ABSTRACTDialectical behavior therapy (DBT) is an extensively studied treatment for borderline personality disorder (BPD), with skills use being one of the hypothesized mechanisms of change. Research has previously been hindered by the absence of an appropriate tool to measure skills use, leading to the development of the DBT Ways of Coping Checklist (DBT‐WCCL). The DBT‐WCCL aims to assess DBT skills use (DSS) as well as dysfunctional coping (DCS), which can be divided into dysfunctional coping in general (DCS1) and blaming others (DCS2). This study evaluated the Dutch version of the DBT‐WCCL by examining (1) the dimensional structure and measurement invariance across BPD and non‐clinical samples, (2) psychometric properties (reliability and validity), and (3) sensitivity to change. A total of 204 participants diagnosed with BPD and 103 non‐clinical controls completed the Dutch DBT‐WCCL along with instruments assessing emotion regulation and BPD manifestations. First, when including all DBT‐WCCL items, the hypothesized two‐factor and three‐factor models were not tenable due to substantial content overlap. When factor analyses included only items representing DBT skills or dysfunctional coping, support was found for three subscales (DSS, DCS1, and DCS2). Partial measurement invariance was established only for the DSS subscale. Reliability and known‐group validity were satisfactory for all scales, while inconclusive results were found for the concurrent validity of the DSS subscale. Finally, the DBT‐WCCL proved to be sensitive to change. In conclusion, our findings largely support the use of the Dutch DBT‐WCCL, but warrant caution when comparing samples on dysfunctional coping.Trial Registration: The BOOTS study was registered in the Overview of Medical Research in the Netherlands (NL‐OMON21337).

The article presents the experience of developing and implementing a 16-week psychocorrective program aimed at psychological support for people living with HIV and resuming antiretroviral therapy (ART) after a long break. The program integrates the methodological foundations of cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT), which allows comprehensive work with a wide range of psychological difficulties typical of this group of patients: guilt, internal stigmatization, emotional dysregulation, low commitment to treatment and a lack of adaptive coping strategies. The study involved 60 people who were treated in a specialized medical institution and divided into an experimental group of 34 patients (17 women and 17 men) aged 37.4 ± 10.8 years and a control group of 26 patients (21 women and 5 men) aged 38.7 ± 8.6 years. The psychocorrective program was based on theoretical analysis and experimental data obtained. To assess the dynamics of the psychological state before and after the implementation of the program, standardized psychodiagnostic methods were used: Hospital Anxiety and Depression Scale (HADS, A. Zigmond and R. Snaith, adapted by M.Y. Drobizhev); aggressiveness test (L.G. Pochebut Questionnaire); methods of coping behavior (Ways of Coping Questionnaire – WCQ, R. Lazarus, S. Folkman, adapted by the V.M. Bekhterev Institute); WHO short questionnaire for assessing the quality of life (QUALITY OF LIFE (WHOQOL) – BREF, adapted by the V.M. Bekhterev Institute); the scale of General Self-Effecacy (GSE, R. Schwarzer, M. Jerusalem, adapted by V.G. Romek); the Morisky-Green compliance scale (Medicine Adhesion report scale, MARS). According to the results of 16 weeks of psychocorrective support, statistically significant changes were recorded: the level of anxiety decreased, the indicators of depression. The level of overall self-efficacy increased, which indicates a strengthening of participants' confidence in their own abilities and ability to cope with difficulties. The analysis of coping strategies revealed a shift of dominant strategies towards adaptive ones – in particular, the use of strategies such as "seeking social support" and "problem solving" increased. In addition, there was a significant improvement in the subjective quality of life. The results obtained confirm the high efficiency and clinical expediency of using the integrative psychotherapeutic approach CBT/DBT in working with HIV-infected patients experiencing a crisis of adherence to therapy. The presented program can be recommended for implementation in the practice of medical and psychological counseling services working with this category of patients.

