Dialectical Behavior Therapy Skills Research Articles

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.

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.

Machine learning prediction of mental health strategy selection in school aged children using neurocognitive data

This study investigates the use of neurocognitive data collected via functional near infrared spectroscopy (fNIRS) for the development of predictive algorithms related to client Dialectical Behavior Therapy (DBT) skill use in Digital Counseling Environments (DCEs). Specifically, the aim of this study is to examine the utility of using neurocognitive data in combination with a machine learning algorithm to predict client selection of strategies in a virtual environment. Participants were recruited from a rural school located in the United States (n = 50). Student participants engaged in one of three DBT skill development conditions: time-delay-control, face-to-face, and virtual reality-based. Neurocognitive responses in the form of ratios of oxygenated and deoxygenated blood in neural tissue (hemodynamic response) were collected during the learning phase within each condition. The data was then used to train and develop a model to predict the success of client selection of DBT strategies when presented with the opportunity in an assessment phase. The average predictive accuracy of the resultant algorithm was ∼83%. Results also illustrated the potential to capture changes in cognition via hemodynamic response as they occur during DBT skill development in near real-time (∼300 ms). Findings from this study illustrate that the use of neurocognitive data in DCEs may be used to successfully predict client outcomes and increase the quality and reliability of counselor assessments of client progress, aid in the development of artificially intelligent counselors, and improve counselors use of client-based analytics in face-to-face and digital counseling environments.

Target-user preferences, motivations, and acceptance for a dialectical behaviour therapy smartphone application for eating disorders

PurposeEvidence shows that dialectical behavioural therapy (DBT) is efficacious for eating disorders (ED), yet few people have access to specialized treatments like DBT. Translating key DBT skills for delivery via a smartphone application may broaden the dissemination of evidence-based interventions. However, prior to developing a DBT-based app, it is crucial to gather information on target-user needs and preferences. Assessing overall acceptance and identifying predictors of acceptance, informed by the UTAUT framework, is also important. This process ensures not only a demand for such an app, but also that users receive content and features tailored to their needs.MethodThis study aimed to understand target-user preferences of DBT-based apps for EDs by assessing willingness to engage, overall acceptance levels, and preferred functionality/content delivery modes (n = 326 symptomatic participants).ResultsEighty-eight percent indicated they would be willing to use a DBT-based ED app if it were available. Acceptance levels of a DBT app were high (64%), which was uniquely predicted by performance expectancy (perceptions of how beneficial an intervention is) and facilitating conditions (expectations of technological infrastructure and support in interventions) in path analysis. Content perceived as important to contain were emotion regulation techniques, tailored intervention strategies, and psychoeducation.ConclusionFindings generate important information about target-user preferences of a DBT-based app for EDs, highlighting necessary design principles for apps of this kind.Level of evidence Level V, cross-sectional descriptive study.

Effectiveness of an online dialectical behavior therapy skills training in adults with attention-deficit/hyperactivity disorder: A randomized controlled trial

Objective The current study aims to examine the efficacy of an add-on dialectical behavior therapy skills training (DBT-ST) on adult attention-deficit/hyperactivity disorder (ADHD). The DBT-ST was applied online under the pandemic conditions that occurred after the study had started. Methods The current randomized controlled trial consists of an intervention group to whom the DBT-ST was applied in online setting and a waitlist control group who received treatment as usual (TAU). Data were collected pre-, post-, and mid-treatment. ADHD symptoms (with the sub-dimensions of inattention and hyperactivity), impulsivity, mindfulness, difficulty with emotion regulation, interpersonal effectiveness, distress tolerance, life satisfaction, functionality in daily life, and general psychological symptom levels were measured with self-report scales. The data were analyzed using mixed-design ANOVA. Results The global ADHD, inattention, and hyperactivity symptoms of the DBT-ST group significantly decreased more than those in the TAU control group. The DBT-ST group also showed a significant decrease regarding difficulty with emotion regulation and increases in life satisfaction and functionality, though the group × time effect was not significant. Conclusion DBT-ST was found effective against the participants’ ADHD symptoms. The treatment was additionally found to improve their emotion regulation and quality of life. Further investigation is needed to investigate DBT-ST in an online setting.

