Elsevier

Behaviour Research and Therapy

Volume 59, August 2014, Pages 40-51
Behaviour Research and Therapy

Dialectical behavior therapy skills for transdiagnostic emotion dysregulation: A pilot randomized controlled trial

https://doi.org/10.1016/j.brat.2014.05.005Get rights and content

Highlights

  • We piloted a group treatment for transdiagnostic emotion dysregulation.

  • We conducted a randomized controlled trial using a support group as control.

  • DBT skills training was successful in reducing difficulties in emotion regulation.

  • Use of skills mediated the differences between conditions on all outcomes.

  • DBT skills training was acceptable, although feasibility needs further testing.

Abstract

Difficulties with emotions are common across mood and anxiety disorders. Dialectical behavior therapy skills training (DBT-ST) reduces emotion dysregulation in borderline personality disorder (BPD). Preliminary evidence suggests that use of DBT skills mediates changes seen in BPD treatments. Therefore, we assessed DBT-ST as a stand-alone, transdiagnostic treatment for emotion dysregulation and DBT skills use as a mediator of outcome. Forty-four anxious and/or depressed, non-BPD adults with high emotion dysregulation were randomized to 16 weeks of either DBT-ST or an activities-based support group (ASG). Participants completed measures of emotion dysregulation, DBT skills use, and psychopathology every 2 months through 2 months posttreatment. Longitudinal analyses indicated that DBT-ST was superior to ASG in decreasing emotion dysregulation (d = 1.86), increasing skills use (d = 1.02), and decreasing anxiety (d = 1.37) but not depression (d = 0.73). Skills use mediated these differential changes. Participants found DBT-ST acceptable. Thirty-two percent of DBT-ST and 59% of ASG participants dropped treatment. Fifty-nine percent of DBT-ST and 50% of ASG participants complied with the research protocol of avoiding ancillary psychotherapy and/or medication changes. In summary, DBT-ST is a promising treatment for emotion dysregulation for depressed and anxious transdiagnostic adults, although more assessment of feasibility is needed.

Section snippets

Participants and design

Intent-to-treat (ITT) participants were 44 men and women from a metropolitan area in the Northwestern United States. Participants were included if they were older than 18 years of age, scored high in emotion dysregulation (above 96 on the Difficulties in Emotion Regulation Scale; DERS; Gratz & Roemer, 2004), and met criteria for at least one current depressive or anxiety disorder on the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I; First, Spitzer, Gibbon, & Williams, 1995).

Sample characteristics and baseline differences

ITT participants were primarily single, heterosexual, Caucasian women who met criteria for multiple Axis I disorders (Mdiagnoses = 2.68, SD = 1.21 in DBT-ST; Mdiagnoses = 2.59, SD = 1.44 in ASG). Current GAD, MDD, and dysthymia were the most frequent diagnoses. Randomization successfully matched participants on gender, psychotropic medication use, and primary diagnosis. No significant demographic differences emerged (Table 2). At pretreatment, 18 participants (40.9% in each condition) reported

Discussion

The present study is a preliminary examination of DBT skills training (DBT-ST) as a stand-alone treatment for emotion dysregulation in a transdiagnostic sample. Compared with a supportive therapy control condition (ASG), DBT-ST was superior in reducing emotion dysregulation, increasing skills use, and reducing anxiety severity in adults who met criteria for depressive and/or anxiety disorders. Although DBT-ST was comparable to ASG in reducing depression severity, recovery from depression was

Author statement

Marsha M. Linehan receives royalties from Guilford Press for books she has written on dialectical behavior therapy (DBT). Marsha M. Linehan and Andrada D. Neacsiu receive fees for DBT trainings. Data was also presented as part of the first author's doctoral dissertation and in conference talks.

Acknowledgments

This research was supported by an American Psychological Association Dissertation Research Award granted to the first author. The authors would like to thank the therapists and clients who took part in this study and to acknowledge Megan Smith, Laura Murphy, Sara Miller, Annika Benedetto, William Kuo, Dan Finnegan, Kevin King, Heidi Heard, Peter P. Vitaliano, and Nancy Whitney for their contributions. We would like to thank Moria Smoski, M. Zachary Rosenthal, and Clive Robins for feedback on

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