Dialectical Behavior Therapy (DBT)

Third wave interventions have demonstrated efficacy as a treatment option to promote wellbeing in adolescents. Evidence of their effectiveness for chronic mental health disorders remains unclear. The PubMed, PsycINFO, ProQuest, Embase, and CINAHL databases were searched from inception until March 2024 for five established interventions: acceptance and commitment therapy (ACT), compassion focused therapy, dialectical behaviour therapy (DBT), mindfulness-based cognitive therapy, and mindfulness-based stress reduction (MBSR). Risk of bias was assessed (QualSyst tool), and standardized mean group differences (Hedges’ g) with associated p-values, 95% confidence intervals, and prediction intervals calculated. Three randomized controlled trials and 10 single-group designs, all assessing DBT and representing 700 adolescents (most with subthreshold or full syndrome borderline personality disorder), were included. All studies were of sound methodological quality. DBT was associated with large and significant reductions in mental health symptoms (depression, anxiety, emotional regulation, suicidal ideation, self-harm, and BPD symptoms; g range = 0.69 to 1.05) – although individual variability in treatment response was noted. Symptom improvements were maintained at follow-up (g range = 0.70 to 1.71), although based on limited data. Neither DBT intensity nor duration significantly moderated treatment effects. DBT is the most assessed intervention for adolescents with severe emotional or behavioral problems. Additional controlled studies with diverse samples are needed to confirm the unique effects of DBT relative to other promising third wave interventions. Protocol registration: Open Science Framework [https://osf.io/fgd2j/].

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Long-term follow-up studies have shown that the symptoms of borderline personality disorder (BPD) tend to remit over time. However, many patients present long lasting symptoms (LLS), including low mood, emptiness, and persistent impairment in psychosocial adjustment. Given the high rate of LLS in BPD patients, new treatment strategies are needed. We conducted a randomized clinical trial (RCT) to evaluate the efficacy of a novel intervention that combines self-compassion and contextual-based skills for patients with persistent symptoms. Sixty BPD individuals with LLS who had received dialectical behavior therapy skills training (DBT-ST) in the previous six months were recruited and randomized to receive the experimental intervention or treatment as usual (TAU) for 12 weeks. All participants were evaluated pre- and post-intervention and at 3-months follow-up. The primary outcome measure was self-reported well-being. Other clinical variables were also evaluated, including depressive symptoms, BPD symptoms, functionality, self-compassion, and self-criticism. Participants in the experimental arm showed a significant increase in indicators of well-being (e.g., happiness and quality of life) and a significant decrease in depressive symptoms. These results were sustained—and even continued to improve—at the three-month follow-up. No significant changes were observed in BPD severity, self-criticism, or self-compassion. More RCTs are needed to test the efficacy of new interventions targeting this population with persistent symptoms, not only to reduce symptoms but also to promote well-being and personal recovery.

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Mindfulness skills training constitute a core element of dialectical behavior therapy (DBT) that has been proposed as a key component to improve emotion dysregulation (ED) in borderline personality disorder (BPD). However, the relationship between the time spent practicing mindfulness skills at home and changes in ED is not well-understood. This study aimed to determine whether daily mindfulness practice meaningfully improves ED, and, if so, the minimum dose needed to do so. A total of 75 BPD outpatients participated in a 10-week DBT mindfulness skill training program. We systematically tracked the participants' mindfulness practice and their ED levels throughout the sessions. A total of 499 observations were recorded. We used multilevel modeling with a time-lagged approach to investigate the association between weekly practice and ED over time. Greater mindfulness practice predicted improvements in ED in the following week. A bidirectional relationship was also found; a higher level of ED impaired subsequent mindfulness practice. When accounting for the previous week's ED level, participants who practiced ≥3 days and >30 min per week experienced a statistically significant decrease in ED compared to those who did not engage in regular practice. These results highlight the key role of mindfulness practice as a behavioral component to improve emotion regulation in individuals with BPD. These findings suggest that therapists should inform patients about the minimum dose of mindfulness practice needed to improve emotion regulation in order to adjust expectations and improve treatment outcomes.

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