Transdiagnostic Skills Training Group of Dialectical Behavior Therapy: a Long-Term Naturalistic Study

Transdiagnostic Skills Training Group of Dialectical Behavior Therapy: a Long-Term Naturalistic Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Transdiagnostic Skills Training Group of Dialectical Behavior Therapy: a Long-Term Naturalistic Study Amaury DURPOIX, Enzo Lachaux, Luisa WEINER, Sébastien WEIBEL This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2845259/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 21 Dec, 2023 Read the published version in Borderline Personality Disorder and Emotion Dysregulation → Version 1 posted 7 You are reading this latest preprint version Abstract Introduction. Dialectical Behavior Therapy (DBT) has assembled a large body of evidence for the treatment of emotional dysregulation in borderline personality disorder (BPD), but also in other disorders characterized by emotional dysregulation (e.g., bipolar disorder (BD) and ADHD). Standalone skills learning groups address the problem of limited resources in several clinical settings. Furthermore, transdiagnostic skills groups facilitate recruitment and decrease scattering of resources in psychiatric settings. However, few studies have focused on the pertinence of transdiagnostic standalone skills groups in naturalistic settings as well as their long-term outcomes. The goal of this study is to assess the patients’ evolution one year after their participation in DBT transdiagnostic skills group. Method. Transdiagnostic DBT skills training groups were provided for BPD, BD and ADHD patients in a University Psychiatric Department (Strasbourg, France), between 2019 and 2020. It consisted of 16 group sessions of 2,5 hours and 3 individual sessions. At 1-year follow-up, ad-hoc questionnaires were proposed to all participants to assess their evolution. Result. 22 of the 31 participants were interviewed at the one-year post-group session (64% BPD, 41% ADHD and 27% BD). 73% participants estimated that group impact was important or very important, 64% stated using the skills learned often or very often, mainly emotional regulation skills. An improvement in emotional instability, substance use, impulsivity and suicidal thoughts was reported by respectively 100%, 91%, 86% and 85% of participants. Quality of life improved according to 90% participants. All patients reported an improvement in suicidality during the post-group year, especially in suicide attempts. Psychotropic medication decreased in 59% of participants. Discussion. Our one-year naturalistic study suggests that transdiagnostic DBT skills training groups are promising in BPD, BD and ADHD patients with emotional dysregulation. The observational design and the lack of control group are the main limitation. Randomized controlled studies are warranted to confirm the long-term efficacy of transdiagnostic skills learning groups in naturalistic settings. dialectical behavior therapy emotional regulation skills training transdiagnostic borderline personality disorder bipolar disorder attention deficit/hyperactivity disorder emotion dysregulation Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Amongst psychosocial interventions for Borderline Personality Disorder (BPD), Dialectical Behavior Therapy (DBT) has the highest evidence level of efficacy ( 1 ). DBT targets emotional dysregulation ( 2 , 3 ), notably by teaching emotional regulation skills. Several studies have shown that DBT is also effective in targeting emotional dysregulation found in other psychiatric disorders characterized by emotional dysregulation ( 4 – 6 ), such as bipolar disorder (BD) ( 7 – 9 ), or ADHD ( 10 ). Although pharmacological treatments are the first-line intervention for the latter, they do not target emotional dysregulation ( 11 ). Comprehensive DBT is an intensive therapy that includes four components (skills training group, individual therapy, phone coaching and team consultation), needing sufficient staff and patient availability, which limits its implementation ( 12 , 13 ). On average, 45.3% of teams that have implemented DBT fail to pursue the delivery of the therapy, usually after 2 to 5 years ( 13 ). These interruptions are especially dramatic because the number of DBT trained therapists is low compared to patients’ needs ( 14 ). For this reason, less resource-intensive and more easily implementable models have been evaluated, in particular ones focusing on DBT skills training groups ( 15 ). DBT skills training group without individual therapy is the most investigated standalone component of adapted DBT models. Recent meta-analysis found 4 randomized controlled studies for BPD with SMD of -1,05 on affective instability ( 16 ) and 12 for other disorders with large overall effect size ( 17 ). DBT has also been adapted in transdiagnostic groups for patients with emotional dysregulation, allowing to have only one group for different diagnoses instead of several groups for each diagnosis. To our knowledge, 4 studies exist on transdiagnostic DBT groups. The only randomized controlled study ( 18 ) found that after a 4-month DBT group, patients with depression and/or anxiety disorder experienced a decrease in emotion dysregulation and anxiety with important effect size compared to the control group. A clinical improvement was also found by others studies in depression and anxiety after a 5-week DBT group with daily sessions ( 19 ). Improvements have also been reported in deliberate self-harm after 6-week DBT group with daily sessions ( 20 ), and in emotion regulation after 6-month DBT group with weekly sessions ( 21 ). However, these studies did not analyze the effectiveness of the transdiagnostic format beyond three-month follow-up and focused mainly on depression and anxiety disorder. Transdiagnostic groups have been less studied with BD or BPD and never studied with ADHD. Yet, the latter are often comorbid and characterized by high levels of impulsivity and emotional dysregulation, which are linked with suicidal behaviors ( 5 , 22 , 23 ). In this study, we were interested in the long-term retrospective evaluation of 4-month DBT transdiagnostic group targeting emotional dysregulation in BPD, BD and ADHD. Method Population Transdiagnostic DBT skills training groups were provided to patients with BPD, BD or ADHD in the Psychiatry Department of Strasbourg University Hospital. Patients were referred by psychiatrists, the referral criteria being a diagnosis of BPD, BD and ADHD associated with emotional dysregulation. Diagnosis was done according to DSM-5 criteria by psychiatrists. One year after the last session of transdiagnostic DBT groups, a semi-structured interview was systematically proposed to patients. DBT intervention Based on Neasciu & al ( 18 , 24 ), the transdiagnostic DBT skills training groups consisted of 16 weekly sessions of 2.5 hours. Divided in 2 cycles with a fixed skills learning program (Table 1 ), it covered the four DBT modules developed by Linehan (( 3 )) : mindfulness, emotion regulation, distress tolerance and interpersonal effectiveness. Each cycle began with mindfulness teaching sessions, participants could enter the program during these sessions, i.e. sessions 1, 2 and 10. Two debriefing sessions were held at the end of each cycle. These debriefing sessions were an opportunity to review the skills learned in the previous sessions, to role-play or model skills, to answer questions, to help participants realize their evolution, and to collect feedback from participants on their experience in the group sessions. This program was named GREMO – in French : Groupe de Régulation Emotionnelle ( 25 , 26 ). In addition to DBT skills training groups, a consultation team was held weekly and patients had treatment as usual (psychiatric consultation, medication, individual psychotherapy…). Therapists were psychiatrists or psychologists trained in dialectical behavior therapy (i.e., the four authors). Table 1 List of taught DBT skills Cycle Modules Sessions Skills Cycle 1 Mindfulness 1 Wise mind and the “what” skills of mindfulness 2 The “How” skills of mindfulness Distress Tolerance 3 STOP & TIP skills 4 ACCEPTS skills 5 IMPROVE and self-soothing skills 6 Radical acceptance and willingness Interpersonal Effectiveness 7 DEAR MAN skill 8 GIVE and FAST skills 9 Validation others and self-validation Debriefing session of cycle 1 Cycle 2 Mindfulness 10 Mindfulness Skills Review Emotional Regulation 11 Understand, identify and name emotions 12 Fact-checking 13 Opposite action 14 Problem solving 15 ABC skills 16 PLEASE skills Debriefing session of cycle 2 Debriefing session at one year Outcome measures