Dialectical Behavior Therapy 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.

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

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

Perceived Change Processes in Dialectical Behaviour Therapy From the Perspective of Clients With a Diagnosis or Traits of Borderline Personality Disorder: A Systematic Literature Review.

To synthesise qualitative research on individuals diagnosed with (or reportedly showing traits of) borderline pattern personality disorder who underwent dialectical behaviour therapy, aiming to comprehend their perceptions of change processes and the therapy's effects. A comprehensive literature search was conducted across multiple online databases and grey literature sources. Papers were quality appraised using an adapted version of the Critical Appraisal Skills Programme tool. A metaethnographic approach was employed during the synthesis. Eleven studies met criteria for inclusion in the review. The main themes identified through the synthesis process were the impact of DBT, the supportive structure and the 1:1 therapy component. The synthesis uncovered the importance of various processes within DBT that patients perceived as active ingredients for their change. Many of these processes aligned with proposed theoretical processes of change and quantitative research on DBT's effectiveness.

변증법적행동치료 기술을 적용한 무용동작치료 프로그램이 학교 부적응 청소년의 자아존중감 향상에 미치는 영향

This study was conducted to examine qualitative changes in self-esteem and movement of research participants by providing a dance movement program applying dialectical behavior therapy techniques to school maladjusted adolescents. 12 first-year middle school students from Suwon were divided into an experimental group and a control group, with 6 students in each group. A short-term program was implemented twice a week for a total of 8 sessions. The program of this study applies the common factor of Dance Movement Therapy (DMT) and Dialectical Behaviour Therapy (DBT), which use a body-based therapeutic approach. The research question analyzed self-esteem and its subfactors, and a movement observation analysis was conducted accordingly to examine qualitative changes in the movements of the experimental group. As a result of the study, first, the dance movement therapy program applying dialectical behavior therapy techniques had a positive effect on improving the self-esteem of School maladjusted adolescents. Second, changes in movement showed improved social skills. This study has confirmed that a positive impact on the self-esteem of School-maladjusted adolescents, and it is hoped that future research will be encouraged using different treatment methods.

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) 2024 APA, all rights reserved).

The role of emotion dysregulation and interpersonal dysfunction in nonsuicidal self-injury during dialectical behavior therapy for borderline personality disorder

Dialectical Behaviour Therapy (DBT) is an evidence-based treatment for borderline personality disorder (BPD), with findings demonstrating improvements in various BPD features and related behaviours, such as nonsuicidal self-injury (NSSI). Theory and research suggest that reductions in emotion dysregulation and interpersonal dysfunction could account for at least some of the reduction in NSSI observed during the course of DBT. The current research investigated: 1) the trajectory of changes in emotion dysregulation, interpersonal dysfunction, and NSSI over the course of DBT, and 2) whether changes in emotion dysregulation mediate the relationship between changes in interpersonal dysfunction and changes in NSSI over treatment. One hundred and twenty individuals with BPD enrolled in a multi-site randomized-clinical trial were assessed at five timepoints over 12 months of standard DBT. Results indicated that interpersonal dysfunction and NSSI decreased over the course of DBT. Emotion dysregulation decreased in a quadratic manner such that most of the gains in emotion dysregulation occurred in earlier phases of DBT. Although changes in interpersonal dysfunction predicted changes in emotion dysregulation, changes in emotion dysregulation did not mediate the relationship between changes in interpersonal dysfunction and changes in NSSI.

The evaluation of a stepped care approach for early intervention of borderline personality disorder

BackgroundThe current study evaluated the stepped care approach applied in AtR!Sk; a specialized outpatient clinic for adolescents with BPD features that offers a brief psychotherapeutic intervention (Cutting Down Program; CDP) to all patients, followed by a more intensive Dialectical Behavioral Therapy for Adolescents (DBT-A) for those whose symptoms persist.MethodsThe sample consisted of 127 patients recruited from two AtR!Sk clinics. The number of BPD criteria, psychosocial functioning, severity of overall psychopathology, number of days with non-suicidal self-injury (NSSI; past month), and the number of suicide attempts (last 3 months) were assessed at clinic entry (T0), after CDP (T1), and at 1- and 2-year follow-up (T2, T3). Based on the T1 assessment (decision criteria for DBT-A: ≥ 3 BPD criteria & ZAN-BPD ≥ 6), participants were allocated into three groups; CDP only (n = 74), CDP + DBT-A (eligible and accepted; n = 36), CDP no DBT-A (eligible, but declined; n = 17).ResultsCDP only showed significantly fewer BPD criteria (T2: β = 3.42, p < 0.001; T3: β = 1.97, p = 0.008), higher levels of psychosocial functioning (T2: β = -1.23, p < 0.001; T3: β = -1.66, p < 0.001), and lower severity of overall psychopathology (T2: β = 1.47, p < 0.001; T3: β = 1.43, p = 0.002) over two years compared with CDP no DBT-A, while no group differences were found with regard to NSSI and suicide attempts. There were no group differences between CDP + DBT-A and CDP no DBT-A, neither at T2 nor at T3.DiscussionThe findings support the decision criterion for the offer of a more intense therapy after CDP. However, there was no evidence for the efficacy of additional DBT-A, which might be explained by insufficient statistical power in the current analysis.

