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Dialectical Behaviour Therapy for Emotion Regulation Difficulties: A Systematic Review

Published online by Cambridge University Press:  26 April 2019

Lauren J. Harvey*
Affiliation:
School of Psychology, University of Sydney, Sydney, New South Wales, Australia
Caroline Hunt
Affiliation:
School of Psychology, University of Sydney, Sydney, New South Wales, Australia
Fiona A. White
Affiliation:
School of Psychology, University of Sydney, Sydney, New South Wales, Australia
*
*Corresponding author: Lauren J. Harvey, School of Psychology, University of Sydney, Sydney NSW 2006, Australia. Email: [email protected]
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Abstract

While dialectical behaviour therapy (DBT) appears efficacious in reducing suicidal and self-harming behaviour, it is unclear whether DBT reduces emotion regulation (ER) difficulties, a purported mechanism of change of treatment. This review aims to investigate and evaluate the current evidence to understand the effectiveness of DBT in improving ER difficulties. A qualitative synthesis of studies investigating the effectiveness of DBT on self-reported ER difficulties as measured by the Difficulties in Emotion Regulation Scale (DERS) was performed, identifying eligible studies using PsycINFO, PubMed, MEDLINE and EMBASE databases. Fourteen studies were identified. Current evidence indicates that DBT does not show consistent benefits relative to existing psychological treatments in improving ER difficulties. The literature is compromised by significant methodological limitations increasing risk of bias across study outcomes. Furthermore, high variability across DBT programs and a lack of investigation regarding adherence and participant engagement within interventions was observed. Further research is needed in order to conclude regarding the effectiveness of DBT in improving ER difficulties. Consistent use of active treatment conditions, greater standardisation of DBT-based interventions, in addition to further examination of participant engagement level in DBT-based interventions in the long term may assist understanding as to whether DBT improves ER difficulties.

