Mapping Aspects of Psychotherapy in Dialectical Behavior Therapy

Study Overview
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Brief Summary
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Although dialectical behavior therapy (DBT) skills training is effective in the treatment of borderline personality disorder, it contains four skills modules and there is little research to guide their modular application. This study compares the unique effects of two distinct DBT skills training modules, relative to a non-DBT therapy group for adults with borderline personality disorder. Using innovative laboratory-based assessment methods, the proposed study will examine the effects of these conditions on emotional responding and interpersonal functioning, as well as clinical outcomes.

Detailed Description
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Borderline personality disorder (BPD) is a severe mental health condition with high morbidity and mortality. Although dialectical behavior therapy (DBT) is an efficacious treatment for BPD, it is resource-intensive and lengthy in its full form, involving one year of weekly individual therapy and group skills training in mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance. As a result, few patients have access to the full treatment. 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. Improvements in both interpersonal and emotional functioning are theorized to underlie improvements in BPD. Thus, emotion regulation and interpersonal effectiveness skills training may be particularly important components of DBT. Therefore, this study examines the unique effects of two distinct DBT skills training modules. Participants are adults with BPD and recent, recurrent self-injurious behaviors (planned N = 81) who are 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 multimethod assessments, this study examines the effects of these conditions on emotional responding and interpersonal functioning, as well as BPD related outcomes. Aim 1 examines 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 non-DBT treatment. Aim 2 examines whether improved emotional functioning predicts reductions in BPD symptoms and self-injury. Aim 3 examines whether baseline emotion dysregulation interacts with treatment condition to predict treatment response. The proposed research is innovative in its experimental examination of the effects of DBT components on specific targets in BPD. Given the high societal costs of BPD, this work has important public health significance. Findings will inform larger studies evaluating the potential modular use of DBT components to result in briefer and more efficient individualized treatments for patients.

Official Title
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Mapping Treatment Components to Targets in Dialectical Behavior Therapy

Conditions
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Borderline Personality Disorder

Intervention / Treatment
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* Behavioral: Dialectical behavior therapy - emotion regulation skills training
* Behavioral: Dialectical behavior therapy - interpersonal effectiveness skills training
* Behavioral: Interpersonal psychotherapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: exhibit 4+ BPD symptoms, have a history of recent (i.e., past-year) and recurrent (> 1 instance) of self-injury, commit to participate in one of our 6-week experimental groups, have an individual health provider who can manage imminent issues, be between 18-60 years old, Exclusion Criteria: not fluent in English, have impaired (uncorrected) vision or hearing that would impair ability to understand study stimuli, a current manic, psychotic, or active physiological dependence on substances (to limit interference in the lab), low cognitive functioning (IQ ≤ 70.4 (TOPF; Pearson Assessments, 2009), past DBT treatment

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Dialectical behavior therapy - emotion regulation skills training<br>Dialectical behavior therapy - emotion regulation skills training | Behavioral: Dialectical behavior therapy - emotion regulation skills training<br>* Arm 1. Dialectical behavior therapy - emotion regulation skills training follows the emotion regulation skills DBT Skills Training Manual Second Edition and the DBT Skills Training Handouts and Worksheets Second Edition. This group involves 6 weekly sessions. Arm 2. Dialectical behavior therapy - interpersonal effectiveness skills training follows the interpersonal effectiveness skills DBT Skills Training Manual Second Edition and the DBT Skills Training Handouts and Worksheets Second Edition. This group involves 6 weekly sessions.<br>|
| Experimental: Dialectical behavior therapy - interpersonal effectiveness skills training<br>Dialectical behavior therapy - interpersonal effectiveness skills training | Behavioral: Dialectical behavior therapy - interpersonal effectiveness skills training<br>* Arm 2. Dialectical behavior therapy - interpersonal effectiveness skills training follows the interpersonal effectiveness skills DBT Skills Training Manual Second Edition and the DBT Skills Training Handouts and Worksheets Second Edition. This group involves 6 weekly sessions.<br>|
| Active Comparator: Non-skills-oriented interpersonal psychotherapy group<br>Non-skills-oriented interpersonal psychotherapy group | Behavioral: Interpersonal psychotherapy<br>* Arm 3. Non-skills-oriented interpersonal psychotherapy group follows evidence-based principles on common factors in a group therapy context. This group involves 6 weekly sessions.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in emotional functioning | Assessed with the Difficulties in Emotion Regulation Scale (DERS), which has total scores that range from 36-180, with higher scores indicating more difficulties | Pre-treatment, mid-treatment week 3-4, post-treatment week 6-7, follow-up week 13-14 | 
| Change in borderline personality disorder features | Assessed with the abbreviated Borderline Symptom List (BSL23), which has mean scores that range from 0-4, with higher scores indicating more symptoms | Pre-treatment, mid-treatment week 3-4, post-treatment week 6-7, follow-up week 13-14 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in self-reported emotional reactivity | Assessed with self-reported emotions in response to emotional cues presented in the lab | Pre-treatment, mid-treatment week 3-4, post-treatment week 6-7, follow-up week 13-14 | 
| Change in self-reported emotional regulation | Assessed with self-reported emotions in response to regulation instructions for emotional cues presented in the lab | Pre-treatment, mid-treatment week 3-4, post-treatment week 6-7 | 
| Change in affect-modulated startle | Assessed with eyeblink startle amplitude in response to emotional cues presented in the lab | Pre-treatment, mid-treatment week 3-4, post-treatment week 6-7 | 
| Change in emotional habituation | Assessed with skin conductance (microsiemens) in response to repeated emotional cues presented in the lab | Pre-treatment, mid-treatment week 3-4, post-treatment week 6-7 | 
| Change in physiological emotional reactivity | Assessed with skin conductance (microsiemens) in response to emotional cues presented in the lab | Pre-treatment, mid-treatment week 3-4, post-treatment week 6-7 | 
| Change in deliberate physiological emotional regulation | Assessed with heart rate variability (ms2/hz) in response to emotional cues presented in the lab | Pre-treatment, mid-treatment week 3-4, post-treatment week 6-7 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Dialectical behavior therapy, Emotions, Behavior and Behavior mechanisms, Randomized Controlled Trials