Suicidal thoughts and self-destructive tendencies among adolescents

One must not ignore or underestimate it when adolescents say that they feel like a burden to those around them or that their life has no meaning. Suicidal thoughts in young people can be a signal of a threat to health or life or of a weakened mental condition. Increasing awareness of the frequent thoughts of giving up and the experience of a lack of meaning in life, characteristic of adolescents, helps to develop standards and preventive strategies in the field of mental health care. The article is an attempt to define terms related to suicide, data regarding the magnitude of the phenomenon among young people and discuss the causes of self-harm and suicide. It is also a reference to the approach of dialectical behaviour therapy (DBT), which considers, for example, emotional dysregulation and suicidal tendencies as a transdiagnostic problem. The characteristics of the transactional model in DBT emphasise that what is most important for a favourable prognosis is the provision of adequate support from the close environment, especially parents and professionals. Suicide prevention among children and adolescents is possible through scientific conferences, suicidological research and preventive programmes. Multidisciplinary cooperation to prevent suicidal intentions during childhood and adolescence is essential. In conclusion, as far as working with patients with emotional dysregulation and suicidal tendencies is concerned, the guiding motto of DBT should be stressed, which is to shape “a life worth living”.

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

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

Evaluation of dialectical behavior therapy for adolescents in routine clinical practice: a pre-post study

BackgroundSelf-harm and suicidal ideation are prevalent among adolescents, cause physical and psychosocial disability, and have potentially life-threatening consequences. Dialectical behavioral therapy for Adolescents (DBT-A) is an evidence-based intervention for reducing self-harm. However, few studies have investigated the effectiveness of DBT-A when delivered in routine clinical practice.MethodsA follow-up cohort study, based on data from a quality assessment register of DBT-A in child and adolescent mental health services including seven outpatient clinics. Inclusion criteria were ongoing or a history of self-harming behavior the last 6 months; current suicidal behavior; at least 3 criteria of DSM-IV Borderline personality disorder (BPD), or at least the self-destruction criterion of DSM-IV BPD, in addition to minimum 2 subthreshold criteria; and fluency in Norwegian. Participants received 20 weeks of DBT-A consisting of multifamily skills training groups and individual therapy sessions. Outcomes from 41 participants included frequency of self-harm, suicide attempts and hospitalizations caused by self-harm or suicide attempts, assessed pre-, during, and post-treatment by self-report and reviews of the patient’s medical records. Suicidal ideation, urge to self-harm and perceived feelings of happiness and sadness were assessed by the patients’ diary cards at week 1, 5, 10, 15 and 20 of the treatment program.ResultsParticipants attended an average of 17.9 (SD = 4.7) individual sessions, 14.7 (SD = 3.4) group-based skills training sessions and 4.6 (SD = 4.1) brief intersession telephone consultations. Moderate to large within-group effect sizes (ES) were found in self-harm from pre-treatment to 1–5 weeks (d = 0.64), 6–10 weeks (d = 0.84), 11–15 weeks (d = 0.99), 16–20 weeks (d = 1.26) and post-treatment (d = 1.68). Nine participants were admitted to hospitalization during DBT-A, whereas five had attempted suicide, but no suicides were completed. No statistically significant changes were found in suicidal ideation, urge to self-harm or perceived feelings of happiness or sadness from pre to post treatment.ConclusionThe findings of the current study are promising as the participants reported considerably reduced self-harm behavior after DBT-A treatment in a child and adolescent mental health outpatient setting.

Dialectical behavioral therapy for complex posttraumatic stress disorder (DBT-PTSD): an evidence-based disorder-specific treatment program

Dialectical behavioral therapy for complex posttraumatic stress disorders (DBT-PTSD) is amodular treatment program that was developed at the Central Institute for Mental Health at the University of Heidelberg, Germany in 2005-2021. DBT-PTSD is designed to meet the needs of patients with complex PTSD related to sexual or physical trauma in childhood and adolescence. It is specifically designed for patients suffering from severe emotional dysregulation, persistent self-injury, chronic suicidal ideation, severe dissociative symptoms and amarkedly negative self-concept with a high level of guilt, shame, self-loathing and interpersonal problems. To address these different core symptoms, DBT-PTSD combines evidence-based therapeutic strategies: principles, rules, and skills of DBT, trauma-specific cognitive and exposure-based techniques, imaginative interventions and procedures for behavioral change. The treatment program is designed to be carried out in an outpatient (45weeks) or residential (12weeks) setting. The results from two randomized controlled trials showed large effect sizes across very different symptom domains and a significant superiority of DBT-PTSD over Cognitive Processing Therapy (CPT). Based on these results, DBT-PTSD is currently a promising evidence-based treatment program for all features of a complex PTSD after sexual abuse in childhood and adolescence.