Aggression is a growing issue, ranking among the top causes of mortality in youth and is a frequent reason for referral to child psychiatry clinics. The presence psychological causes, like emotion dysregulation, has been confirmed. The authors adapted Dialectical Behavior Therapy (DBT) skills for children’s developmental level, as well as the Arabic language and culture. The study sample included 66 children with a diagnosis of ADHD and impulsive aggression who had not previously taken medication for their condition. They were randomized into two groups: an intervention group (Group A) that, along with their parents, attended a weekly Arabic DBT-C skills training program, and a control group (Group B) that received primary ADHD medication and regular psychoeducation sessions. The Arabic DBT-C skills training significantly reduced the severity of impulsive aggression. This was associated with improvements in the children’s executive functions, psychological resilience, ADHD symptoms (particularly impulsivity and hyperactivity), and their parents’ emotion dysregulation. These effects were maintained at a 3-month follow-up. Regression analysis identified that the reduction in aggression severity was primarily associated with improvements in self-motivation and response inhibition executive functions, improved parental emotion dysregulation, and an increased resilience i.e. use of adaptive skills by the children. The Arabic DBT-C skills training is a proven, acceptable, and effective therapeutic tool for impulsive aggression in children with ADHD, and it was found to be superior to the combination of Atomoxetine and psychoeducation.

Depersonalization/Derealization Disorder (DDD) is a dissociative condition characterized by feelings of detachment from oneself or one’s environment, often accompanied by functional impairment and comorbidity with other disorders. This study aim to demonstrate the application of integrative psychotherapy for a young adult female (20 years old) with DDD, severe depression, self-harming behaviour, suicidal ideation., and negative self-perceptions. Using a single case study design, the intervention followed an integrative protocol combining Cognitive Behavioural Therapy (CBT), Dialectical Behavioural Therapy (DBT) and Acceptance and Commitment Therapy (ACT) over 12 sessions, while examining the specific techniques and strategies employed in each therapeutic approach. Pre-test result showed severe levels of stress (33), anxiety (32), and depression (25). After 12 sessions, reassessment indicated a clinical decrease in score for stress (28), anxiety (26), and depression (20), alongside subjective improvements in emotional regulation, cognitive regulation. and reduced dissociative frequency. This study confirms that staged integrative approach targeting specific symptom cluster can serve as an effective framework for addressing the clinical complexity of DDD. Further rigorous research is recommended to validate this framework and to consider any notables challenges encounter during the integrative psychotherapy sessions.

BackgroundYouth at clinical high risk (CHR) for psychosis often experience emotional dysregulation, psychiatric symptoms, substance use, suicidality, and functional impairment. Dialectical behaviour therapy (DBT) is an evidence-based intervention that improves emotion regulation, clinical outcomes, and functioning across psychiatric populations. Digital adaptations (d-DBT) may enhance accessibility and engagement for CHR youth, but acceptability and potential benefits in this group are unknown.ObjectiveTo adapt d-DBT for CHR youth and evaluate the acceptability of delivering it to this population, as well as the feasibility of a larger-scale clinical trial.MethodsThis mixed-methods clinical trial has two phases. In Phase 1, d-DBT will be adapted for CHR youth in collaboration with a lived-experience youth advisory group. In Phase 2, an assessor-masked randomized controlled trial will compare d-DBT (n = 30) with treatment as usual (n = 30). The intervention consists of eight weekly modules, with primary outcomes assessing acceptability, usability, and trial feasibility. Secondary outcomes include changes in emotional dysregulation, psychiatric symptoms, substance use, suicidality, and functioning.ConclusionsWe anticipate that d-DBT will be acceptable to CHR youth and that conducting a larger trial will be feasible. Preliminary findings may demonstrate improvements in emotion regulation, psychiatric symptoms, suicidality, and functioning. Results will guide further refinement of the intervention and inform the design of a confirmatory clinical trial.Trial registrationClinicalTrials.gov #NCT06928935

