Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder

Abstract

A central component of Dialectical Behavior Therapy (DBT) is the teaching of specific behavioral skills with the aim of helping individuals with Borderline Personality Disorder (BPD) replace maladaptive behaviors with skillful behavior. Although existing evidence indirectly supports this proposed mechanism of action, no study to date has directly tested it. Therefore, we examined the skills use of 108 women with BPD participating in one of three randomized control trials throughout one year of treatment and four months of follow-up. Using a hierarchical linear modeling approach we found that although all participants reported using some DBT skills before treatment started, participants treated with DBT reported using three times more skills at the end of treatment than participants treated with a control treatment. Significant mediation effects also indicated that DBT skills use fully mediated the decrease in suicide attempts and depression and the increase in control of anger over time. DBT skills use also partially mediated the decrease of nonsuicidal self-injury over time. Anger suppression and expression were not mediated. This study is the first to clearly support the skills deficit model for BPD by indicating that increasing skills use is a mechanism of change for suicidal behavior, depression, and anger control. KeywordsDialectical Behavior Therapy; Borderline Personality Disorder; Mechanism of Change; Suicidal Behavior; Major Depression; Anger Dialectical Behavior Therapy (DBT) is a cognitive-behavioral treatment program originally developed to treat suicidal individuals with Borderline Personality Disorder (BPD). The model of BPD that informs DBT suggests that: 1) BPD is a disorder of emotion dysregulation stemming from important deficits in interpersonal, emotion-regulation (including regulation of mood dependent behaviors), and distress tolerance skills, 2) adaptive behavioral skills that individuals do have in their repertoire are often inhibited or interfered with by maladaptive behavior, and 3) maladaptive behaviors (that constitute many of the criteria of BPD) such as suicidal behaviors or other impulsive behaviors are Please address correspondence to Andrada D. Neacsiu, Behavioral Research and Therapy Clinics, Department of Psychology, Box 351525, University of Washington, Seattle, WA 98195-1525. andrada@u.washington.edu.. andrada@u.washington.edu linehan@u.washington.edu slrizvi@rci.rutgers.edu Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptBehav Res Ther. Author manuscript; available in PMC 2011 September 1. N...

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