Dialectical Behavior Therapy with Transitional Youth

Background: Bipolar II disorder (BD-II) is a chronic mental illness with recurrent episodes of depression that causes emotional disorders in patients. Objectives: The present study aimed to investigate the effects of Emotional Schema Therapy (EST) and Dialectical Behavior Therapy (DBT) on psychological distress and cognitive-behavioral avoidance in patients with BD-II. Methods: This study was carried out using a quasi-experimental pretest-posttest design with a control group. The study population consisted of all patients with BD-II visiting the counseling centers in Dezful, Iran, in 2021, and the research sample included 45 eligible individuals selected using purposive sampling. The patients were randomly assigned to two intervention groups and one control group (n = 15 per group). The participants in the first and second intervention groups attended eleven 90-minute sessions of EST and DBT, respectively. However, those in the control group were placed on the waiting list. The research instruments included the Kessler Psychological Distress Scale (K10) and the Cognitive-Behavioral Avoidance Scale. The data were analyzed using analysis of covariance (ANCOVA) and Bonferroni post hoc test in SPSS software (version 26). Results: According to the results, there was a significant reduction in levels of psychological distress and cognitive-behavioral avoidance among the participants of the EST and DBT groups, compared to those in the control group (P < 0.001). Conclusions: Emotional Schema Therapy and Dialectical Behavior Therapy reduced psychological distress and cognitive-behavioral avoidance in patients with BD-II. Therefore, therapists and health professionals can use EST and DBT interventions, along with other effective therapeutic approaches, to reduce psychological distress and cognitive-behavioral avoidance in patients with BD-II.

Suicide is a leading cause of death among 10- to 24-year-old individuals in the United States; evidence on effective treatment for adolescents who engage in suicidal and self-harm behaviors is limited. To evaluate the efficacy of dialectical behavior therapy (DBT) compared with individual and group supportive therapy (IGST) for reducing suicide attempts, nonsuicidal self-injury, and overall self-harm among high-risk youths. This randomized clinical trial was conducted from January 1, 2012, through August 31, 2014, at 4 academic medical centers. A total of 173 participants (pool of 195; 22 withdrew or were excluded) 12 to 18 years of age with a prior lifetime suicide attempt (≥3 prior self-harm episodes, suicidal ideation, or emotional dysregulation) were studied. Adaptive randomization balanced participants across conditions within sites based on age, number of prior suicide attempts, and psychotropic medication use. Participants were followed up for 1 year. Study participants were randomly assigned to DBT or IGST. Treatment duration was 6 months. Both groups had weekly individual and group psychotherapy, therapist consultation meetings, and parent contact as needed. A priori planned outcomes were suicide attempts, nonsuicidal self-injury, and total self-harm assessed using the Suicide Attempt Self-Injury Interview. A total of 173 adolescents (163 [94.8%] female and 97 [56.4%] white; mean [SD] age, 14.89 [1.47] years) were studied. Significant advantages were found for DBT on all primary outcomes after treatment: suicide attempts (65 [90.3%] of 72 receiving DBT vs 51 [78.9%] of 65 receiving IGST with no suicide attempts; odds ratio [OR], 0.30; 95% CI, 0.10-0.91), nonsuicidal self-injury (41 [56.9%] of 72 receiving DBT vs 26 [40.0%] of 65 receiving IGST with no self-injury; OR, 0.32; 95% CI, 0.13-0.70), and self-harm (39 [54.2%] of 72 receiving DBT vs 24 [36.9%] of 65 receiving IGST with no self-harm; OR, 0.33; 95% CI, 0.14-0.78). Rates of self-harm decreased through 1-year follow-up. The advantage of DBT decreased, with no statistically significant between-group differences from 6 to 12 months (OR, 0.65; 95% CI, 0.12-3.36; P = .61). Treatment completion rates were higher for DBT (75.6%) than for IGST (55.2%), but pattern-mixture models indicated that this difference did not informatively affect outcomes. The results of this trial support the efficacy of DBT for reducing self-harm and suicide attempts in highly suicidal self-harming adolescents. On the basis of the criteria of 2 independent trials supporting efficacy, results support DBT as the first well-established, empirically supported treatment for decreasing repeated suicide attempts and self-harm in youths. ClinicalTrials.gov Identifier: NCT01528020.