Background: Substance use disorders (SUDs) are a major global health burden, and third-wave therapies that target transdiagnostic processes such as psychological flexibility and mindfulness have emerged as promising options. This systematic review synthesized evidence on third-wave interventions for adults with diagnostic and statistical manual of mental disorder (DSM)-defined SUDs. Methods: A comprehensive search of seven databases (2014–2025) identified randomized and non-randomized studies of acceptance and commitment therapy (ACT), related mindfulness-based programs, and dialectical behavioral therapy skills training. Two reviewers screened records, extracted data, assessed risk of bias with Risk of Bias 2 (RoB 2) and risk of bias in non-randomized studies of interventions (ROBINS-I), and synthesized findings using SWiM-consistent narrative methods. The review was prospectively registered in PROSPERO (CRD420251028610). Results: Forty-seven studies (35 randomized, 12 non-randomized) met inclusion criteria. Across modalities, third-wave interventions yielded small-to-moderate benefits on abstinence, craving, and substance use outcomes compared with control conditions, with larger and more consistent gains in psychological flexibility, emotion regulation, and mindfulness. Effect sizes varied and most trials showed some concerns or serious risk of bias, resulting in generally low-to-moderate certainty of evidence. Conclusions: Third-wave interventions may serve as adjunctive or alternative SUD treatments by engaging targeted mechanisms, enhancing psychological functioning, and producing modest but clinically relevant substance-use benefits. More rigorous, adequately powered mechanism-focused trials are needed to clarify comparative efficacy and guide process-based personalization and implementation in routine addiction services.

ABSTRACT Mindfulness, emotion regulation, and distress tolerance are hypothesised mechanisms that underpin Dialectical Behaviour Therapy (DBT) for binge eating, yet their role in app-based interventions is unclear. This study examined whether (1) a digital DBT app improved these skills compared to a control condition and (2) baseline skill levels predicted post-treatment symptom change. This secondary analysis drew on data from a randomised controlled trial (n = 576) of adults with recurrent binge eating. Participants in the intervention (n = 287) completed a six-week self-guided DBT app, while controls (n = 289) were waitlisted. Mindfulness, emotion regulation, and distress tolerance were assessed at baseline, post-test, and 12-week follow-up. Outcomes were binge eating episodes and the Eating Disorder Examination Questionnaire (EDEQ). Linear mixed models tested treatment effects, while univariate and multivariate models assessed baseline predictors. The app produced small-to-moderate improvements in four emotion regulation facets—lack of emotional clarity (d = -0.33), limited strategies (d = -0.22), difficulty with goal-directed behaviour (d = -0.28), and non-acceptance (d = -0.30)—and in the mindfulness facet of observing (d = 0.28). No group differences emerged for distress tolerance. Baseline non-acceptance predicted EDEQ improvement in univariate analyses, but not objective binge eating or multivariate models. A self-guided DBT app may strengthen components of mindfulness and emotion regulation. These results may point towards possible mechanisms through which DBT treatments work. That core DBT skills at baseline were unrelated to outcomes suggesting that they may bear little prognostic value, however may be suitable for broad implementation.

Despite advances in treatment, up to 20% of cases of bulimia nervosa and anorexia nervosa (AN) persist chronically, with about 25% of individuals with AN being re-hospitalized. This study examined demographic and clinical characteristics associated with one versus multiple admissions to an inpatient eating disorder unit. The sample included 1609 individuals, treated on an inpatient medical stabilization unit, diagnosed with an eating disorder. Of those, 25.4% (n = 326) required multiple admissions. Cox proportional hazard models evaluated adjusted associations of age, gender, eating disorder diagnosis, race, ethnicity, length of stay, presence of non-suicidal self-injury (NSSI), body mass index (BMI), and insurance type at initial admission with the likelihood of multiple admissions. No significant group differences were found in age, gender, BMI, initial length of stay, or ethnicity. Adjusting for other variables, multiple admissions were more likely for those with NSSI (adjusted HR = 1.46) hazard ratio (HR) and with lower BMI at initial admission (adjusted HR = 0.96) as well as Black patients (adjusted HR = 2.07). Relative to individuals with anorexia nervosa, those with Avoidant Restrictive Food Intake Disorder demonstrated a lower likelihood of multiple admissions (adjusted HR = 0.54). NSSI, lower BMI at initial admission, and Black race were associated with greater likelihood of multiple admissions, suggesting that emotion dysregulation, greater illness severity, and demographic factors contribute to rehospitalization. Future research may consider integrating interventions such as Dialectical Behavior Therapy into inpatient care to reduce risk of readmission. Early identification of high-risk behaviors (e.g., NSSI) is critical to tailoring treatment and improving long-term outcomes.