An individual debriefing session at 1-year post-group was done through semi-structured interview guided with an ad hoc questionnaire. This questionnaire was divided in three parts. The first concerned DBT skills: impact of skills training group, frequency of skills use, the most used skills (mindfulness, emotional regulation, distress tolerance or interpersonal effectiveness). The second focused on perceived change for specific symptoms (emotional instability, depression, sleeping, suicidal thoughts, impulsivity, substances use, eating behavior, emptiness feeling, loneliness feeling), quality of life in general and in specific domains (couple life, friendship life, spiritual life, professional life, studies/training, leisure, health, hope, meaning of life, self-esteem). Responses were rated according to a 7-point Likert scale (very highly improved, highly improved, slightly improved, stable, slightly worsened, highly worsened, very highly worsened) or “non-applicable”. The third part focused on suicidality and use of services (psychiatric hospitalization, suicide attempt, parasuicidal behavior, consultation frequency of psychiatrist or psychologist, and psychotropic medication take). Following the debriefing sessions held between 2019–2020, we analyzed this questionnaire as part of this naturalistic study. Statistical analysis Descriptive analyses were used. In addition, Fisher exact tests were performed to explore relation between emotional instability and suicidal ideation change at 1 year, between both these symptoms and socio-demographic characteristics, the frequency of skills use, the type and intensity of follow-up during the post-group year. These statistical analyses were performed using IBM SPSS Statistics 27 software. Ethical aspects Participants were individually informed in written that their data could be used anonymously to evaluate the program and that they were allowed to refuse to participate. This research was approved by the ethics committee of the Strasbourg’s Medicine Faculty (CE-2021-108). Results Characteristics of Population Between March 2018 and December 2019, 4 transdiagnostic DBT groups were conducted with 31 different patients, including 3 who prematurely dropped out. Out of the remaining 28 participants, 6 did not attend the 1-year follow-up debriefing session between 2019 and 2020 (4 renewed their participation in DBT group before this debriefing and were therefore not included, and 2 did not respond). Therefore, 22 patients responded to the 1-year questionnaire. 86% were women, with an average age of 33.3 years (SD = 8.5). Around half of them have a history of self-harm (55%), suicide attempt (50%) and psychiatric hospitalizations (55%). In the referral letters, the main diagnosis was BPD (64%), ADHD (41%) and BD (27%). At least 2 diagnoses were mentioned for 5 patients (23%). Perception of change at the one-year debriefing session - Perception of DBT skills training impact at 1 year DBT skills training impact was estimated as important or very important by 73% of participants (Fig. 1 ). One year following the last session, 64% stated using the skills learned often or very often, emotional regulation skills being the most used according to the participants (Fig. 2 ). - Clinical evolution at 1 year At 1-year post-intervention, 100% of participants reported experiencing an improvement of emotional instability, 91% of substance use (for the 11 concerned participants), 86% of impulsivity and 85% of suicidal thoughts (for the 20 concerned participants). Improvements in feelings of emptiness, depression, eating behavior and feeling of loneliness were less frequently noticed (Fig. 3 ). According to our survey, 90% of participants reported an increase in their overall quality of life. More specifically, 85% experienced improvements in self-esteem, 82% in the meaning given to their life, 81% in work/study and hope, 68% in leisure, 64% in friendly relationship, 60% in romantic relationship, 50% in health issues, and 38% in sleeping difficulties (Fig. 4 ). - Perceived evolution of suicidality and use of services at one-year post-DBT All patients reported an improvement in suicidality if they were concerned, especially in suicide attempts (Fig. 5 ). None reported stabilization or worsening. Regarding their use of services, 13 patients said that their medication was decreased (59%), 3 patients that it was increased (14%) and 6 that it was stable (27%). The frequency of psychiatric or psychological consultations decreased according to 50% of patients and remained stable according to others. It was once a year for two patients (9%), one to three times a month for 10 (45,5%), and once a week for 10 (45,5%). The type of continued psychotherapeutic follow-up was individual DBT for 6 patients (27%), CBT for 6 (27%), and other for 10 (46%). - Predictors of improvement: According to exact Fisher test, improvement in emotional instability or suicidal ideation was not associated with socio-demographic characteristics (sex, age or disorder), nor with the type of individual therapy and its intensity during this post-group year. In contrast, the frequency of skill use was associated with improvement in emotional instability (p = 0.014). Furthermore, improvement in emotional instability and improvement in suicidal ideation were correlated (p = 0.010). Nevertheless, the frequency of skill use was not associated with improvement in suicidal ideation. Discussion This naturalistic study aimed to explore the one-year impact of transdiagnostic 4-month DBT skills training groups for BPD, BD and/or ADHD. To our knowledge, our study is the first to investigate the long-term impact of a transdiagnostic DBT group. One-year post-treatment, all participants deemed that the DBT skills training group had had a positive impact, which was rated as important or very important by three quarters of them. All participants reported improvements in emotional instability, and over 85% in substance use, impulsivity, and suicidal thoughts. Although other symptoms showed less improvements, more than half of participants noticed improvements in eating behavior, depression, feelings of emptiness and over a third in feelings of loneliness. For each assessed symptom, participants reported more improvements than stability or worsening. Improvements were also reported by the majority of patients for quality of life, suicidal behaviors, and use of services. Consistent with other studies ( 27 , 28 ), the use of DBT skills was associated with improvement in emotional instability. Moreover, this improvement was correlated with suicidal thoughts improvement. In contrast, none of these symptoms were correlated with patients’ socio-demographics characteristics nor with individual therapy attended during the post-group year. Participants reported using mainly of emotional regulation skills. This is in contrast with findings suggesting that during the course of the group, the most used skills are usually distress tolerance ones ( 29 ). The absence of correlation between socio-demographics characteristics and emotional instability improvement suggests that regardless of age, sex or diagnosis, emotional stability improves after the transdiagnostic DBT group. The literature on DBT stand-alone transdiagnostic groups is recent and scarcely developed. The Neasciu et al. study ( 18 ), which inspired our DBT program, included anxious or depressed patients and excluded those with high suicidality. Similar to Neasciu et al., we observed an improvement in emotional dysregulation associated with the use of DBT skills. However, the authors found that this was the case post-therapy and at two months follow-up. Like Gibson et al. ( 20 ), who evaluated a 6-week daily group program in a sample with 18,6% BD and 74,3% BPD individuals, we found an improvement in self-harm behaviors, though their post-group follow-up was held at three months only. Other short programs of transdiagnostic DBT groups found clinical improvements in emotion regulation, depression and hope, but a follow-up was not provided ( 19 , 21 ). Therefore, our study adds to this literature by providing evidence for longer-term effects (up to a year) of a short DBT skills training group in people with BD, BPD and or/ADHD. Several important limitations should be noted. First, the absence of a control group does not allow us to conclude that the DBT skills training group is the active ingredient of clinical improvement. While emotional dysregulation in ADHD and BD is usually considered stable over 1–2 years without therapeutic intervention, this is less consensual in BPD because remission in BPD symptoms reaches 