BackgroundDialectical behavior therapy (DBT) is a first‐line treatment for the prevention of suicide. Zhong‐Yong thinking could be viewed as a Chinese way of dialectical thinking, has long been a culturally dictating thinking style in China. To enhance cultural adaptability, we integrated Zhong‐Yong thinking into DBT group skills training and examined its efficacy in suicidal prevention compared with a supportive group therapy and a wait‐list group in high‐risk suicidal Chinese college students.MethodsA total of 97 suicidal participants were randomized to either Zhong‐Yong thinking based DBT group skills training (DBTZYT, n = 33), or supportive group therapy (SGT; n = 32), or wait‐list group (WL; n = 32). DBTZYT was a 12‐week program based on Zhong‐Yong thinking instead of dialectical thinking, coaching participants mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. Supportive group therapy was a 12‐week program aiming at improving interpersonal effectiveness and emotion regulation skills. Outcome measures were assessed at pre‐ and post‐treatment and 6‐month follow‐up.ResultsAt post‐treatment measures, the levels of suicidal ideation, hopelessness, psychache symptoms, and general psychopathology had significantly decreased in both intervention groups; at the 6‐month follow‐up measures, the intervention effects were better maintained in the DBTZYT group rather than in the SGT group. Specifically, DBTZYT was more effective in relieving participants’ long‐term obsessive‐compulsive, anxiety, hostility, phobic, psychotic, and additional symptoms.ConclusionsZhong‐Yong thinking not only could integrate with DBT skills training in Chinese young adult population, but also has special strength in enhancing DBT’s efficacy.

Dialectical behavior therapy (DBT) has demonstrated effectiveness for a range of emotional difficulties, and DBT skills training groups may be necessary to produce symptom change. However, it is unclear how skills training groups influence outcomes. Specifically, is participation in DBT skills modules associated with general effects (i.e., changes in multiple domains) or domain-specific effects (i.e., changes in the conceptually relevant domain)? Participants recruited from a university training clinic (n = 87; 75.9% diagnosed with borderline personality disorder) participated in standard DBT for 6 months. We conducted hierarchical linear mixed models to test whether self-reported changes in emotion regulation, interpersonal problems, and distress tolerance were associated with the specific DBT module intended to target that outcome. In 3 models, we regressed end-of-module ratings of each of our measures of interest on (a) premodule ratings of each measure of interest, (b) time, and (c) dummy-coded module completed. Although all modules were associated with similar reductions in emotion dysregulation, the Emotion Regulation module was associated with the greatest improvements in both interpersonal problems and distress tolerance. In contrast, the first skills module completed was unrelated to changes in any of these domains. These results suggest that Emotion Regulation skills are associated with improvements in patient symptoms across relevant domains and offer potential directions for optimizing the delivery of DBT. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Trichotillomania is a mental disorder characterized by recurrent and irresistible urges to pull out hair from the body. The present study aimed to elucidate the effectiveness of dialectical behavior therapy on impulsivity, emotion regulation, rumination, and self-criticism in individuals with trichotillomania. From an objective standpoint, this study is considered applied research and, methodologically, a quasi-experimental study with a pre-test, post-test, and follow-up test design, including a control group with a 2-month follow-up period. The population of this research included all individuals with trichotillomania in districts 2 and 4 of Tehran, from whom 18 persons for each group were selected through purposive non-random sampling and were randomly assigned to either the experimental or control group. The instruments used in this research included the Massachusetts Hair Pulling Questionnaire, Williams and colleagues' (1997) Emotion Regulation Scale, Barratt and colleagues' (1990) Impulsivity Scale, Gilbert and colleagues' (2004) Self-Criticism Scale, and Nolen-Hoeksema and colleagues' (1991) Rumination Scale. The dialectical behavior therapy intervention was conducted over 8 one-hour sessions; however, the control group did not receive any intervention. The research was analyzed through mixed ANOVA (with repeated measures) and Bonferroni follow-up tests using SPSS version 22. The results of the present study indicated that dialectical behavior therapy has a significant effect on impulsivity (P<0.01), emotion regulation (P<0.01), rumination (P<0.01), and self-criticism (P<0.01), and these effects continue in the follow-up phase. It can be concluded that dialectical behavior therapy is effective in reducing impulsivity, improving emotion regulation, decreasing rumination, and reducing self-criticism, and can therefore be beneficial for individuals with trichotillomania.