Supplemental Material for 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

Supplemental Material for 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

An Integrated Therapeutic Application Using Elements of Cognitive Behavioral Therapy and Mindfulness-based Cognitive Therapy in Treatment of Panic Disorder

The commonly used protocol for the treatment of panic disorder has been the application of cognitive behavioral therapy (CBT). With the advent of third-wave psychotherapies such as acceptance and commitment therapy, dialectical behavioral therapy, and mindfulness-based cognitive therapy (MBCT), which focuses on experiential acceptance, there have been variations in the treatment of panic disorder. However, no case report has adopted an integrated treatment protocol using elements of CBT and MBCT. Here, we have presented a practical psychotherapy report of a 31-year-old woman who was treated over 16 sessions using such an integrated treatment protocol based on her personality and clinical profile. During the first phase of treatment, components of CBT were introduced to help her obtain firsthand evidence of her catastrophic misinterpretation of bodily sensations and to change her underlying threat schemas related to physical sensations. Aspects of MBCT were implemented in the intermediate phase to allow awareness and observation of her anxiety sensitivity, discourage immediate reactivity, and reduce overall catastrophizing tendencies. Moreover, MBCT also served to prevent relapse by enriching her overall quality of life by cultivating present-moment awareness through encouraging full engagement in experiences rather than being consumed by future-oriented concerns.

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

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

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

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

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

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

The Role of Cognitive Reappraisal Strategies in Modulating Traumatic Memories

Cognitive reappraisal is a cognitive-behavioral technique that plays a crucial role in modulating emotional responses to traumatic memories, especially in clinical settings treating disorders such as post-traumatic stress disorder (PTSD) and borderline personality disorder (BPD). This paper provides an in-depth exploration of the integration of cognitive reappraisal into therapeutic modalities, including Cognitive-Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT). It examines the empirical evidence supporting the efficacy of cognitive reappraisal, discusses the challenges and considerations in its clinical application, and highlights the necessity for tailored approaches to enhance therapeutic outcomes. The systematic review of literature reveals that cognitive reappraisal significantly reduces emotional distress and improves psychological functioning, with neurobiological evidence showing changes in brain activity related to emotion processing. Despite its benefits, the effective implementation of cognitive reappraisal faces challenges such as therapist training, patient resistance, cultural considerations, and the need for integration with other therapeutic techniques. Addressing these challenges is essential for maximizing the effectiveness of cognitive reappraisal in therapy. This paper underscores the potential of cognitive reappraisal to transform therapeutic practices and enhance mental health care for individuals experiencing trauma-related disorders.

Psychotherapy and Treatment-Resistant Depression

Treatment-resistant depression (TRD) describes those who have not responded to at least two other treatments for depression. These individuals require additional support to reach remission of their symptoms. Psychotherapy modalities can be a way to augment treatment of depression without additional medications. This article discusses the use of interpersonal therapy, dialectical behavioral therapy, radically open dialectical behavioral therapy, cognitive-behavioral therapy, and intensive short-term dynamic psychotherapy. All of these therapies can achieve increased rates of remission and improvement of depressive symptoms when compared to treatment as usual. No significant adverse events have noted in the studies that have looked at these various treatments. Areas for future research include delineation of which specific modalities are best suited to addressing the needs of individual patients. As part of a comprehensive treatment plan, psychotherapy should be considered when addressing TRD. [ Psychiatr Ann . 2024;54(6):e182–e185.]

Unraveling Relapse in Male Forensic Psychiatric Patients with Substance Use Disorders—The Impact of Social, Psychiatric, and Personality Factors Post Long-Term Remission

AbstractSubstance use disorder, labelled a chronic relapse condition by the WHO, remains challenging to address with limited progress in effective relapse prevention measures. Scientific evaluation is hindered by cost, but an opportunity arises in the German forensic psychiatric setting governed by § 64 of the German criminal code. Here, patients undergo two-year multi-modal therapy followed by up to five years of supervised oversight post-release. This retrospective study analyzed legal and medical records, revealing key determinants of relapse, including emotional stress, social activities, personality disorder diagnosis, inpatient treatment relapse, age at first conviction, and loss of motivation. Surprisingly, social factors like family and work status, living situation at discharge, and dialectical behavioral therapy during admission showed no impact, nor did index crime type. Polysubstance use, except for cannabinoids and psychostimulants other than cocaine, increased relapse probability. Multiple inpatient pretreatments were insignificant predictors. A generalized linear model highlighted substance use during inpatient treatment, personality disorder, and previous convictions as most central predictors of post-discharge relapse, challenging conventional notions and informing effective substance use disorder management.

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

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