39% at 2 years ( 30 – 32 ). However, this did not mean complete regression of all symptoms or absence of relapse risk ( 33 ). At one-year, the control groups referenced in Finch's meta-analysis ( 34 ) had low effect size on BPD symptoms and nearly zero on suicidality. Second, the retrospective self-reported data may have been influenced by a social desirability bias and a memory bias. These biases may have overestimated the results. However, the evolution is not the same for all symptoms, which suggests that these biases did not explain all the improvements found here. Third, the small sample limits the reliability of Fisher exact test to determine if some characteristics of the participants could have moderated the response of the intervention (age, initial severity of ED, diagnosis). However, the analysis found results consistent with the literature. Fourth, individual DBT sessions was offered to some of the patients presenting with severe BPD symptoms. Thus, we cannot affirm that the skills group stand-alone is sufficient for all patients presenting with severe ED. Conclusion Transdiagnostic DBT skills training groups seem to have positive outcomes at one year for individuals with BPD, BD and/or ADHD presenting with emotional dysregulation. These results are relevant in terms of DBT implementation, notably when evidence-based psychotherapies are difficult to implement due to access to services limitation. The transdiagnostic format can be more easily implemented outside of specialized settings for a specific disorder. Comparative effectiveness studies are still needed. Declarations Ethical Approval and Consent to participate The study was approved by the ethics committee of the Strasbourg’s Medicine Faculty (CE-2021-108). Participants were individually informed in written that their data could be used anonymously to evaluate the program and that they were allowed to refuse to participate. Consent for publication All of the material is owned by the authors and/or no permissions are required. Availability of data and materials The results/data/figures in this manuscript have not been published elsewhere, nor are they under consideration (from you or one of your Contributing Authors) by another publisher. Competing interests The authors declare that they have no competing interests. Funding Open access funding provided by University Hospitals of Strasbourg. The authors received no specific funding for this work. Authors' contributions A. D., L. W., E. L. and S. W designed the research protocol. S. W., L. W., A. D. and E. L. developed the intervention program and therapy materials for patients. S. W., L. W., A. D., and E.L., recruited participants and conducted therapy sessions together. A. D. conducted the statistical analyses and wrote the first draft of the manuscript, which was then reviewed by S.W, E. L, and L. W. Acknowledgements : We want to thank the clinicians who helped us to implement these DBT groups in Strasbourg: Ms Saliha Derrouazi, Ms Valérie Poussardin and Ms Doha Bemmouna. We also want to thank the professionals who trained us to DBT: Pr Nader Perroud, Pr Shelley McMain and Pr Michaela Swales. References Storebø OJ, Stoffers-Winterling JM, Völlm BA, Kongerslev MT, Mattivi JT, Jørgensen MS, et al. Psychological therapies for people with borderline personality disorder. Cochrane Database Syst Rev. 4 mai 2020;2020(5):CD012955. Linehan MM. Cognitive-behavioral treatment of borderline personality disorder. New York, NY, US: Guilford Press; 1993. xvii, 558 p. (Cognitive-behavioral treatment of borderline personality disorder). Linehan MM. Skills training manual for treating borderline personality disorder. New York, NY, US: Guilford Press; 1993. xii, 180 p. (Skills training manual for treating borderline personality disorder). Kring AM, Sloan DM. Emotion Regulation and Psychopathology: A Transdiagnostic Approach to Etiology and Treatment. Guilford Press; 2009. 479 p. Moukhtarian TR, Mintah RS, Moran P, Asherson P. Emotion dysregulation in attention-deficit/hyperactivity disorder and borderline personality disorder. Borderline Personality Disorder and Emotion Dysregulation. 20 mai 2018;5(1):9. Rigucci S, Sarubbi S, Erbuto D, Rogante E, Hantouche EG, Innamorati M, et al. Negative emotion dysregulation is linked to the intensity of suicidal ideation in a mixed inpatient sample. J Affect Disord. 15 févr 2021;281:605‑8. Goldstein TR, Fersch-Podrat RK, Rivera M, Axelson DA, Merranko J, Yu H, et al. Dialectical Behavior Therapy for Adolescents with Bipolar Disorder: Results from a Pilot Randomized Trial. J Child Adolesc Psychopharmacol. 1 mars 2015;25(2):140‑9. Van Dijk S, Jeffrey J, Katz MR. A randomized, controlled, pilot study of dialectical behavior therapy skills in a psychoeducational group for individuals with bipolar disorder. J Affect Disord. 5 mars 2013;145(3):386‑93. Wright K, Dodd AL, Warren FC, Medina-Lara A, Dunn B, Harvey J, et al. Psychological therapy for mood instability within bipolar spectrum disorder: a randomised, controlled feasibility trial of a dialectical behaviour therapy-informed approach (the ThrIVe-B programme). Int J Bipolar Disord. 1 juill 2021;9:20. Cole P, Weibel S, Nicastro R, Hasler R, Dayer A, Aubry JM, et al. CBT/DBT skills training for adults with attention deficit hyperactivity disorder (ADHD). Psychiatr Danub. sept 2016;28(Suppl-1):103‑7. Paulus FW, Ohmann S, Möhler E, Plener P, Popow C. Emotional Dysregulation in Children and Adolescents With Psychiatric Disorders. A Narrative Review. Front Psychiatry. 25 oct 2021;12:628252. Carmel A, Rose M, Fruzzetti AE. Barriers and Solutions to Implementing Dialectical Behavior Therapy in a Public Behavioral Health System. Adm Policy Ment Health. sept 2014;41(5):608‑14. King JC, Hibbs R, Saville CWN, Swales MA. The survivability of dialectical behaviour therapy programmes: a mixed methods analysis of barriers and facilitators to implementation within UK healthcare settings. BMC Psychiatry. déc 2018;18(1):1‑11. Iliakis EA, Sonley AKI, Ilagan GS, Choi-Kain LW. Treatment of Borderline Personality Disorder: Is Supply Adequate to Meet Public Health Needs? PS. sept 2019;70(9):772‑81. Dimeff LA, Rizvi SL, Koerner K. Dialectical Behavior Therapy in Clinical Practice, Second Edition. Guilford Publications; 2020. 466 p. Delaquis CP, Joyce KM, Zalewski M, Katz LY, Sulymka J, Agostinho T, et al. Dialectical behaviour therapy skills training groups for common mental health disorders: A systematic review and meta-analysis. J Affect Disord. 1 mars 2022;300:305‑13. Stoffers-Winterling JM, Storebø OJ, Kongerslev MT, Faltinsen E, Todorovac A, Jørgensen MS, et al. Psychotherapies for borderline personality disorder: a focused systematic review and meta-analysis. The British Journal of Psychiatry. sept 2022;221(3):538‑52. Neacsiu AD, Eberle JW, Kramer R, Wiesmann T, Linehan MM. Dialectical behavior therapy skills for transdiagnostic emotion dysregulation: a pilot randomized controlled trial. Behav Res Ther. août 2014;59:40‑51. Ritschel LA, Cheavens JS, Nelson J. Dialectical behavior therapy in an intensive outpatient program with a mixed-diagnostic sample. J Clin Psychol. mars 2012;68(3):221‑35. Gibson J, Booth R, Davenport J, Keogh K, Owens T. Dialectical behaviour therapy-informed skills training for deliberate self-harm: a controlled trial with 3-month follow-up data. Behav Res Ther. sept 2014;60:8‑14. Heath N, Midkiff MF, Gerhart J, Turow RG. Group-based DBT skills training modules are linked to independent and additive improvements in emotion regulation in a heterogeneous outpatient sample. Psychotherapy Research. 17 nov 2021;31(8):1001‑11. Richard-Lepouriel H, Kung AL, Hasler R, Bellivier F, Prada P, Gard S, et al. Impulsivity and its association with childhood trauma experiences across bipolar disorder, attention deficit hyperactivity disorder and borderline personality disorder. Journal of Affective Disorders. 1 févr 2019;244:33‑41. Bayes A, Parker G, McClure G. Emotional dysregulation in those with bipolar disorder, borderline personality disorder and their comorbid expression. Journal of Affective Disorders. 1 nov 2016;204:103‑11. Neacsiu AD, Bohus M, Linehan MM. Dialectical behavior therapy: An intervention for emotion dysregulation. In: Handbook of emotion regulation, 2nd ed. New York, NY, US: The Guilford Press; 2014. p. 491‑507. Durpoix A, Bemmouna D, Weiner L, Weibel S. Évaluation de l’impact immédiat et à un an d’un groupe de thérapie comportementale dialectique transnosographique implementé dans un contexte ambulatoire en France : le Groupe de Régulation EMOtionnelle. French Journal of Psychiatry. 