The present study investigated the effectiveness of dialectical behavioral therapy (DBT) and the effect of improvement in DBT skills on clinical outcomes. Participants included 57 adults who attended a community mental health service and underwent one of two modes of DBT. Twenty-six adults had been diagnosed with borderline personality disorder (BPD) and participated in comprehensive DBT (DBT-C; including group skills training, individual therapy, and phone coaching). Thirty-one adults had BPD traits and participated in DBT skills training (DBT-S; group skills training only). In the present study, the DBT skills examined were mindfulness, emotion regulation, and interpersonal effectiveness; the clinical outcomes examined were borderline symptoms, psychological distress, and quality of life. Six 2 × 2 analysis of covariances indicated significant improvements in psychological distress, quality of life, mindfulness, and interpersonal effectiveness (but not borderline symptoms and emotion regulation), over a 6-month period. Mode of delivery of DBT did not impact on the improvement in DBT skills and clinical outcomes over the 6-month period. Hierarchical multiple regression results indicated that improvement in DBT skills (mindfulness, emotion regulation, and interpersonal effectiveness) were associated with reductions in borderline symptoms and psychological distress, with emotion regulation the only skill uniquely associated with improvements in clinical outcomes. The results of the present study support the effectiveness of DBT and the specific role of emotion regulation for favorable clinical outcomes over a 6-month period, independent of the mode of delivery of DBT.

Dialectical Behavior Therapy (DBT) has been proven to be successful for reducing symptoms related to Borderline Personality Disorder [1,2] . However, because of the gap that exists between mental health and substance abuse treatment approaches, little research has been done to show the effects of DBT approaches on addictive thinking and behaviors. In addition, only recently have researchers begun applying DBT interventions with a teenage population [3]. Using selfreport methods, the authors examine the use of a modified DBT approach with 13 participants from ages 14-26, exploring the effects of a DBT group modality on symptoms commonly found in individuals with substance use disorders (SUDs). Preliminary findings resulted in an overall mean score of 3.24 for 14 items corresponding to SUD symptomology, suggesting that DBT interventions helped to reduce: a) Self-destructive behaviors and a propensity for relapse b) Identity disturbances and low self esteem c) Relationship conflict and social skills difficulties and d) Dichotomous thinking and emotion dysregulation. Future studies are needed using larger sample sizes, informant reports, and a sample of individuals with a primary diagnosis of SUDs, to gain confidence in these findings.

Remission, Recovery, Relapse, and Recurrence Rates for Suicide Attempts and Nonsuicidal Self-Injury for Suicidal Youth Treated With Dialectical Behavior Therapy or Supportive Therapy

Objective: To examine the feasibility and initial efficacy of 2 abbreviated dialectical behavior therapy (DBT) skills training groups: emotion regulation skills only and emotion regulation with mindfulness skills. Participants: Participants were 24 undergraduates (aged 18–29) with significant emotion dysregulation who participated between February and May of 2010, 2011, and 2012. Methods: Participants participated in 2-hour weekly group sessions for 8 weeks and completed outcome measures at baseline, midtreatment, posttreatment, and 4-week follow-up. Results: Participants in both conditions made significant gains, with large effect sizes, across measures of emotion regulation, affect, skills use, and functioning. There were no differences between the 2 groups, suggesting no additive benefit of mindfulness skills. Conclusions: This pilot study provides support for the acceptability and efficacy of abbreviated DBT skills training in colleges, given significant improvements, positive feedback, and low attrition. Impediments to feasibility included recruitment difficulties, particularly due to scheduling constraints.

