4 - (SYM 113) Mapping Treatment Components to Targets in Dialectical Behavior Therapy

Abstract Body

Objective: Although dialectical behavior therapy (DBT) is an efficacious treatment for BPD (DeCou, Comtois, & Landes, 2019; Kliem et al., 2010), it is resource-intensive and lengthy in its full form. A better understanding of how the distinct components of DBT affect different sets of symptoms could help to streamline this treatment and personalize its use with specific patients. DBT emotion regulation skills training may be a particularly important component of DBT. Emotion dysfunction is theorized to underlie many of the problems seen in BPD, including impairments in decision-making, impulsive behaviors, and self-injury. Early data suggest that the emotion regulation DBT module may be helpful across more symptom domains than other modules (Cheavens, Southward, Howard, Heiy, & Altenburger, 2022; Dixon-Gordon, Chapman, & Turner, 2015), although these data have not been examined experimentally. Therefore, the present study examined the unique effects of two distinct DBT skills training modules relative to a non-skills-oriented control.

Method: Participants were adults with BPD and recent, recurrent self-injurious behaviors (N = 84) who were randomly assigned to six weeks of DBT emotion regulation skills training (DBT-ER), DBT interpersonal effectiveness skills training (DBT-IE), or a non-skills control group. Using innovative laboratory-based assessment methods, we examined the effects of these conditions on emotional responding and interpersonal functioning, as well as BPD related outcomes. Aim 1 examined the unique effects of DBT-ER and DBT-IE on their respective emotion-related (subjective and biological emotional reactivity, behavioral emotion regulation, skills use) and interpersonal (subjective and behavioral) targets, compared to the control. Aim 2 examined whether DBT-ER target engagement predicts reductions in BPD symptoms and self-injury. Aim 3 examined whether baseline high emotion dysregulation predicts greater response to the DBT-ER condition versus the other conditions.

Results: Preliminary findings suggested rapid and comparable reductions in BPD symptoms and ER difficulties across the three conditions. We will also examine the role of patient characteristics as moderators of these effects, and identify mechanisms of change diverge across these conditions.

Conclusions: Findings will inform efforts examining modular use of DBT components to result in briefer and more efficient individualized treatments for patients.