1 déc 2019;1:S186. Weiner L. Évaluation de la faisabilité et de l’efficacité d’un groupe de thérapie comportementale dialectique (TCD) transnosographique : le groupe de régulation EMOtionnelle (GREMO). French Journal of Psychiatry. 1 déc 2019;1:S24‑5. Neacsiu AD, Rizvi SL, Linehan MM. Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder. Behaviour Research and Therapy. 1 sept 2010;48(9):832‑9. Southward MW, Eberle JW, Neacsiu AD. Multilevel associations of daily skill use and effectiveness with anxiety, depression, and stress in a transdiagnostic sample undergoing dialectical behavior therapy skills training. Cogn Behav Ther. mars 2022;51(2):114‑29. Lindenboim N, Comtois KA (Kate), Linehan MM. Skills Practice in Dialectical Behavior Therapy for Suicidal Women Meeting Criteria for Borderline Personality Disorder. Cognitive and Behavioral Practice. 1 mai 2007;14(2):147‑56. Zanarini MC, Frankenburg FR, Hennen J, Silk KR. The Longitudinal Course of Borderline Psychopathology: 6-Year Prospective Follow-Up of the Phenomenology of Borderline Personality Disorder. AJP. févr 2003;160(2):274‑83. Zanarini MC, Frankenburg FR, Hennen J, Reich DB, Silk KR. Prediction of the 10-Year Course of Borderline Personality Disorder. AJP. mai 2006;163(5):827‑32. Zanarini MC, Frankenburg FR, Reich DB, Silk KR, Hudson JI, McSweeney LB. The Subsyndromal Phenomenology of Borderline Personality Disorder: A 10-Year Follow-Up Study. AJP. juin 2007;164(6):929‑35. Zanarini MC, Frankenburg FR, Reich DB, Fitzmaurice G. Attainment and Stability of Sustained Symptomatic Remission and Recovery Among Patients With Borderline Personality Disorder and Axis II Comparison Subjects: A 16-Year Prospective Follow-Up Study. AJP. mai 2012;169(5):476‑83. Finch EF, Iliakis EA, Masland SR, Choi-Kain LW. A meta-analysis of treatment as usual for borderline personality disorder. Personality Disorders: Theory, Research, and Treatment. 2019;10:491‑9. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 21 Dec, 2023 Read the published version in Borderline Personality Disorder and Emotion Dysregulation → Version 1 posted Editorial decision: Major revision 04 Oct, 2023 Reviews received at journal 10 Jul, 2023 Reviewers agreed at journal 29 Jun, 2023 Reviewers invited by journal 03 May, 2023 Editor assigned by journal 03 May, 2023 Submission checks completed at journal 02 May, 2023 First submitted to journal 21 Apr, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2845259","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":196904592,"identity":"e75c9bd3-7528-4543-b043-0400a463873a","order_by":0,"name":"Amaury DURPOIX","email":"data:image/png;base64,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","orcid":"","institution":"University Hospitals of Strasbourg","correspondingAuthor":true,"prefix":"","firstName":"Amaury","middleName":"","lastName":"DURPOIX","suffix":""},{"id":196904594,"identity":"91d12070-6395-438b-95b0-7454d2f9451f","order_by":1,"name":"Enzo Lachaux","email":"","orcid":"","institution":"University Hospitals of Strasbourg","correspondingAuthor":false,"prefix":"","firstName":"Enzo","middleName":"","lastName":"Lachaux","suffix":""},{"id":196904600,"identity":"35e7ce4d-b788-4376-9a6e-412465ad5eea","order_by":2,"name":"Luisa WEINER","email":"","orcid":"","institution":"University Hospitals of Strasbourg","correspondingAuthor":false,"prefix":"","firstName":"Luisa","middleName":"","lastName":"WEINER","suffix":""},{"id":196904602,"identity":"abdacc59-66d8-485b-915c-5d31cc8e7bdb","order_by":3,"name":"Sébastien WEIBEL","email":"","orcid":"","institution":"University Hospitals of Strasbourg","correspondingAuthor":false,"prefix":"","firstName":"Sébastien","middleName":"","lastName":"WEIBEL","suffix":""}],"badges":[],"createdAt":"2023-04-21 11:59:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2845259/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2845259/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s40479-023-00243-y","type":"published","date":"2023-12-21T15:01:09+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":36658714,"identity":"25efd6eb-8c18-4d1c-94ae-9eda47a7e1e3","added_by":"auto","created_at":"2023-05-05 21:19:42","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":88420,"visible":true,"origin":"","legend":"\u003cp\u003eparticipants’ estimate of DBT skills training impact at 1 year (N = 22)\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2845259/v1/a23a536282b72128034ec1f8.jpg"},{"id":36659472,"identity":"a037900f-cdbe-4f8e-87f6-2cd9660a0558","added_by":"auto","created_at":"2023-05-05 21:35:42","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":136430,"visible":true,"origin":"","legend":"\u003cp\u003eparticipants’ assessment of skill use over the post-group year (N = 22)\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2845259/v1/1557bddfe7bc89a3728d35b8.jpg"},{"id":36658910,"identity":"6d82a9c3-e139-48c4-8ab8-59fbd883977a","added_by":"auto","created_at":"2023-05-05 21:27:42","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":354919,"visible":true,"origin":"","legend":"\u003cp\u003eparticipants’ assessment of symptom evolution at 1 year post-group (N = 22)\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2845259/v1/69e40476beb6f1833052f66e.jpg"},{"id":36658715,"identity":"418d6b98-c140-4bd5-984e-bec7b49690f1","added_by":"auto","created_at":"2023-05-05 21:19:42","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":400457,"visible":true,"origin":"","legend":"\u003cp\u003eparticipants’ assessment of the evolution of their quality of life at 1-year post-group (N = 22)\u003c/p\u003e","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2845259/v1/c67650871256775e40b62bba.jpg"},{"id":36658718,"identity":"47165198-e486-4233-bbfd-41357a6596fd","added_by":"auto","created_at":"2023-05-05 21:19:42","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":175881,"visible":true,"origin":"","legend":"\u003cp\u003eparticipants’ assessment of the evolution of suicidality at 1-year post-group\u003c/p\u003e","description":"","filename":"5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2845259/v1/a7658398181fc750d8b8d90c.jpg"},{"id":48776677,"identity":"99395649-65e6-4b72-b2df-1c8d89e64868","added_by":"auto","created_at":"2023-12-25 15:07:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":675908,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2845259/v1/af314c2c-d80e-4736-b0e4-00a9e41c1af7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Transdiagnostic Skills Training Group of Dialectical Behavior Therapy: a Long-Term Naturalistic Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAmongst psychosocial interventions for Borderline Personality Disorder (BPD), Dialectical Behavior Therapy (DBT) has the highest evidence level of efficacy (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). DBT targets emotional dysregulation (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), notably by teaching emotional regulation skills. Several studies have shown that DBT is also effective in targeting emotional dysregulation found in other psychiatric disorders characterized by emotional dysregulation (\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), such as bipolar disorder (BD) (\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), or ADHD (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Although pharmacological treatments are the first-line intervention for the latter, they do not target emotional dysregulation (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eComprehensive DBT is an intensive therapy that includes four components (skills training group, individual therapy, phone coaching and team consultation), needing sufficient staff and patient availability, which limits its implementation (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). On average, 45.3% of teams that have implemented DBT fail to pursue the delivery of the therapy, usually after 2 to 5 years (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). These interruptions are especially dramatic because the number of DBT trained therapists is low compared to patients\u0026rsquo; needs (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). For this reason, less resource-intensive and more easily implementable models have been evaluated, in particular ones focusing on DBT skills training groups (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). DBT skills training group without individual therapy is the most investigated standalone component of adapted DBT models. Recent meta-analysis found 4 randomized controlled studies for BPD with SMD of -1,05 on affective instability (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) and 12 for other disorders