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.

변증법적 행동치료 기술훈련 집단상담 경험에 대한 근거이론 연구

Objectives The purpose of this study is to explore the experiences and changes of participants in a Dialectical Behavior Therapy(DBT) skills training group counseling.&#x0D; Methods To do this, a 12-week DBT skills training group counseling was conducted for 11 graduate students, and data from participant reflections recording data and reports were collected for each session, and analyzed using a grounded theory approach. The open coding, axis coding, process analysis and selective coding was conducted.&#x0D; Results The analysis resulted in a total of 154 concepts, 43 subcategories, and 19 categories. The central phe-nomena that emerged were ‘self-awareness and hope’ and ‘will for growth,’ while causal conditions included ‘emotional difficulties,’ ‘cognitive difficulties,’ ‘behavioral difficulties,’ and ‘self-identity difficulties.’ Contextual conditions encompassed ‘hesitancy about group participation,’ ‘confronting one's own inadequacies,’ and ‘difficulties in applying the skills.’ Mediating conditions included ‘group cohesion’ and ‘positive interactions within the group.’ Action/interaction strategies involved ‘opening the heart’ and ‘trying,’ and the outcomes included ‘e-motional change,’ ‘cognitive change,’ ‘behavioral change,’ ‘self-identity change,’ and ‘interpersonal relationship change.’ Process analysis revealed the stages of DBT skills training group counseling as ‘facing pain and in-adequacy,’ ‘willingness for change,’ ‘self-disclosure and mutual encouragement,’ ‘effort,’ and ‘growth and change.’&#x0D; Conclusions The study confirmed the group counseling experience and positive changes of the DBT skills training group counseling participants.

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.

Comparison of the Effectiveness of Dialectical Behavior Therapy Skills Training (DBT-ST) and Mindfulness-Based Cognitive Therapy (MBCT) on Cognitive Emotion Regulation in Individuals with Symptoms of Borderline Personality Disorder

Objective: Borderline Personality Disorder (BPD) is the most common personality disorder in psychiatric settings and one of the disorders that causes the most harm to individuals. The aim of the present study was to compare the effectiveness of Dialectical Behavior Therapy Skills Training (DBT-ST) and Mindfulness-Based Cognitive Therapy (MBCT) on cognitive emotion regulation in individuals with symptoms of Borderline Personality Disorder. Methods and Materials: This research was a semi-experimental study, utilizing a pre-test, post-test design with a control group and a follow-up period. The statistical population included all clients aged 18 to 45 who referred to counseling centers in the city of Sari during the first half of 2022 and had files. From all these individuals, those willing to cooperate were selected through purposive non-random sampling, resulting in a sample of 45 participants. These individuals were then randomly assigned to three groups (Group 1: Dialectical Behavior Therapy Skills Training, n = 15; Group 2: Mindfulness-Based Cognitive Therapy, n = 15; and Group 3: Control group, n = 15). Data collection was conducted using the Cognitive Emotion Regulation Questionnaire by Garnefski et al. (2001). The Dialectical Behavior Therapy Skills Training group (2003) participated in 12 weekly 90-minute group sessions, and the Mindfulness-Based Cognitive Therapy group (2002) participated in 8 weekly 90-minute group sessions. Data were analyzed using repeated measures ANOVA. Findings: The results indicated that Dialectical Behavior Therapy Skills Training and Mindfulness-Based Cognitive Therapy were effective on cognitive emotion regulation in individuals with symptoms of Borderline Personality Disorder (P = 0.001). There was a significant difference in the effectiveness of Dialectical Behavior Therapy Skills Training and Mindfulness-Based Cognitive Therapy on cognitive emotion regulation between the experimental groups and the control group. Conclusion: Based on the results of this study, it can be concluded that Dialectical Behavior Therapy Skills Training and Mindfulness-Based Cognitive Therapy, through individuals' cognitive coping strategies, can lead to improvements in psychological indicators and enhancement of mental health in individuals with symptoms of Borderline Personality Disorder.