ABSTRACT Background There is a critical need for outpatient services that address suicide and self-harm risk in youth, with an emphasis on caregiver engagement in safety and treatment planning. Objective This study evaluated the feasibility, acceptability, and preliminary efficacy of a telehealth-delivered, Dialectical Behavior Therapy (DBT)-informed workshop for caregivers of youth at risk for self-harm. Methods A four-session workshop was offered to 17 caregivers. Content included safety planning, understanding levels of care, and DBT-based strategies to support youth emotion regulation and behavioral change. Caregivers completed pre- and post-workshop surveys and interviews. Results Findings support acceptability and feasibility of the workshop; 70% of caregivers accepted referral to participate, 77% of participants attended all four sessions, and nearly half of caregivers engaged in additional consultation outside of group meetings. Implementation required approximately 10.1 to 14.3 provider hours per group, 80% of which were direct services. Acceptability and areas for improvement were indicated through qualitative feedback, engagement with at-home practice (71%), and reported changes in caregiver beliefs about both their role in youth mental health care and use of higher levels of care. Caregivers also endorsed that the format and content of the workshop were helpful and relevant. In terms of preliminary efficacy, caregivers reported a significant increase in knowledge (t = -3.36, p < .001) and a significant reduction in caregiver strain (t = 2.60, p = .02). No youth suicide attempts or emergency room visits were reported during the workshop period. Conclusions This pilot study provides preliminary support for the feasibility and acceptability of a DBT-informed, caregiver-focused workshop delivered via telehealth, with promising early evidence of impact on caregiver knowledge and stress. Next steps include evaluation with a larger, more diverse sample and assessment of longer-term outcomes.

BackgroundIntrusive memories are a core symptom of posttraumatic stress disorder (PTSD), yet their retrospective assessment is prone to biases, making real-time methods such as e-diaries essential. While trauma-focused treatments target intrusive symptoms, their efficacy has not yet been evaluated using real-time assessments.ObjectiveThis study aimed to use e-diaries to assess and compare the effects of dialectical behavior therapy for PTSD (DBT-PTSD) and cognitive processing therapy (CPT) on intrusive memories and related inner tension in a large sample of women with childhood abuse–related PTSD and co-occurring borderline personality disorder (BPD) symptoms.MethodsIn a multicenter randomized controlled trial, 193 women with PTSD related to childhood sexual or physical abuse and at least 3 BPD criteria were randomized to receive either DBT-PTSD or CPT. e-Diary assessments were conducted at 3 time points: before treatment, after 6 months, and after 12 months of therapy. At each time point, participants reported intrusive memories and related inner tension over 5 consecutive days using an event-based design.ResultsBoth intrusive memories and related inner tension decreased significantly over time (intrusions: ß=–0.53, P<.001; inner tension: ß=–0.15, P<.001). While reductions in intrusion frequency did not differ significantly between treatment groups (ß=0.05, P=.45), DBT-PTSD was associated with significantly greater reductions in intrusion-related inner tension compared with CPT (ß=–0.16, P<.001).ConclusionsThis study provides the first real-time evaluation of trauma-focused PTSD treatments using e-diaries in daily life. Both interventions were associated with reduced intrusion frequency, while DBT-PTSD showed greater reductions in associated emotional distress—potentially reflecting its emphasis on emotion-regulation strategies and distress tolerance, which may be particularly relevant for individuals with comorbid BPD symptoms. These findings highlight the value of e-diaries for capturing treatment-related symptom change in ecologically valid contexts.