with large overall effect size (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDBT has also been adapted in transdiagnostic groups for patients with emotional dysregulation, allowing to have only one group for different diagnoses instead of several groups for each diagnosis. To our knowledge, 4 studies exist on transdiagnostic DBT groups. The only randomized controlled study (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) found that after a 4-month DBT group, patients with depression and/or anxiety disorder experienced a decrease in emotion dysregulation and anxiety with important effect size compared to the control group. A clinical improvement was also found by others studies in depression and anxiety after a 5-week DBT group with daily sessions (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Improvements have also been reported in deliberate self-harm after 6-week DBT group with daily sessions (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), and in emotion regulation after 6-month DBT group with weekly sessions (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). However, these studies did not analyze the effectiveness of the transdiagnostic format beyond three-month follow-up and focused mainly on depression and anxiety disorder. Transdiagnostic groups have been less studied with BD or BPD and never studied with ADHD. Yet, the latter are often comorbid and characterized by high levels of impulsivity and emotional dysregulation, which are linked with suicidal behaviors (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this study, we were interested in the long-term retrospective evaluation of 4-month DBT transdiagnostic group targeting emotional dysregulation in BPD, BD and ADHD.\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003ePopulation\u003c/h2\u003e\n\u003cp\u003eTransdiagnostic DBT skills training groups were provided to patients with BPD, BD or ADHD in the Psychiatry Department of Strasbourg University Hospital. Patients were referred by psychiatrists, the referral criteria being a diagnosis of BPD, BD and ADHD associated with emotional dysregulation. Diagnosis was done according to DSM-5 criteria by psychiatrists.\u003c/p\u003e\n\u003cp\u003eOne year after the last session of transdiagnostic DBT groups, a semi-structured interview was systematically proposed to patients.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n\u003ch2\u003eDBT intervention\u003c/h2\u003e\n\u003cp\u003eBased on Neasciu \u0026amp; al (\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e), the transdiagnostic DBT skills training groups consisted of 16 weekly sessions of 2.5 hours. Divided in 2 cycles with a fixed skills learning program (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e), it covered the four DBT modules developed by Linehan ((\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e)) : mindfulness, emotion regulation, distress tolerance and interpersonal effectiveness. Each cycle began with mindfulness teaching sessions, participants could enter the program during these sessions, i.e. sessions 1, 2 and 10. Two debriefing sessions were held at the end of each cycle. These debriefing sessions were an opportunity to review the skills learned in the previous sessions, to role-play or model skills, to answer questions, to help participants realize their evolution, and to collect feedback from participants on their experience in the group sessions. This program was named GREMO \u0026ndash; in French : Groupe de R\u0026eacute;gulation Emotionnelle (\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e). In addition to DBT skills training groups, a consultation team was held weekly and patients had treatment as usual (psychiatric consultation, medication, individual psychotherapy\u0026hellip;). Therapists were psychiatrists or psychologists trained in dialectical behavior therapy (i.e., the four authors).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eList of taught DBT skills\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCycle\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eModules\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSessions\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSkills\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"9\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eCycle 1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMindfulness\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWise mind and the \u0026ldquo;what\u0026rdquo; skills of mindfulness\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eThe \u0026ldquo;How\u0026rdquo; skills of mindfulness\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eDistress Tolerance\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSTOP \u0026amp; TIP skills\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eACCEPTS skills\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIMPROVE and self-soothing skills\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRadical acceptance and willingness\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eInterpersonal Effectiveness\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDEAR MAN skill\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGIVE and FAST skills\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eValidation others and self-validation\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e\u003cspan class=\"BoldItalic\"\u003eDebriefing session of cycle 1\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"7\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eCycle 2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMindfulness\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMindfulness Skills Review\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"6\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eEmotional Regulation\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUnderstand, identify and name emotions\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFact-checking\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOpposite action\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eProblem solving\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eABC skills\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePLEASE skills\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e\u003cspan class=\"BoldItalic\"\u003eDebriefing session of cycle 2\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e\u003cspan class=\"BoldItalic\"\u003eDebriefing session at one year\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n\u003ch2\u003eOutcome measures\u003c/h2\u003e\n\u003cp\u003eAn individual debriefing session at 1-year post-group was done through semi-structured interview guided with an ad hoc questionnaire. This questionnaire was divided in three parts. The first concerned DBT skills: impact of skills training group, frequency of skills use, the most used skills (mindfulness, emotional regulation, distress tolerance or interpersonal effectiveness). The second focused on perceived change for specific symptoms (emotional instability, depression, sleeping, suicidal thoughts, impulsivity, substances use, eating behavior, emptiness feeling, loneliness feeling), quality of life in general and in specific domains (couple life, friendship life, spiritual life, professional life, studies/training, leisure, health, hope, meaning of life, self-esteem). Responses were rated according to a 7-point Likert scale (very highly improved, highly improved, slightly improved, stable, slightly worsened, highly worsened, very highly worsened) or \u0026ldquo;non-applicable\u0026rdquo;. The third part focused on suicidality and use of services (psychiatric hospitalization, suicide attempt, parasuicidal behavior, consultation frequency of psychiatrist or psychologist, and psychotropic medication take).\u003c/p\u003e\n\u003cp\u003eFollowing the debriefing sessions held between 2019\u0026ndash;2020, we analyzed this questionnaire as part of this naturalistic study.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n\u003ch2\u003eStatistical analysis\u003c/h2\u003e\n\u003cp\u003eDescriptive analyses were used. In addition, Fisher exact tests were performed to explore relation between emotional instability and suicidal ideation change at 1 year, between both these symptoms and socio-demographic characteristics, the frequency of skills use, the type and intensity of follow-up during the post-group year. These statistical analyses were performed using IBM SPSS Statistics 27 software.