Comparing the Effectiveness of Acceptance and Commitment Therapy (ACT) and Dialectical Behavior Therapy Skills Training (DBT-ST) on Self-Care and Psychological Well-being in Patients with Type 2 Diabetes

Objective: Diabetes is a chronic, multifaceted, threatening disease with significant psychological consequences. The present study aimed to compare the effectiveness of Acceptance and Commitment Therapy (ACT) and Dialectical Behavior Therapy Skills Training (DBT-ST) on self-care and psychological well-being in patients with Type 2 diabetes. Methods and Materials: The present study was a quasi-experimental, pre-test-post-test with a control group design. The population included all patients with Type 2 diabetes visiting a medical clinic in the city of Sari, among whom 45 were conveniently selected and randomly assigned into two experimental groups (Acceptance and Commitment Therapy and Dialectical Behavior Therapy Skills Training) and one control group. Data were collected using the Self-Care Questionnaire (Toobert et al., 2000), and the Psychological Well-being Scale (Ryff &amp; Keyes, 1995) at three stages: pre-test, post-test, and follow-up, and were analyzed using analysis of variance with repeated measures. Findings: The results showed that both Dialectical Behavior Therapy Skills Training and Acceptance and Commitment Therapy were effective on the scores of self-care and psychological well-being. However, the effect of Acceptance and Commitment Therapy was greater than that of Dialectical Behavior Therapy Skills Training on the scores of self-care and psychological well-being. Conclusion: Based on the results of this study, it can be stated that Acceptance and Commitment Therapy and Dialectical Behavior Therapy Skills Training, through cognitive coping strategies, can lead to the improvement of psychological indicators and enhance the mental and physical health of patients with Type 2 diabetes.

The Psychotherapy Practice of Dialectical Behavior Therapy Group Skills Training in Indonesia: An Indonesian Language Module Development

Introduction: There is an increasing number of suicides in Indonesia. A high risk of suicide is often associated with borderline personality disorder (BPD). To address this issue, dialectical behavior therapy (DBT) has been specifically designed for patients with frequent suicidal behavior and BPD. This study aims to develop DBT skills modules in Indonesian language for groups therapy and implement in clinical practice.Methods: This research was conducted in three stages. Stage 1 involved preparing the DBT skills module for 13 weeks, including the adding of TIPP (Temperature, Intense exercise, Paced Breathing, Paired Muscle Relaxation) distress tolerance skills and chain analysis. Stage 2 focused on module validation using face validity and content validity assessment conducted by two psychotherapy consultants. Stage 3 involved modules trials, both of whom had completed DBT training, practicing the prepared modules with two groups of 10 patients.Result: The face validity scores from the two experts for the DBT module on BPD in Indonesian was 3.188, indicating a high level of correctness. The content validity results from the two experts for the DBT module on BPD in Indonesian language were 84.06, indicating that almost everything was done correctly. After practicing DBT group skills training, two psychotherapists achieved a very good interrater score of 0.969 (p=0.003; 95% CI 0.746-0.997).Conclusion: Based on the face validity and content validity scores by the two experts, it was concluded that the DBT module for BPD in Indonesian language is suitable for use in clinical services.

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).

Effectiveness of internet-delivered dialectical behavior therapy skills training on executive functions among college students with borderline personality traits: a non-randomized controlled trial.