Dialectical behavior therapy (DBT) is an empirically supported treatment for suicidal individuals. However, DBT consists of multiple components, including individual therapy, skills training, telephone coaching, and a therapist consultation team, and little is known about which components are needed to achieve positive outcomes. To evaluate the importance of the skills training component of DBT by comparing skills training plus case management (DBT-S), DBT individual therapy plus activities group (DBT-I), and standard DBT which includes skills training and individual therapy. We performed a single-blind randomized clinical trial from April 24, 2004, through January 26, 2010, involving 1 year of treatment and 1 year of follow-up. Participants included 99 women (mean age, 30.3 years; 69 [71%] white) with borderline personality disorder who had at least 2 suicide attempts and/or nonsuicidal self-injury (NSSI) acts in the last 5 years, an NSSI act or suicide attempt in the 8 weeks before screening, and a suicide attempt in the past year. We used an adaptive randomization procedure to assign participants to each condition. Treatment was delivered from June 3, 2004, through September 29, 2008, in a university-affiliated clinic and community settings by therapists or case managers. Outcomes were evaluated quarterly by blinded assessors. We hypothesized that standard DBT would outperform DBT-S and DBT-I. The study compared standard DBT, DBT-S, and DBT-I. Treatment dose was controlled across conditions, and all treatment providers used the DBT suicide risk assessment and management protocol. Frequency and severity of suicide attempts and NSSI episodes. All treatment conditions resulted in similar improvements in the frequency and severity of suicide attempts, suicide ideation, use of crisis services due to suicidality, and reasons for living. Compared with the DBT-I group, interventions that included skills training resulted in greater improvements in the frequency of NSSI acts (F1,85 = 59.1 [P < .001] for standard DBT and F1,85 = 56.3 [P < .001] for DBT-S) and depression (t399 = 1.8 [P = .03] for standard DBT and t399 = 2.9 [P = .004] for DBT-S) during the treatment year. In addition, anxiety significantly improved during the treatment year in standard DBT (t94 = -3.5 [P < .001]) and DBT-S (t94 = -2.6 [P = .01]), but not in DBT-I. Compared with the DBT-I group, the standard DBT group had lower dropout rates from treatment (8 patients [24%] vs 16 patients [48%] [P = .04]), and patients were less likely to use crisis services in follow-up (ED visits, 1 [3%] vs 3 [13%] [P = .02]; psychiatric hospitalizations, 1 [3%] vs 3 [13%] [P = .03]). A variety of DBT interventions with therapists trained in the DBT suicide risk assessment and management protocol are effective for reducing suicide attempts and NSSI episodes. Interventions that include DBT skills training are more effective than DBT without skills training, and standard DBT may be superior in some areas. clinicaltrials.gov Identifier: NCT00183651.

