A Treatment Mechanism for Emotion Dysregulation Across Mood and Anxiety Disorders

Abstract

Dialectical Behavior Therapy (DBT; Linehan, 1993a) has been consistently shown to successfully improve indices of emotion regulation in a variety of client populations (e.g., Bohus et al., 2004; Lynch et al., 2007; Feigenbaum et al., 2011). Furthermore, evidence suggests that use of DBT skills is a mechanism of change for emotion dysregulation in Borderline Personality Disorder (BPD; Neacsiu, Rizvi, & Linehan, 2010). Thus, DBT may offer a mechanism of treatment for emotion dysregulation. In this paper, evidence supporting emotion dysregulation as a transdiagnostic mechanism of disorder is presented. A theoretical model that accounts for the effectiveness of DBT skills training, a component of DBT, at reducing emotion dysregulation across disorders is proposed. In addition, the transdiagnostic effectiveness of DBT skills training to change emotion dysregulation is assessed via a randomized controlled trial. Forty-four men and women who met criteria for at least one mood or anxiety disorder and who reported high emotion dysregulation were included in the study. Participants were randomly assigned to DBT skills training or an Activities Based Support Group, designed to control for nonspecific factors. The randomization algorithm matched participants on gender, primary disorder and reported use of medication. Both treatment conditions were administered in a group format and lasted for 16 weeks, two hours per week. Enrolled participants were assessed before treatment started, at the middle of the treatment, at the end of treatment and at a 2-month follow up. Analyses using hierarchical linear modeling supported that DBT skills training was superior to the support group in increasing skills use and in reducing emotion dysregulation, general distress, shame, anger suppression and anxiety. Both treatments performed similarly in reducing depression, disgust and anger expression. Furthermore, use of DBT skills mediated all of the changes seen between conditions. Findings are discussed in the context of the current treatment literature.