Given the enormous influence of emotions on cognitive processes, individuals with borderline personality disorder (BPD) suffer from marked deficits in higher-order thinking abilities. Considering the prevalence of BPD among college students, this study aimed to investigate the changes in perceived executive functioning among college students with traits/presence of BPD undergoing internet-delivered dialectical behavior therapy skills training (DBT-ST) that included the mindfulness and emotion regulation modules. An internet-delivered version of DBT-ST was opted for, as technological advancements in the present era promote the use of online platforms for psychotherapy. This non-randomized controlled trial consisted of 36 college students with traits/presence of BPD. The intervention group attended 13 sessions of DBT-ST, and the control group attended 13 sessions of behavioral activation. Perceived executive functioning was assessed using the Behavior Rating Inventory of Executive Functions for Adults. A 2-way repeated measures analysis of variance was used to evaluate the treatment impact on the outcome variable. Results showed that the DBT-ST group had larger improvements in their abilities to initiate, plan, and organize current and future-oriented task demands and to organize their everyday environment, compared to the control group. Both, the DBT-ST group and the control group demonstrated improvements in emotional control, working memory, and their abilities to shift and task monitor. Findings suggest that the internet-delivered version of DBT-ST, consisting of the mindfulness and emotion regulation modules, can foster notable improvements in executive functions among college students with traits/presence of BPD. Improved executive functioning is one of the several multifaceted outcomes of dialectical behavior therapy.

Developing the social and emotional competence of adolescents through implementation of the STEPS-A curriculum

AimsThis research explores the curriculum, Dialectical Behaviour Therapy (DBT)Skills in Schools: Skills Training for Emotional Problem Solving for Adolescents (STEPS-A)(Mazza et al., 2016). It aims to trial STEPS A, exploring its impact on Social Emotional Learning (SEL), in addition to understanding facilitative implementation conditions for the programme.RationaleThe rationale for the study lies within the potential of the programme to be a universally accessible tool for change in nurturing the SEL of adolescents within the secondary school context.MethodsUsing a mixed method case study design, six sessions were delivered in two mainstream mixed secondary comprehensive schools to key stage three groups by trained staff facilitators. Focus groups were carried out, alongside the Child and Adolescent Mindfulness Measure (CAMM) (Greco, Baer, &amp; Smith, 2011) and the Difficulties in Emotion Regulation Scale – Short Form (DERSF-SF) (Kaufman et al., 2016) pre and post intervention.FindingsData informed the development of an implementation framework, alongside a consultation tool for EPs to support STEPS-A planning in schools. Impact results are promising; mixed ANOVAs revealed two significant and two non-significant time* intervention interactions. Follow up t tests demonstrated intervention group changes in mindfulness and emotional regulation skills in schools 1 and 2 respectively.ImplicationsThe study has implications for the adoption of the STEPS A curriculum to support SEL within secondary schools, whereby school staff are actively supported by EPs to use an implementation framework to maximise efficacy. The encouraging impact findings provide psychological and ethical weight to the use of the framework.LimitationsDue to a small sample size and short intervention period, the need for replication of the quantitative results with a larger sample over a longer period is acknowledged. The implementation framework requires validation across contexts.ConclusionsThe study found that the STEPS-A programme, the first curriculum-based DBT programme designed to be taught in schools by teachers, was well-received by participants. It indicates that, within the context of empirically supported implementation conditions, skills which were initially designed for teaching to clinical populations as part of a comprehensive therapy programme have value and can potentially effect change for adolescents with and without additional identified needs.