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n\u003ch2\u003eEthical aspects\u003c/h2\u003e\n\u003cp\u003eParticipants were individually informed in written that their data could be used anonymously to evaluate the program and that they were allowed to refuse to participate. This research was approved by the ethics committee of the Strasbourg\u0026rsquo;s Medicine Faculty (CE-2021-108).\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n\u003ch2\u003eCharacteristics of Population\u003c/h2\u003e\n\u003cp\u003eBetween March 2018 and December 2019, 4 transdiagnostic DBT groups were conducted with 31 different patients, including 3 who prematurely dropped out. Out of the remaining 28 participants, 6 did not attend the 1-year follow-up debriefing session between 2019 and 2020 (4 renewed their participation in DBT group before this debriefing and were therefore not included, and 2 did not respond).\u003c/p\u003e\n\u003cp\u003eTherefore, 22 patients responded to the 1-year questionnaire. 86% were women, with an average age of 33.3 years (SD\u0026thinsp;=\u0026thinsp;8.5). Around half of them have a history of self-harm (55%), suicide attempt (50%) and psychiatric hospitalizations (55%). In the referral letters, the main diagnosis was BPD (64%), ADHD (41%) and BD (27%). At least 2 diagnoses were mentioned for 5 patients (23%).\u003c/p\u003e\n\u003ch2\u003ePerception of change at the one-year debriefing session\u003c/h2\u003e\n\u003cdiv id=\"Sec10\" class=\"Section3\"\u003e\n\u003ch2\u003e- Perception of DBT skills training impact at 1 year\u003c/h2\u003e\n\u003cp\u003eDBT skills training impact was estimated as important or very important by 73% of participants (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). One year following the last session, 64% stated using the skills learned often or very often, emotional regulation skills being the most used according to the participants (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section3\"\u003e\n\u003ch2\u003e- Clinical evolution at 1 year\u003c/h2\u003e\n\u003cp\u003eAt 1-year post-intervention, 100% of participants reported experiencing an improvement of emotional instability, 91% of substance use (for the 11 concerned participants), 86% of impulsivity and 85% of suicidal thoughts (for the 20 concerned participants). Improvements in feelings of emptiness, depression, eating behavior and feeling of loneliness were less frequently noticed (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv id=\"Sec12\" class=\"Section4\"\u003e\n\u003cp\u003eAccording to our survey, 90% of participants reported an increase in their overall quality of life. More specifically, 85% experienced improvements in self-esteem, 82% in the meaning given to their life, 81% in work/study and hope, 68% in leisure, 64% in friendly relationship, 60% in romantic relationship, 50% in health issues, and 38% in sleeping difficulties (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section3\"\u003e\n\u003ch2\u003e- Perceived evolution of suicidality and use of services at one-year post-DBT\u003c/h2\u003e\n\u003cp\u003eAll patients reported an improvement in suicidality if they were concerned, especially in suicide attempts (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e). None reported stabilization or worsening.\u003c/p\u003e\n\u003cp\u003eRegarding their use of services, 13 patients said that their medication was decreased (59%), 3 patients that it was increased (14%) and 6 that it was stable (27%). The frequency of psychiatric or psychological consultations decreased according to 50% of patients and remained stable according to others. It was once a year for two patients (9%), one to three times a month for 10 (45,5%), and once a week for 10 (45,5%). The type of continued psychotherapeutic follow-up was individual DBT for 6 patients (27%), CBT for 6 (27%), and other for 10 (46%).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section3\"\u003e\n\u003ch2\u003e- Predictors of improvement:\u003c/h2\u003e\n\u003cp\u003eAccording to exact Fisher test, improvement in emotional instability or suicidal ideation was not associated with socio-demographic characteristics (sex, age or disorder), nor with the type of individual therapy and its intensity during this post-group year. In contrast, the frequency of skill use was associated with improvement in emotional instability (p\u0026thinsp;=\u0026thinsp;0.014). Furthermore, improvement in emotional instability and improvement in suicidal ideation were correlated (p\u0026thinsp;=\u0026thinsp;0.010). Nevertheless, the frequency of skill use was not associated with improvement in suicidal ideation.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis naturalistic study aimed to explore the one-year impact of transdiagnostic 4-month DBT skills training groups for BPD, BD and/or ADHD. To our knowledge, our study is the first to investigate the long-term impact of a transdiagnostic DBT group. One-year post-treatment, all participants deemed that the DBT skills training group had had a positive impact, which was rated as important or very important by three quarters of them. All participants reported improvements in emotional instability, and over 85% in substance use, impulsivity, and suicidal thoughts. Although other symptoms showed less improvements, more than half of participants noticed improvements in eating behavior, depression, feelings of emptiness and over a third in feelings of loneliness. For each assessed symptom, participants reported more improvements than stability or worsening. Improvements were also reported by the majority of patients for quality of life, suicidal behaviors, and use of services.\u003c/p\u003e \u003cp\u003eConsistent with other studies (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), the use of DBT skills was associated with improvement in emotional instability. Moreover, this improvement was correlated with suicidal thoughts improvement. In contrast, none of these symptoms were correlated with patients\u0026rsquo; socio-demographics characteristics nor with individual therapy attended during the post-group year. Participants reported using mainly of emotional regulation skills. This is in contrast with findings suggesting that during the course of the group, the most used skills are usually distress tolerance ones (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). The absence of correlation between socio-demographics characteristics and emotional instability improvement suggests that regardless of age, sex or diagnosis, emotional stability improves after the transdiagnostic DBT group.\u003c/p\u003e \u003cp\u003eThe literature on DBT stand-alone transdiagnostic groups is recent and scarcely developed. The Neasciu et al. study (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), which inspired our DBT program, included anxious or depressed patients and excluded those with high suicidality. Similar to Neasciu et al., we observed an improvement in emotional dysregulation associated with the use of DBT skills. However, the authors found that this was the case post-therapy and at two months follow-up. Like Gibson et al. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), who evaluated a 6-week daily group program in a sample with 18,6% BD and 74,3% BPD individuals, we found an improvement in self-harm behaviors, though their post-group follow-up was held at three months only. Other short programs of transdiagnostic DBT groups found clinical improvements in emotion regulation, depression and hope, but a follow-up was not provided (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Therefore, our study adds to this literature by providing evidence for longer-term effects (up to a year) of a short DBT skills training group in people with BD, BPD and or/ADHD.\u003c/p\u003e \u003cp\u003eSeveral important limitations should be noted. First, the absence of a control group does not allow us to conclude that the DBT skills training group is the active ingredient of clinical improvement. While emotional dysregulation in ADHD and BD is usually considered stable over 1\u0026ndash;2 years without therapeutic intervention, this is less consensual in BPD because remission in BPD symptoms reaches 39% at 2 years (\u003cspan additionalcitationids=\"CR31\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). However, this did not mean complete regression of all symptoms or absence of relapse risk (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). At one-year, the control groups referenced in Finch's meta-analysis (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e) had low effect size on BPD symptoms and nearly zero on suicidality. Second, the retrospective self-reported data may have been influenced by a social desirability bias and a memory bias. These biases may have overestimated the results. However, the evolution is not the same for all symptoms, which suggests that these biases did not explain all the improvements found here. Third, the small sample limits the reliability of Fisher exact test to determine if some characteristics of the participants could have moderated the response of the intervention (age, initial severity of ED, diagnosis). However, the analysis found results consistent with the literature. Fourth, individual DBT sessions was offered to some of the patients presenting with severe BPD symptoms. Thus, we cannot affirm that the skills group stand-alone is sufficient for all patients presenting with severe ED.