Many psychological treatments have shown effect on reducing self-harm in adults with borderline personality disorder. There is a need of brief psychotherapeutical treatment alternative for suicide prevention in specialized outpatient clinics. The DiaS trial was designed as a pragmatic single-center, two-armed, parallel-group observer-blinded, randomized clinical superiority trial. The participants had at least two criteria from the borderline personality disorder diagnosis and a recent suicide attempt (within a month). The participants were offered 16 weeks of dialectical behavior therapy (DBT) versus up to 16 weeks of collaborative assessment and management of suicidality (CAMS) treatment. The primary composite outcome was the number of participants with a new self-harm (nonsuicidal self-injury [NSSI] or suicide attempt) at week 28 from baseline. Other exploratory outcomes were: severity of borderline symptoms, depressive symptoms, hopelessness, suicide ideation, and self-esteem. At 28 weeks, the number of participants with new self-harm in the DBT group was 21 of 57 (36.8%) versus 12 of 51 (23.5%) in the CAMS treatment (OR: 1.90; 95% CI: 0.80-4.40; P = .14). When assessing the effect of DBT versus CAMS treatment on the individual components of the primary outcome, we observed no significant differences in the number of NSSI (OR: 1.60; 95% CI: 0.70-3.90; P = .31) or number of attempted suicides (OR: 2.24; 95% CI: 0.80-7.50; P = .12). In adults with borderline personality traits and disorder and a recent suicide attempt, DBT does not seem superior compared with CAMS for reduction of number of self-harm or suicide attempts. However, further randomized clinical trials may be needed.

A Type 2 randomized clinical trial (RCT) of psychosocial treatment for avoidant personality disorder compared three group-administered behavioral interventions (graded exposure, standard social skills training, intimacy-focused social skills training) with a wait-list control; although all three treatments were more efficacious than the control condition, no differences among the treatments were identified either after the 10-week treatment or at follow-up. For the treatment of borderline personality disorder, a Type 1 RCT randomized 101 women with recent suicidal and self-injurious behaviors and borderline personality disorder to either dialectical behavior therapy (DBT) or community-treatment-by-experts psychotherapists (CTBE). Over the 2-year treatment and follow-up period, DBT was superior to CTBE on rates of suicide attempt, hospi-talization for suicide ideation, and overall medical risk (combining suicide attempts and self-injurious acts). Patients in the DBT group were also less likely to drop out of treatment and had fewer psychiatric emergency room visits and fewer psychiatric hospitalizations. There were no significant group differences on measures of depression, reasons for living, and suicide ideation, with patients in both treatment groups improving significantly on these measures. Four additional Type 2 and Type 3 studies support the efficacy of DBT as a treatment for borderline personality disorder with or without comorbid substance abuse or dependence. No RCTs of psychological treatment for other personality disorders have been reported. Several review articles have found a consistent adverse impact of personality disorders on outcomes of treatment for a wide range of Axis I disorders.

Introduction: Individuals with borderline personality disorder have many problems in emotion regulation and quality of life. Regarding this, the aim of the current study was to investigate the effectiveness of dialectical behavior therapy on the improvement of emotion regulation and quality of life among women with borderline personality disorder in Shahr-e Kord, Iran, in 2015. Materials and Methods: This semi-experimental study was conducted on women with borderline personality disorder referring to the psychology and counseling centers of Shahr-e Kord city in 2015 using a pretest-posttest control group design. The study population was selected using convenience sampling technique out of the women voluntarily participating in a treatment course held by the researchers. The inclusion criteria were: 1) borderline personality diagnosis based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, 2) a minimum of high school education (diploma degree), 3) age range of 20-40 years, and 4) at least one suicide attempt. The participants were then randomly assigned into two groups of intervention (n=10) and control (n=10). The intervention group was subjected to eight 90-minute sessions of dialectical behavior therapy; however, the control group received no intervention. The data were collected using the Emotion Regulation Scale and Quality of Life Questionnaire. Data analysis was performed in SPSS software (version 18) using covariance. Results: According to the results, there was a significant difference between the control and intervention groups in terms of emotion regulation (F=7.61, P=0.01) and quality of life (F=13.68, P=0.001) after the intervention. Conclusion: Based on the findings, it seems that dialectical behavior therapy improved the emotion regulation and quality of life among the women with borderline personality disorder.

Dialectical Behavior Therapy for Suicidal Self-Harming Youth: Emotion Regulation, Mechanisms, and Mediators

Sustained efficacy of dialectical behaviour therapy for borderline personality disorder