Type
Review Article
Copyright
Copyright © The Author(s) 2019 

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References

American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association.Google Scholar
*Azizi, A, Borjali, A and Golzari, M (2010). The effectiveness of emotion regulation training and cognitive therapy on the emotional and addictional problems of substance abusers. Iranian Journal of Psychiatry, 5, 6065.Google Scholar
Behavioural Tech. (2017). Behavioural Tech – A Linehan Institute Training Company. Retrieved April 30, 2018, from http://www.behaviouraltech.orgGoogle Scholar
Biskin, RS (2015). The lifetime course of borderline personality disorder. The Canadian Journal of Psychiatry, 60, 303308.Google Scholar
Bloom, J, & Woodward, E, & Susmaras, T and Pantalone, D (2012). Use of dialectical behaviour therapy in inpatient treatment of borderline personality disorder: A systematic review. Psychiatric Services, 63, 881888.Google Scholar
*Burckhardt, R, Manicavasagar, V, Shaw, F, Fogarty, A, Batterham, PJ, Dobinson, K and Karpin, I (2018). Preventing mental health symptoms in adolescents using dialectical behaviour therapy skills group: A feasibility study. International Journal of Adolescence and Youth, 23, 7085.Google Scholar
*Cancian, ACM, de Souza, LAS, Liboni, RPA, de Lara Machado, W and da Silva Oliveira, M (2017). Effects of a dialectical behaviour therapy-based skills group intervention for obese individuals: A Brazilian pilot study. Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity, 113. Advance online publication. doi:10.1007/s40519-017-0461-2.Google Scholar
Christensen, DR, Dowling, NA, Jackson, AC, Brown, M, Russo, J, Francis, KL and Umemoto, A (2013). A proof of concept for using brief dialectical behavior therapy as a treatment for problem gambling. Behaviour Change, 30, 117137.Google Scholar
*Chugani, CD, Ghali, MN and Brunner, J (2013). Effectiveness of short term dialectical behaviour therapy skills training in college students with cluster B personality disorders. Journal of College Student Psychotherapy, 27, 323336.Google Scholar
Cole, PM (2014). Moving ahead in the study of the development of emotion regulation. International Journal of Behavioural Development, 38, 203207.Google Scholar
Cristea, IA, Gentili, C, Cotet, CD, Palomba, D, Barbui, C and Cuijpers, P (2017). Efficacy of psychotherapies for borderline personality disorder: A systematic review and metaanalysis. JAMA Psychiatry, 74, 319328.Google Scholar
DeCou, CR, Comtois, KA and Landes, SJ (2018). Dialectical behaviour therapy is effective for the treatment of suicidal behaviour: A meta-analysis. Behaviour Therapy. Advance online publication. doi:10.1016/j.beth.2018.03.009Google Scholar
Dimeff, LA and Linehan, MM (2008). Dialectical Behaviour Therapy for Substance Abusers. Addiction Science & Clinical Practice, 4, 3947.Google Scholar
*Dixon-Gordon, KL, Chapman, AL and Turner, BJ (2015). A preliminary pilot study comparing dialectical behaviour therapy emotion regulation skills with interpersonal effectiveness skills and a control group treatment. Journal of Experimental Psychopathology, 6, 117.Google Scholar
Feigenbaum, JD, Fonagy, P, Pilling, S, Jones, A, Wildgoose, A and Bebbington, PE (2012). A real-world study of the effectiveness of DBT in the UK National Health Service. British Journal of Clinical Psychology, 51, 121141.Google Scholar
*Gibson, J, Booth, R, Davenport, J, Keogh, K and Owens, T (2014). Dialectical behaviour therapy-informed skills training for deliberate self-harm: A controlled trial with 3-month follow-up data. Behaviour Research and Therapy, 60, 814.Google Scholar
Gratz, KL and Roemer, L (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioural Assessment, 26, 4154.Google Scholar
Higgins, JP and Green, S (2011). Cochrane handbook for systematic reviews of interventions (version 5.1.0). Retrieved from www.cochrane-handbook.orgGoogle Scholar
*Jamilian, HR, Malekirad, AA, Farhadi, M, Habibi, M and Zamani, N (2014). Effectiveness of group dialectical behaviour therapy (based on core distress tolerance and emotion regulation components) on Expulsive Anger and Impulsive Behaviours. Global Journal of Health Science, 6, 116123.Google Scholar
Kliem, S, Kröger, C and Kosfelder, J (2010). Dialectical behaviour therapy for borderline personality disorder: A meta-analysis using mixed-effects modeling. Journal of Consulting and Clinical Psychology, 78, 936951.Google Scholar
Koechlin, H, Coakley, R, Schechter, N, Werner, C and Kossowsky, J (2018). The role of emotion regulation in chronic pain: A systematic literature review. Journal of Psychosomatic Research, 107, 3845.Google Scholar
Lachin, JM (2016). Fallacies of last observation carried forward analyses. Clinical Trials, 13, 161168.Google Scholar
Linehan, M (2015). DBT skills training manual (2nd ed.). New York, NY: Guilford Press.Google Scholar
Linehan, M (1993). Cognitive-behavioural treatment of borderline personality disorder. New York, NY: Guilford Press.Google Scholar
Linehan, MM (1987). Dialectical behavioural therapy: A cognitive behavioural approach to parasuicide. Journal of Personality Disorders, 1, 328333.Google Scholar
Linehan, MM, Armstrong, HE, Suarez, A, Allmon, D and Heard, HL (1991). Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48, 10601064.Google Scholar