Supplemental Material for Acculturation of Dialectical Behavior Therapy (DBT) Skills Training for Family Caregivers of Suicidal Patients in Taiwan: Initial Feasibility and Outcomes

Background/Aims Women with borderline personality disorder are a vulnerable group. This critical review aimed to understand the experiences of mothers with borderline personality disorder in the perinatal period. Methods CINAHL, PubMed, APAPsych and the Psychology and Behavioural Sciences collection were searched for primary research studies or systematic reviews. These articles were critically appraised and analysed narratively. Results Maternal borderline personality disorder has links to poor neonatal and obstetric outcomes and can impact mother–infant attachment. Women diagnosed with borderline personality disorder experienced stigma and judgement, both from healthcare professionals and the wider community. Some reported positive perceptions of dialectical behaviour therapy interventions, but these did not seem to affect symptoms of the disorder or mother–infant attachment. Conclusions The mechanism by which maternal borderline personality disorder affects poor obstetric and neonatal outcomes remains unclear. The parenting behaviours of mothers with borderline personality disorder and negative experiences of care may contribute to poorer outcomes. Implications for practice For some mothers with borderline personality disorder, group-based dialectical behaviour therapy appeared to offer benefit. However, there is limited research exploring the experiences of these mothers during the perinatal period.

Introduction: Intensive short-term dynamic psychotherapy (ISTDP) focuses on emotional processing and the resolution of internal conflicts. This randomized pilot and feasibility study evaluated the implementation of a novel 12-week group program based on ISTDP model, and compared clinical outcomes in reducing symptoms associated with personality vulnerabilities (e.g., emotion regulation, self-harm). The setting of the study was an Australian Public Hospital Service. Methods: Participants were referred to a brief intervention service for personality disorders and were randomly assigned to either the ISTDP group or the dialectical behavior therapy (DBT) group. Outcome measures included questionnaires assessing mood and distress, emotion dysregulation, disassociation, and DBT skill use. Feasibility outcomes, such as recruitment, attrition, and potential participants' experiences of the therapy, were also evaluated. Results: A total of 15 participants were recruited, with nine randomly allocated to the ISTDP group and six to the DBT group. Both groups showed improvements in clinical symptoms, including reductions in depression, emotion dysregulation, and dissociation. The ISTDP group also demonstrated a reduction in anxiety and stress. Follow-up surveys indicated that participants found both group interventions relevant, useful, and beneficial for managing their thoughts and emotions. Conclusion: Both the ISTDP and DBT interventions were well received by participants, and no adverse events were reported, further supporting their potential for implementation in public hospital settings and feasibility.

Borderline personality disorder (BPD) can be treated successfully with specific psychological treatments, but there is no clear evidence of superiority of one specific treatment at the group level. Due to high heterogeneity in BPD, individual patients might benefit differently from specific treatments. Based on a randomised trial comparing 18 months of dialectical behaviour therapy (DBT) and schema therapy (ST) for BPD, differential effectiveness was examined using causal forest analyses. Baseline variables on BPD criteria, general psychopathology, traumatic childhood experiences, rejection sensitivity, level of functioning, coping skills, schemas and medication were included to predict the Borderline Personality Disorder Severity Index (BPDSI-IV) during treatment and follow-up (24 and 30 months after start of treatment). A subgroup was identified that benefited significantly more from DBT compared to ST. This group showed a significantly greater reduction in symptoms post treatment (post-treatment difference of 5.79 BPDSI points, SMD=0.65, p=.028), but no longer at follow-up (p=.771). The group that showed better results with DBT displayed a pattern of specific baseline characteristics: higher levels of functioning, less frequent emotional neglect and sexual abuse, more severe anxiety symptoms and more pronounced schema 'failure to achieve'. No pattern of variables was identified associated with a superiority of ST. Moderators of the short-term effect of DBT versus ST were found. However, this moderator effect was no longer significant at follow-up. Identifying patient characteristics associated with differential treatment effect might be a promising way to improve BPD treatment outcomes faster. Retrospectively registered (German Clinical Trials Register: DRKS00011534) without protocol changes.