Feasibility and Efficacy of Intensive Dialectical Behavior Therapy Skills Training in An Outpatient Setting for A Group of Patients with Extensive Care Needs - A Transdiagnostic Approach

PurposeDialectical behavior therapy (DBT) is a treatment originally developed för chronically suicidal adults. It is common to adapt it by using one specific component, the DBT skills training (DBT-ST) and apply it in a group therapy setting for a variety of mental disorders. The primary aim of the study was to explore whether patients with extended care needs would report improved mental health after participating in an intensive form of DBT-ST. The secondary aim was to explore whether the use of psychiatric inpatient care for the group would decrease.MethodsThirty-seven participants completed the Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM), and visual analogue scale (VAS) at three time points: pre-intervention, post-intervention and at 6-month follow-up after intensive DBT-ST. ResultsOne-way ANOVA showed a significant effect for time on the CORE-OM: F (2,35) = 7.93, p = .001, η2 = 0.312 (large effect size). Post hoc tests indicated a significant difference between pre-intervention and post-intervention (p = .001) and between pre-intervention and follow-up (p = .01). A Friedman test indicated a statistically significant difference in the VAS scale scores across the three time points, with p-values between 0.00 and 0.05. There was no difference in psychiatric healthcare consumption.ConclusionThese study results confirm to some extent the feasibility and effectiveness of the intensive DBT-ST in a transdiagnostic clinical setting. The participants had a positive outcome from the skills training program, but psychiatric healthcare consumption did not decrease.

Investigating the efficacy of a Dialectical behaviour therapy-based universal intervention on adolescent social and emotional well-being outcomes

There is increasing research interest as to whether Dialectical Behaviour Therapy (DBT), specifically the group skills training component, is an effective early intervention approach when delivered universally in schools. The current study aimed to provide the first large-scale examination of a universal DBT-based intervention and to also determine the extent to which home practice of DBT skills predicted changes in social and emotional outcomes over time. A non-randomised controlled trial design was employed whereby 1071 participants (51.30% Male; M age = 13.48 years) completed either an adapted eight-session DBT skills-training intervention (‘WISE Teens) (n = 563) or class-as-per-usual (n = 508). On average, the ‘WISE Teens’ intervention did not improve outcomes with significant deteriorations or null effects observed across outcomes relative to class-as-per-usual immediately post-intervention. The largest deteriorations were observed for depressive (d = −0.22; 95% CI = −0.35, −0.08) and anxiety symptoms (d = −0.28; 95%CI - = −0.41, −0.14). Applying Bonferroni corrections, most group differences in outcomes had dissipated at follow-up, however, ‘WISE Teens’ participants continued to report significantly poorer quality of parent-child relationships relative to control (d = .16 for mother (95% CI = 0.01, 0.31); d = 0.17 for father (95% CI = 0.02, 0.33). While home practice was modest on average, further exploratory analyses nevertheless revealed that greater home practice was generally associated with more positive outcomes both immediately post-intervention and at follow-up. Based on these findings, the DBT-based ‘WISE Teens’ intervention is not recommended in its current format for universal dissemination amongst early adolescents in schools. Further research is needed to determine how to improve engagement and feasibility of delivery of DBT-based interventions universally in this context.

