based on the PTSD symptom clusters they treat. We describe the goals, similarities, and differences between hypnosis and mindfulness, Dialectical Behavioral Therapy, and Acceptance and Commitment Therapy. We describe how adding hypnosis to PTSD treatment protocols such as PE and CPT boosts their impact. We encourage the use of hypnotic techniques which can enhance the therapeutic palette of the CBT practitioner treating PTSD.

Inpatient dialectical behavior therapy combined with trauma-focused therapy for PTSD and borderline personality disorder symptoms: study design of the naturalistic trauma therapy study.

Childhood traumatization can result in physical and mental health problems in adulthood, such as post-traumatic stress disorder (PTSD), which negatively influences quality of life and social functioning. Although evidence based trauma treatments benefit clients with PTSD after childhood abuse and comorbid personality disorders, they are less effective than in clients who were traumatized in adulthood, and drop-out is substantial. The current study aims to assess the effects of inpatient dialectical behavior therapy combined with prolonged exposure (DBT-PTSD) on severity of PTSD, dissociation, parasuicidal behavior and borderline personality disorder (BPD) in clients with severe PTSD and comorbid psychiatric disorders. Secondary outcomes are social functioning, quality of life, borderline and cluster C personality disorder symptoms as treatment predictors, treatment trajectories, clients' experiences and health economic consequences. The naturalistic, longitudinal Trauma Therapy Study is conducted from January 2019 until May 2025 in a mental healthcare center in the Netherlands. Clients with severe PTSD and comorbid conditions who are referred to inpatient DBT-PTSD are included into the study. Based on power analyses a total sample size of N=56 is needed. Measurements take place before the waiting list period, at pre- and posttreatment and at six- and twelve-months follow-up. Clients fill in a daily DBT-PTSD diary, which gives insight into individual symptom trajectories. Statistical analyses include two-sided paired samples t-tests, linear mixed model analyses and cost-effectiveness analyses. Qualitative interviews are conducted within two years posttreatment and analyzed using a phenomenological approach. We correct for chance capitalization by using a conservative α-level of.01. Multiple imputation is used to handle missing data. Research on the effects of integrated treatment programs for clients with severe PTSD and co-morbid conditions is scarce. This study extends current knowledge on the effects of inpatient DBT-PTSD on PTSD and BPD symptoms, clients' social functioning and quality of life. In addition, it provides insight into individual symptom trajectories and experiences, inspiring future treatment improvements for clients with severe psychopathology. Medical Ethical Committee approval (NL669060018, RTPO1044/01.10.2018). Preregistration: Dutch registration database Centrale Commissie Mensgebonden Onderzoek and International Clinical Trials Registry Platform (NL-OMON46167/01.10.2018/https://trialsearch.who.int/Trial2.aspx?TrialID=NL-OMON46167).

The Effects of Dialectical Behavioural Therapy (DBT) on Cognitive and Emotional Symptoms of Adult ADHD: A Randomised Pilot Study

ABSTRACTBackgroundAttention deficit hyperactivity disorder (ADHD) is a developmental disorder with emotional and cognitive symptoms.AimsThis study aimed to investigate the effect of dialectical behavioural therapy (DBT) on cognitive and emotional aspects of ADHD in adults.Materials and methodsA quasi‐experimental pre‐test/post‐test design with a control group (waiting list) was applied. Forty participants were selected for the study among the target population of adult ADHD patients. They were randomly assigned to the control and experimental (group DBT) groups. The Adult ADHD Self‐Report Scale (ASRS), Tower of London, Stroop test, Wisconsin sorting test, Continuous Performance Test, Eysenck Impulsivity Test, and Difficulties in Emotion Regulation Scale (DERS) were used for assessment purposes. The data analysis was conducted using SPSS‐23 and the MANCOVA method.ResultsThe results showed that DBT was significantly effective in improving emotion regulation (31.4%), impulsivity (37.4%), Stroop scores (21.9%), attention and concentration (31.8%), and hyperactivity (41%) compared to the control group. However, there was no significant difference in the subscales of the Tower of London, Wisconsin test and the attentional subscale of the ASRS.ConclusionIt can be inferred from this research that DBT can significantly reduce the emotional difficulties of adults with ADHD, but may not be very helpful for the cognitive aspects of this disorder.

Alcohol use prior to episodes of nonsuicidal self-injury in women with borderline personality disorder participating in a randomized clinical trial of dialectical behavior therapy.

Alcohol use is an important, but understudied, risk factor for nonsuicidal self-injury (NSSI), defined as deliberate physical harm to oneself without intent to die. Alcohol use may facilitate engagement in NSSI by increasing impulsivity and physical pain tolerance. Limited data also suggest that people engage in more medically severe NSSI under the influence of alcohol. This secondary analysis study examined the use of alcohol prior to NSSI in a sample of 79 female patients with borderline personality disorder who were enrolled in a randomized clinical trial of dialectical behavior therapy. We used multilevel modeling (MLM) to examine preregistered hypotheses that alcohol use prior to NSSI would be related to the impulsivity of NSSI, physical pain experienced during NSSI, and the medical severity of injuries from NSSI. Participants endorsed alcohol use prior to 21.96% (47/221) of NSSI episodes, and roughly one third of participants (n = 27) reported at least one episode of NSSI preceded by alcohol use. For NSSI episodes preceded by alcohol use, more than half (52.38%) of participants reported using alcohol up to the moment of initiating NSSI. Alcohol use was significantly associated with higher impulsivity of NSSI episodes (b = 1.16, p = .041), but not physical pain from NSSI or medical severity of NSSI. Findings need to be replicated but indicate that alcohol use occurs frequently prior to NSSI and could be a target for reducing impulsive episodes of NSSI. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Dialectical Behavior Therapy Prolonged Exposure (DBT PE) Adapted via Telehealth for Diverse Patient Populations – A Case Report

Dialectical Behavior Therapy Prolonged Exposure (DBT PE) Adapted via Telehealth for Diverse Patient Populations – A Case Report