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eTransdiagnostic DBT skills training groups seem to have positive outcomes at one year for individuals with BPD, BD and/or ADHD presenting with emotional dysregulation. These results are relevant in terms of DBT implementation, notably when evidence-based psychotherapies are difficult to implement due to access to services limitation. The transdiagnostic format can be more easily implemented outside of specialized settings for a specific disorder. Comparative effectiveness studies are still needed.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthical Approval and Consent to participate\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the ethics committee of the Strasbourg\u0026rsquo;s Medicine Faculty (CE-2021-108). Participants were individually informed in written that their data could be used anonymously to evaluate the program and that they were allowed to refuse to participate.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll of the material is owned by the authors and/or no permissions are required.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe results/data/figures in this manuscript have not been published elsewhere, nor are they under consideration (from you or one of your Contributing Authors) by another publisher.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eOpen access funding provided by University Hospitals of Strasbourg. The authors received no specific funding for this work.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors\u0026apos; contributions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA. D., L. W., E. L. and S. W designed the research protocol. S. W., L. W., A. D. and E. L. developed the intervention program and therapy materials for patients. S. W., L. W., A. D., and E.L., recruited participants and conducted therapy sessions together. A. D. conducted the statistical analyses and wrote the first draft of the manuscript, which was then reviewed by S.W, E. L, and L. W.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e:\u003c/p\u003e\n\u003cp\u003eWe want to thank the clinicians who helped us to implement these DBT groups in Strasbourg: Ms Saliha Derrouazi, Ms Val\u0026eacute;rie Poussardin and Ms Doha Bemmouna.\u003c/p\u003e\n\u003cp\u003eWe also want to thank the professionals who trained us to DBT: Pr Nader Perroud, Pr Shelley McMain and Pr Michaela Swales.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eStoreb\u0026oslash; OJ, Stoffers-Winterling JM, V\u0026ouml;llm BA, Kongerslev MT, Mattivi JT, J\u0026oslash;rgensen MS, et al. Psychological therapies for people with borderline personality disorder. Cochrane Database Syst Rev. 4 mai 2020;2020(5):CD012955. \u003c/li\u003e\n\u003cli\u003eLinehan MM. Cognitive-behavioral treatment of borderline personality disorder. New York, NY, US: Guilford Press; 1993. xvii, 558 p. (Cognitive-behavioral treatment of borderline personality disorder). \u003c/li\u003e\n\u003cli\u003eLinehan MM. Skills training manual for treating borderline personality disorder. New York, NY, US: Guilford Press; 1993. xii, 180 p. (Skills training manual for treating borderline personality disorder). \u003c/li\u003e\n\u003cli\u003eKring AM, Sloan DM. Emotion Regulation and Psychopathology: A Transdiagnostic Approach to Etiology and Treatment. Guilford Press; 2009. 479 p. \u003c/li\u003e\n\u003cli\u003eMoukhtarian TR, Mintah RS, Moran P, Asherson P. Emotion dysregulation in attention-deficit/hyperactivity disorder and borderline personality disorder. Borderline Personality Disorder and Emotion Dysregulation. 20 mai 2018;5(1):9. \u003c/li\u003e\n\u003cli\u003eRigucci S, Sarubbi S, Erbuto D, Rogante E, Hantouche EG, Innamorati M, et al. Negative emotion dysregulation is linked to the intensity of suicidal ideation in a mixed inpatient sample. J Affect Disord. 15 f\u0026eacute;vr 2021;281:605‑8. \u003c/li\u003e\n\u003cli\u003eGoldstein TR, Fersch-Podrat RK, Rivera M, Axelson DA, Merranko J, Yu H, et al. Dialectical Behavior Therapy for Adolescents with Bipolar Disorder: Results from a Pilot Randomized Trial. J Child Adolesc Psychopharmacol. 1 mars 2015;25(2):140‑9. \u003c/li\u003e\n\u003cli\u003eVan Dijk S, Jeffrey J, Katz MR. A randomized, controlled, pilot study of dialectical behavior therapy skills in a psychoeducational group for individuals with bipolar disorder. J Affect Disord. 5 mars 2013;145(3):386‑93. \u003c/li\u003e\n\u003cli\u003eWright K, Dodd AL, Warren FC, Medina-Lara A, Dunn B, Harvey J, et al. Psychological therapy for mood instability within bipolar spectrum disorder: a randomised, controlled feasibility trial of a dialectical behaviour therapy-informed approach (the ThrIVe-B programme). Int J Bipolar Disord. 1 juill 2021;9:20. \u003c/li\u003e\n\u003cli\u003eCole P, Weibel S, Nicastro R, Hasler R, Dayer A, Aubry JM, et al. CBT/DBT skills training for adults with attention deficit hyperactivity disorder (ADHD). Psychiatr Danub. sept 2016;28(Suppl-1):103‑7. \u003c/li\u003e\n\u003cli\u003ePaulus FW, Ohmann S, M\u0026ouml;hler E, Plener P, Popow C. Emotional Dysregulation in Children and Adolescents With Psychiatric Disorders. A Narrative Review. Front Psychiatry. 25 oct 2021;12:628252. \u003c/li\u003e\n\u003cli\u003eCarmel A, Rose M, Fruzzetti AE. Barriers and Solutions to Implementing Dialectical Behavior Therapy in a Public Behavioral Health System. Adm Policy Ment Health. sept 2014;41(5):608‑14. \u003c/li\u003e\n\u003cli\u003eKing JC, Hibbs R, Saville CWN, Swales MA. The survivability of dialectical behaviour therapy programmes: a mixed methods analysis of barriers and facilitators to implementation within UK healthcare settings. BMC Psychiatry. d\u0026eacute;c 2018;18(1):1‑11. \u003c/li\u003e\n\u003cli\u003eIliakis EA, Sonley AKI, Ilagan GS, Choi-Kain LW. Treatment of Borderline Personality Disorder: Is Supply Adequate to Meet Public Health Needs? PS. sept 2019;70(9):772‑81. \u003c/li\u003e\n\u003cli\u003eDimeff LA, Rizvi SL, Koerner K. Dialectical Behavior Therapy in Clinical Practice, Second Edition. Guilford Publications; 2020. 466 p. \u003c/li\u003e\n\u003cli\u003eDelaquis CP, Joyce KM, Zalewski M, Katz LY, Sulymka J, Agostinho T, et al. Dialectical behaviour therapy skills training groups for common mental health disorders: A systematic review and meta-analysis. J Affect Disord. 1 mars 2022;300:305‑13. \u003c/li\u003e\n\u003cli\u003eStoffers-Winterling JM, Storeb\u0026oslash; OJ, Kongerslev MT, Faltinsen E, Todorovac A, J\u0026oslash;rgensen MS, et al. Psychotherapies for borderline personality disorder: a focused systematic review and meta-analysis. The British Journal of Psychiatry. sept 2022;221(3):538‑52. \u003c/li\u003e\n\u003cli\u003eNeacsiu AD, Eberle JW, Kramer R, Wiesmann T, Linehan MM. Dialectical behavior therapy skills for transdiagnostic emotion dysregulation: a pilot randomized controlled trial. Behav Res Ther. ao\u0026ucirc;t 2014;59:40‑51. \u003c/li\u003e\n\u003cli\u003eRitschel LA, Cheavens JS, Nelson J. Dialectical behavior therapy in an intensive outpatient program with a mixed-diagnostic sample. J Clin Psychol. mars 2012;68(3):221‑35. \u003c/li\u003e\n\u003cli\u003eGibson J, Booth R, Davenport J, Keogh K, Owens T. Dialectical behaviour therapy-informed skills training for deliberate self-harm: a controlled trial with 3-month follow-up data. Behav Res Ther. sept 2014;60:8‑14. \u003c/li\u003e\n\u003cli\u003eHeath N, Midkiff MF, Gerhart J, Turow RG. Group-based DBT skills training modules are linked to independent and additive improvements in emotion regulation in a heterogeneous outpatient sample. Psychotherapy Research. 17 nov 2021;31(8):1001‑11. \u003c/li\u003e\n\u003cli\u003eRichard-Lepouriel H, Kung AL, Hasler R, Bellivier F, Prada P, Gard S, et al. Impulsivity and its association with childhood trauma experiences across bipolar disorder, attention deficit hyperactivity disorder and borderline personality disorder. Journal of Affective Disorders. 