The independent roles of mindfulness and distress tolerance in treatment outcomes in dialectical behavior therapy skills training.

Abstract

Despite research supporting the effectiveness of dialectical behavior therapy (DBT) for borderline personality disorder (BPD), few studies have examined how DBT leads to clinical change. DBT is theorized to lead to improved clinical outcomes by enhancing the capacity for emotion regulation, including improvement in skills (e.g., mindfulness and distress tolerance) for managing emotional distress and impulsive behaviors. Therefore, the aim of this study was to test whether improvements in mindfulness and distress tolerance indirectly affect the relationship between DBT skills training and clinical outcomes. The sample consists of 84 patients diagnosed with BPD who were enrolled in a randomized controlled trial comparing 20 weeks of DBT-skills group (DBT-S) to an active waitlist control. Mindfulness and distress tolerance were assessed at baseline and at the end of the 20 weeks. BPD symptoms, general psychiatric symptoms, and social adjustment were assessed at the end of 20 weeks and combined into a latent variable representing a broad assessment of general psychopathology. Relative to the waitlist control group, improvements in mindfulness and distress tolerance each independently indirectly affected the relationship between DBT-S and posttreatment general psychopathology. Findings suggest that DBT-S exerts its effects on outcomes through improvements in mindfulness and distress tolerance. These findings support the significance of mindfulness and distress tolerance in DBT-S for BPD. Limitations, future directions, and clinical implications are discussed.

Body connection mediates the relationship between traumatic childhood experiences and impaired emotion regulation in borderline personality disorder

“…Although our cross-sectional mediation analyses do not allow for causal interpretations, there is evidence that strengthening body connection has positive effects on BPD symptomatology. Mindfulness is an important aspect of psychotherapies such as Dialectical Behavioral Therapy [ 9 ], an effective treatment for BPD [ 75 ]. Furthermore, recent results for a training intervention specifically targeting interoceptive skills, that is, the Mindful Awareness in Body-oriented Therapy [ 76 ], show beneficial effects on emotion regulation capabilities in traumatized women with substance use disorder [ 77 , 78 ] and could therefore also be of interest for the treatment of BPD.…”

The association of distress tolerance and mindful awareness with mental health in first responders.

“…Conceptually, distress tolerance is described as the dispositional ability to tolerate physical and emotional discomfort (McHugh & Otto, 2012). Although typically viewed as a trait, dispositional distress tolerance can also be modified through interventions such as mindfulness-based stress reduction (MBSR; Nila et al, 2016) and dialectical behavioral therapy (DBT; Zeifman et al, 2020).…”

Implementation of brief dialectical behavior therapy skills training among borderline personality disorder patients in Malaysia: feasibility, acceptability, and preliminary outcomes

“…Therefore, there is emerging research evaluating various adaptations of DBT, including delivery of components of the treatment in a shorter duration. Of the four modes of DBT, the skills group has received the most research attention, given the relative ease of transferability of the skills, and also the fact that DBT skills have been found to be key processes underlying clinical outcomes resulting from DBT [ 15 , 16 ]. For example, improvements in mindfulness and distress tolerance skills have been found to predict improvements in general psychopathological symptoms resulting from DBT skills training [ 16 ].…”