Little, H, Tickle, A and das Nair, R (2018). Process and impact of dialectical behaviour therapy: A systematic review of perceptions of clients with a diagnosis of borderline personality disorder. Psychology and Psychotherapy: Theory, Research and Practice, 91, 278301.Google Scholar
Lynch, TR, Chapman, AL, Rosenthal, MZ, Kuo, JR and Linehan, MM (2006). Mechanisms of change in dialectical behaviour therapy: Theoretical and empirical observations. Journal of Clinical Psychology, 62, 459480.Google Scholar
Marissen, MA, Meuleman, L and Franken, IH (2010). Altered emotional information processing in borderline personality disorder: An electrophysiological study. Psychiatry Research: Neuroimaging, 181, 226232.Google Scholar
*Masson, PC, von Ranson, KM, Wallace, LM and Safer, DL (2013). A randomized waitlist controlled pilot study of dialectical behaviour therapy guided self-help for binge eating disorder. Behaviour Research and Therapy, 51, 723728.Google Scholar
*McMain, SF, Guimond, T, Barnhart, R, Habinski, L and Streiner, DL (2017). A randomized trial of brief dialectical behaviour therapy skills training in suicidal patients suffering from borderline disorder. Acta Psychiatrica Scandinavica, 135, 138148.Google Scholar
Moher, D, Shamseer, L, Clarke, M, Ghersi, D, Liberati, A, Petticrew, MStewart, LA (2015). Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic Reviews, 4, 1.Google Scholar
*Neacsiu, AD, Eberle, JW, Kramer, R, Wiesmann, T and Linehan, MM (2014). Dialectical behaviour therapy skills for transdiagnostic emotion dysregulation: A pilot randomized controlled trial. Behaviour Research and Therapy, 59, 4051.Google Scholar
Neacsiu, AD, Rizvi, SL and Linehan, MM (2010). Dialectical behaviour therapy skills use as a mediator and outcome of treatment for borderline personality disorder. Behaviour Research and Therapy, 48, 832839.Google Scholar
Panos, PT, Jackson, JW, Hasan, O and Panos, A (2014). Meta-analysis and systematic review assessing the efficacy of dialectical behaviour therapy (DBT). Research on Social Work Practice, 24, 213223.Google Scholar
Posner, MI, Rothbart, MK, Vizueta, N, Levy, KN, Evans, DE, Thomas, KM and Clarkin, JF (2002). Attentional mechanisms of borderline personality disorder. Proceedings of the National Academy of Sciences, 99, 1636616370.Google Scholar
Prendergast, N and McCausland, J (2007). Dialectic behaviour therapy: A 12-month collaborative program in a local community setting. Behaviour Change, 24, 2535. doi: 10.1375/bech.24.1.25Google Scholar
Robins, CJ and Chapman, AL (2004). Dialectical behaviour therapy: Current status, recent developments, and future directions. Journal of Personality Disorders, 18, 7389.Google Scholar
Rudge, S, Feigenbaum, JD and Fonagy, P (2017). Mechanisms of change in dialectical behaviour therapy and cognitive behaviour therapy for borderline personality disorder: A critical review of the literature. Journal of Mental Health, 8, 111.Google Scholar
Safer, DL, Telch, CF and Agras, WS (2001). Dialectical behaviour therapy for bulimia nervosa. American Journal of Psychiatry, 158, 632634.Google Scholar
*Safer, D, Robinson, A and Jo, B (2010). Outcome from a randomized controlled trial of group therapy for BED: Comparing DBT adapted for binge eating to an active comparison group therapy. Behaviour Therapy, 41, 106120.Google Scholar
Substance Abuse and Mental Health Services Administration (SAMHSA). (2012). Report to Congress on Borderline Personality Disorder. US Department of Health and Human Services. Retrieved from http://www.ncdsv.org/images/SAMHSA_Reportto-Congress-on-Borderline-Personality-Disorder_5-2011.pdfGoogle Scholar
Telch, CF, Agras, WS, & Linehan, MM (2001). Dialectical behaviour therapy for binge eating disorder. Journal of Consulting and Clinical Psychology, 69, 10611065.Google Scholar
Tucker, L, Bauer, SF, Wagner, S, Harlam, D and Sher, I (1987). Long-term hospital treatment of borderline patients: a descriptive outcome study. The American Journal of Psychiatry, 144, 14431448.Google Scholar
*Uliaszek, AA, Rashid, T, Williams, GE and Gulamani, T (2016). Group therapy for university students: A randomized control trial of dialectical behaviour therapy and positive psychotherapy. Behaviour Research and Therapy, 77, 7885.Google Scholar
Valentine, SE, Bankoff, SM, Poulin, RM, Reidler, EB and Pantalone, DW (2015). The use of dialectical behaviour therapy skills training as stand-alone treatment: A systematic review of the treatment outcome literature. Journal of Clinical Psychology, 71, 120.Google Scholar
*Ward-Ciesielski, EF, Tidik, JA, Edwards, AJ and Linehan, MM (2017). Comparing brief interventions for suicidal individuals not engaged in treatment: A randomized clinical trial. Journal of Affective Disorders, 222, 153161.Google Scholar
*Wilks, CR, Lungu, A, Ang, SY, Matsumiya, B, Yin, Q, & Linehan, MM (2018). A randomized controlled trial of an internet delivered dialectical behaviour therapy skills training for suicidal and heavy episodic drinkers. Journal of Affective Disorders, 232, 219228. 28Google Scholar
Zalewski, M, Lewis, JK, & Martin, CG (2018). Identifying novel applications of dialectical behaviour therapy: Considering emotion regulation and parenting. Current Opinion in Psychology, 21, 122126.Google Scholar
van Zutphen, L, Siep, N, Jacob, GA, Goebel, R and Arntz, A (2015). Emotional sensitivity, emotion regulation and impulsivity in borderline personality disorder: A critical review of fMRI studies. Neuroscience & Biobehavioural Reviews, 51, 6476Google Scholar