Research suggests that standalone dialectical behaviour therapy (DBT) skills training results in reduced emotion regulation difficulties, depression, and anxiety across various clinical populations. Although autistic individuals experience heightened emotion regulation difficulties compared to the general population, limited research is available on the effectiveness of DBT for autistic populations, particularly adapted DBT programmes to meet the specific needs of the autistic community. In this study, we aimed to examine the preliminary impact of a neurodiversity-affirming informed DBT group skills training programme (NDA-DBT) on emotion regulation difficulties, psychological distress, mindfulness and quality of life. We collected data from 12 participants using the Difficulties in Emotion Regulation Scale, Depression Anxiety and Stress Scale, Five Facet Mindfulness Questionnaire, and World Health Organization Quality of Life-Brief (WHOQOL-BREF). Preliminary results of the pilot study suggest decreased emotion regulation difficulties and psychological distress, increased mindfulness skills and improvement across the psychological and social quality of life domains. The results of this pilot study suggest that the NDA-DBT programme seems promising for reducing emotion regulation difficulties and psychological distress and increasing mindfulness skills. Future research on neurodiversity-affirming informed DBT will assist the autistic community in accessing psychological support adapted to their unique needs and challenges.

The business of recovery: A novel pilot study psychosocial intervention to build self-efficacy and reduce relapse risk in adolescent substance use treatment.

Borderline personality disorder

ABSTRACT Background Eating disorder (ED) symptoms are common in the general population and are often associated with childhood maltreatment (CM). Emotion regulation difficulties are likewise linked to both CM and ED symptoms, yet the role of cognitive emotion regulation strategies (CERS) in this relationship remains underexplored. Culturally specific forms of adversity, such as parental overprotection and overcontrol (OP–OC), have also been largely overlooked. Method This cross‐sectional study investigated whether adaptive and maladaptive CERS mediate the associations between six forms of CM and ED symptoms in a non‐clinical sample of 352 Turkish adults. Participants completed the Childhood Trauma Questionnaire–Expanded, the Eating Disorder Examination Questionnaire–Short Form, and the Cognitive Emotion Regulation Questionnaire. Mediation analyses were conducted using the PROCESS macro (Model 4) in SPSS v29. Results The results revealed that, except for physical abuse, maladaptive CERS significantly mediated the associations between all CM types and ED symptoms, with full mediation found for emotional neglect and sexual abuse. Although adaptive CERS did not mediate these relationships, their use was significantly lower among individuals exposed to emotion‐related maltreatment, including OP–OC. Discussion These findings underscore the potential of maladaptive CERS as early indicators and modifiable risk factors in subclinical populations. Tailoring emotion regulation components within interventions like Cognitive Behavioural Therapy–Enhanced (CBT‐E) and Dialectical Behaviour Therapy (DBT) may enhance efficacy, especially for trauma‐exposed individuals. Preventive psychoeducational programmes in youth and community settings could offer timely support before clinical symptoms emerge.

Stratified Stepped-Care for Reducing Suicide Attempts and Self-Harm in Youth: A Randomized Clinical Trial.

ABSTRACTNon‐suicidal self‐injury (NSSI) is a complex and often misunderstood behavior linked to emotional dysregulation, trauma, and substance use. In this case report we present a 19‐year‐old female with a history of childhood trauma and substance use, who engaged in self‐injurious behavior as a coping mechanism to manage distress and maintain sobriety. Through her narrative and clinical course, we explore the multifaceted drivers of NSSI, its diagnostic considerations, and therapeutic interventions including dialectical behavior therapy. This case report underscores the importance of trauma‐informed, individualized care and highlights emerging insights into the neurobiological underpinnings of self‐injury. This case advocates for early recognition, compassionate engagement, and integrated treatment approaches to support recovery.