1 f\u0026eacute;vr 2019;244:33‑41. \u003c/li\u003e\n\u003cli\u003eBayes A, Parker G, McClure G. Emotional dysregulation in those with bipolar disorder, borderline personality disorder and their comorbid expression. Journal of Affective Disorders. 1 nov 2016;204:103‑11. \u003c/li\u003e\n\u003cli\u003eNeacsiu AD, Bohus M, Linehan MM. Dialectical behavior therapy: An intervention for emotion dysregulation. In: Handbook of emotion regulation, 2nd ed. New York, NY, US: The Guilford Press; 2014. p. 491‑507. \u003c/li\u003e\n\u003cli\u003eDurpoix A, Bemmouna D, Weiner L, Weibel S. \u0026Eacute;valuation de l\u0026rsquo;impact imm\u0026eacute;diat et \u0026agrave; un an d\u0026rsquo;un groupe de th\u0026eacute;rapie comportementale dialectique transnosographique implement\u0026eacute; dans un contexte ambulatoire en France : le Groupe de R\u0026eacute;gulation EMOtionnelle. French Journal of Psychiatry. 1 d\u0026eacute;c 2019;1:S186. \u003c/li\u003e\n\u003cli\u003eWeiner L. \u0026Eacute;valuation de la faisabilit\u0026eacute; et de l\u0026rsquo;efficacit\u0026eacute; d\u0026rsquo;un groupe de th\u0026eacute;rapie comportementale dialectique (TCD) transnosographique : le groupe de r\u0026eacute;gulation EMOtionnelle (GREMO). French Journal of Psychiatry. 1 d\u0026eacute;c 2019;1:S24‑5. \u003c/li\u003e\n\u003cli\u003eNeacsiu AD, Rizvi SL, Linehan MM. Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder. Behaviour Research and Therapy. 1 sept 2010;48(9):832‑9. \u003c/li\u003e\n\u003cli\u003eSouthward MW, Eberle JW, Neacsiu AD. Multilevel associations of daily skill use and effectiveness with anxiety, depression, and stress in a transdiagnostic sample undergoing dialectical behavior therapy skills training. Cogn Behav Ther. mars 2022;51(2):114‑29. \u003c/li\u003e\n\u003cli\u003eLindenboim N, Comtois KA (Kate), Linehan MM. Skills Practice in Dialectical Behavior Therapy for Suicidal Women Meeting Criteria for Borderline Personality Disorder. Cognitive and Behavioral Practice. 1 mai 2007;14(2):147‑56. \u003c/li\u003e\n\u003cli\u003eZanarini MC, Frankenburg FR, Hennen J, Silk KR. The Longitudinal Course of Borderline Psychopathology: 6-Year Prospective Follow-Up of the Phenomenology of Borderline Personality Disorder. AJP. f\u0026eacute;vr 2003;160(2):274‑83. \u003c/li\u003e\n\u003cli\u003eZanarini MC, Frankenburg FR, Hennen J, Reich DB, Silk KR. Prediction of the 10-Year Course of Borderline Personality Disorder. AJP. mai 2006;163(5):827‑32. \u003c/li\u003e\n\u003cli\u003eZanarini MC, Frankenburg FR, Reich DB, Silk KR, Hudson JI, McSweeney LB. The Subsyndromal Phenomenology of Borderline Personality Disorder: A 10-Year Follow-Up Study. AJP. juin 2007;164(6):929‑35. \u003c/li\u003e\n\u003cli\u003eZanarini MC, Frankenburg FR, Reich DB, Fitzmaurice G. Attainment and Stability of Sustained Symptomatic Remission and Recovery Among Patients With Borderline Personality Disorder and Axis II Comparison Subjects: A 16-Year Prospective Follow-Up Study. AJP. mai 2012;169(5):476‑83. \u003c/li\u003e\n\u003cli\u003eFinch EF, Iliakis EA, Masland SR, Choi-Kain LW. A meta-analysis of treatment as usual for borderline personality disorder. Personality Disorders: Theory, Research, and Treatment. 2019;10:491‑9. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"borderline-personality-disorder-and-emotion-dysregulation","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bded","sideBox":"Learn more about [Borderline Personality Disorder and Emotion Dysregulation](http://bpded.biomedcentral.com)","snPcode":"40479","submissionUrl":"https://submission.nature.com/new-submission/40479/3","title":"Borderline Personality Disorder and Emotion Dysregulation","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"dialectical behavior therapy, emotional regulation, skills training, transdiagnostic, borderline personality disorder, bipolar disorder, attention deficit/hyperactivity disorder, emotion dysregulation","lastPublishedDoi":"10.21203/rs.3.rs-2845259/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2845259/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDialectical Behavior Therapy (DBT) has assembled a large body of evidence for the treatment of emotional dysregulation in borderline personality disorder (BPD), but also in other disorders characterized by emotional dysregulation (e.g., bipolar disorder (BD) and ADHD). Standalone skills learning groups address the problem of limited resources in several clinical settings. Furthermore, transdiagnostic skills groups facilitate recruitment and decrease scattering of resources in psychiatric settings. However, few studies have focused on the pertinence of transdiagnostic standalone skills groups in naturalistic settings as well as their long-term outcomes. The goal of this study is to assess the patients’ evolution one year after their participation in DBT transdiagnostic skills group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTransdiagnostic DBT skills training groups were provided for BPD, BD and ADHD patients in a University Psychiatric Department (Strasbourg, France), between 2019 and 2020. It consisted of 16 group sessions of 2,5 hours and 3 individual sessions. At 1-year follow-up, ad-hoc questionnaires were proposed to all participants to assess their evolution.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e22 of the 31 participants were interviewed at the one-year post-group session (64% BPD, 41% ADHD and 27% BD). 73% participants estimated that group impact was important or very important, 64% stated using the skills learned often or very often, mainly emotional regulation skills. An improvement in emotional instability, substance use, impulsivity and suicidal thoughts was reported by respectively 100%, 91%, 86% and 85% of participants. Quality of life improved according to 90% participants. All patients reported an improvement in suicidality during the post-group year, especially in suicide attempts. Psychotropic medication decreased in 59% of participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur one-year naturalistic study suggests that transdiagnostic DBT skills training groups are promising in BPD, BD and ADHD patients with emotional dysregulation. The observational design and the lack of control group are the main limitation. Randomized controlled studies are warranted to confirm the long-term efficacy of transdiagnostic skills learning groups in naturalistic settings.\u003c/p\u003e","manuscriptTitle":"Transdiagnostic Skills Training Group of Dialectical Behavior Therapy: a Long-Term Naturalistic Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-05-05 21:19:37","doi":"10.21203/rs.3.rs-2845259/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2023-10-04T08:35:07+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-07-10T08:56:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"9a68d81e-940c-4de7-8fce-fadedf12a975","date":"2023-06-29T07:46:46+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-05-03T07:50:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-05-03T05:36:14+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-05-02T14:27:50+00:00","index":"","fulltext":""},{"type":"submitted","content":"Borderline Personality Disorder and Emotion Dysregulation","date":"2023-04-21T11:50:14+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"borderline-personality-disorder-and-emotion-dysregulation","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bded","sideBox":"Learn more about [Borderline Personality Disorder and Emotion Dysregulation](http://bpded.biomedcentral.com)","snPcode":"40479","submissionUrl":"https://submission.nature.com/new-submission/40479/3","title":"Borderline Personality Disorder and Emotion Dysregulation","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"30394423-7f4b-4daa-a0b9-c991b3126682","owner":[],"postedDate":"May 5th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-12-25T15:03:15+00:00","versionOfRecord":{"articleIdentity":"rs-2845259","link":"https://doi.org/10.1186/s40479-023-00243-y","journal":{"identity":"borderline-personality-disorder-and-emotion-dysregulation","isVorOnly":false,"title":"Borderline Personality Disorder and Emotion Dysregulation"},"publishedOn":"2023-12-21 15:01:09","publishedOnDateReadable":"December 21st, 2023"},"versionCreatedAt":"2023-05-05 21:19:37","video":"","vorDoi":"10.1186/s40479-023-00243-y","vorDoiUrl":"https://doi.org/10.1186/s40479-023-00243-y","workflowStages":[]},"version":"v1","identity":"rs-2845259","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2845259","identity":"rs-2845259","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}