53 Adolescent Dialectical Behaviour Therapy: Levels of Care

Abstract Introduction/Background A growing body of research supports the efficacy of Dialectical Behavioural Therapy (DBT) for adolescents with various mental health diagnoses, but a traditional DBT program uses intensive resources (weekly individual and group therapy). To see whether a less intensive program could benefit certain participants, a complementary program called “DBT Lite” was designed and implemented at a large acute care Children’s Hospital. The group format (youth and parents together), therapeutic principals and coping skills taught were the same (based on “DBT Skills Manual for Adolescents”, Miller &amp; Rathus, 2014), but DBT Lite involved only group therapy, and was offered over a shorter time frame (12 weeks vs. 19 weeks). Objectives The purpose of this study was to compare the effectiveness of “DBT Full” and “DBT Lite” on improving emotion regulation and family functioning/parental stress and decreasing emergency department (ED) visits and hospitalizations among adolescents age 13-17 with mental health diagnoses. Participants were not randomized; the treatment was selected according to severity of illness. We hypothesized that both treatment programs would show benefits but that “Full DBT” would result in greater improvements than “DBT Lite” due to its more comprehensive treatment model. Design/Methods Data was collected prospectively pre- and post-treatment from youth and parents participating in both programs over a 3-year period. The primary outcome measures were the DERS (Difficulties in Emotion Regulation Scale), the FACES-IV (Family Adaptability and Cohesion Scale, 4th Ed), and the PSS (Parental Stress Scale). Results were analyzed using paired-sample t-tests. We also examined ED and hospital admission data 6 months prior to starting the group and 6 months following completion of the group. Results In “Full DBT”, emotion regulation improved in both youth (n=9) and parents (n=12) post-treatment (DERS total score: youth p=0.02; parents p=0.01). Parents reported significant improvements on measures of parental stress (PSS p=0.002), and family functioning (FACES-IV family communication p=0.000, satisfaction p=0.008, and overall family functioning p=0.002). However, these improvements were not significant in youth measures. In “DBT Lite”, youth (n=16) and parents (n=17) did not report significant improvements in emotion regulation or family functioning, but did report decreases in parental stress (PSS p=0.005). Both groups resulted in measurable differences in acute care use: the percentage of patients with ED presentations 6 months pre- vs. 6 months post-group decreased from 70% to 27% for “Lite”, and 81% to 50% for “Full”. The percentage of patients requiring hospital admission decreased from 13% to 10% for “Lite”, and 56% to 28% for “Full”. Conclusion These results suggest that although “DBT Lite” may not have the same family functioning and emotion regulation benefits as its full-service counterpart, it can still reduce parental stress and decrease use of acute care resources. This study confirms the patient and family benefits of a full DBT program, but also has important implications for centres with limited mental health resources, given that “Full DBT” requires 38 clinician hours per patient to deliver, versus 12 hours for “DBT Lite”.

Protocol for a randomized control trial of the Building Regulation in Dual Generations Program (BRIDGE): preventing the intergenerational transmission of mental illness in at-risk preschool children

BackgroundSince the onset of the COVID-19 pandemic, the worldwide prevalence of maternal depression has risen sharply; it is now estimated that one quarter of mothers experience clinically significant depression symptoms. Exposure to maternal depression during early childhood increases the risk for the development of childhood mental illness (MI) in offspring, with altered parenting practices mediating the association between maternal depression and child outcomes. Dual-generation interventions, which aim to simultaneously treat parent and child mental health, show promise for improving outcomes for mothers with depression and their young children. The Building Regulation in Dual Generations (BRIDGE) program combines Dialectical Behavior Therapy (DBT) and parenting skills training to concurrently treat maternal depression and improve parenting practices. In pilot within-group studies, BRIDGE has led to large reductions in maternal depression and child MI symptoms. The aim of the current study is to evaluate the efficacy of BRIDGE in reducing maternal depression and child MI symptoms (primary outcomes) as well as parenting stress and harsh parenting (secondary outcomes).MethodsA three-armed randomized control trial with equal group sizes will be conducted to compare the efficacy of (1) BRIDGE (DBT + parenting skills), (2) DBT skills training, and (3) services-as-usual. Participants (n = 180) will be mothers of 3- to 5-year-old children who report elevated depression symptoms. Those randomized to BRIDGE or DBT skills training will complete a 16-week group therapy intervention. Assessments will be administered at pre-intervention(T1) post-intervention (T2), and 6-month follow-up (T3).DiscussionDual-generation programs offer an innovative approach to prevent the intergenerational transmission of mental illness. The current study will add to the evidence base for BRIDGE by comparing it to a stand-alone mental health intervention and a services-as-usual group. These comparisons will provide valuable information on the relative efficacy of including parenting support in a mental health intervention for parents. The results will contribute to our understanding of how maternal depression affects children’s development and how intervening at both a mental health and parenting level may affect child and family outcomes.Trial registrationName of registry: Clinical Trials Protocol Registration and Results System; trial registration number: NCT05959538; date of registry: July 24, 2023; available: https://classic.clinicaltrials.gov/ct2/show/NCT05959538