Evaluating a brief MBCT programme for non-suicidal self-injury in individuals with BPD: A quasi-experimental, nonrandomised pre–post design pilot study

Evaluating a brief MBCT programme for non-suicidal self-injury in individuals with BPD: A quasi-experimental, nonrandomised pre–post design pilot 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 Evaluating a brief MBCT programme for non-suicidal self-injury in individuals with BPD: A quasi-experimental, nonrandomised pre–post design pilot study Szilvia Kresznerits, Ágnes Zinner-Gérecz, Mónika Miklósi, Tamás Szekeres, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7989892/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 09 Mar, 2026 Read the published version in Borderline Personality Disorder and Emotion Dysregulation → Version 1 posted 9 You are reading this latest preprint version Abstract Background Non-suicidal self-injury (NSSI) is highly prevalent among individuals with borderline personality disorder (BPD) and is one of the most robust predictors of future suicide attempts and suicide deaths. Access to comprehensive treatments such as dialectical behaviour therapy remains limited. Methods This exploratory study evaluated the feasibility and preliminary outcomes of a brief, group-based mindfulness-based cognitive therapy program tailored to reduce NSSI (MBCT-NSSI) and improve associated psychological processes. Using a nonrandomised pre–post design with a within-subject waitlist control comparator, assessments were conducted at three time points: 8–12 weeks pre-intervention (T1) (n = 120), immediately pre-intervention (T2) (n = 72), and post-intervention (T3) (n = 50). Outpatients diagnosed with BPD and recent NSSI were recruited from psychiatric clinics to participate in a 9-week MBCT-NSSI group programme. Exclusion criteria included current psychosis, manic episodes, severe substance use, and acute suicide risk. Primary outcomes were NSSI frequency and mindfulness. Secondary outcomes included self-compassion, self-esteem, impulsivity, depression, dissociation, and emotion regulation. Within-subject changes were analysed via linear mixed modelling and Wilcoxon signed-rank tests. Binary logistic regression identified predictors of dropout among eligible participants. No blinding or randomisation procedures were applied. Results Participants who completed the MBCT-NSSI intervention (N = 50) presented significant reductions in NSSI frequency, depressive symptoms, hopelessness, impulsivity, and maladaptive emotion regulation, alongside improvements in mindfulness, self-compassion, and self-esteem. These changes were observed primarily during the intervention phase and not during the waiting-list period, suggesting treatment-specific effects. Dissociative symptoms showed a non-significant trend toward improvement. Dropout among eligible patients (N = 120) was associated with higher impulsivity, maladaptive regulation, and, unexpectedly, higher self-compassion, whereas fewer comorbid diagnoses predicted lower treatment retention. Conclusions MBCT-NSSI may be a feasible and effective adjunctive intervention for individuals with BPD who engage in NSSI, improving emotion regulation and reducing self-harm frequency. These findings support further investigations via controlled trials and longer follow-up periods. Trial registration: Not applicable. The study was a nonrandomized, quasi-experimental pre–post design without a control condition, and therefore does not meet the ICMJE definition of a clinical trial. The study was retrospectively registered on the Open Science Framework (OSF) at https://doi.org/10.17605/OSF.IO/ZUR84 . Borderline personality disorder self-mutilation mindfulness emotional regulation self-compassion suicide prevention Figures Figure 1 1. Introduction “You can’t stop the waves, but you can learn to surf.” This quote by Jon Kabat-Zinn not only captures the core philosophy of mindfulness but also reflects the lived experience of individuals with borderline personality disorder (BPD), whose lives are often shaped by emotional turbulence. BPD is a complex psychiatric condition characterised by enduring difficulties in emotion regulation, impulsivity, self-image, and interpersonal functioning. It is frequently associated with high rates of psychiatric comorbidity, functional impairment, and increased use of healthcare services ( 1 – 5 ). Among the most concerning behaviours associated with BPD is non-suicidal self-injury (NSSI), defined as the deliberate infliction of harm to one’s own body without suicidal intent ( 6 , 7 ). NSSI is highly prevalent in this population and has multiple functions: it may act as a maladaptive coping strategy to alleviate emotional distress, a form of self-punishment, or a compulsive behaviour with addictive features—all of which are associated with elevated risk for future suicide attempts ( 8 – 12 ). Despite the high level of clinical need, individuals with BPD often face substantial barriers to accessing evidence-based care. These include long waiting lists, clinician stigma, and limited availability of specialised treatments ( 13 – 18 ). While comprehensive interventions such as Dialectical Behaviour Therapy (DBT) remain the gold standard treatments for BPD ( 19 – 21 ), their duration and complexity often limit their accessibility and scalability in real-world clinical settings. Consequently, there has been a growing interest in low-intensity, time-limited psychotherapeutic interventions that can be more widely implemented, especially within outpatient settings ( 22 , 23 ). These interventions—often structured around brief group formats—have the potential to engage patients earlier in their treatment trajectory, reduce risk, and build foundational skills prior to or alongside longer-term therapies. Emotion dysregulation has been consistently identified as a central mechanism underpinning both BPD symptoms and NSSI ( 20 , 24 – 26 ). Theoretical models implicate deficits in self-regulation, impulsivity, experiential avoidance, and low self-compassion in the onset and maintenance of NSSI ( 27 – 31 ). According to the mindfulness deficit theory, individuals with BPD experience heightened impulsivity and emotion dysregulation due to reduced mindfulness capacity, resulting in greater reliance on maladaptive coping strategies such as substance use or self-injury ( 32 – 34 ). Recent findings further support this model, with trait mindfulness shown to negatively correlate with BPD symptom severity ( 35 ), underscoring its relevance as a treatment target. Mindfulness-based interventions (MBIs) aim to improve emotional functioning by cultivating present-moment awareness, non-judgmental acceptance, and behavioural flexibility ( 36 , 37 ). Mindfulness-based cognitive therapy (MBCT), originally developed to prevent relapse in depression, has demonstrated efficacy in reducing depressive symptoms and suicidal ideation ( 38 , 39 ). However, only a few studies have directly examined the effects of MBCT programmes specifically designed to reduce NSSI or improve emotion regulation among individuals with BPD ( 37 , 40 ). Recent findings have shown that short-term MBIs can significantly improve psychological distress and emotion regulation among individuals with NSSI in a non-clinical sample, with effects sustained at follow-up ( 41 ). Developing mindfulness skills is also essential in DBT: mindfulness skills directly address impulsivity ( 42 , 43 ) and promote self-injury inhibition ( 44 , 45 ). Even the mindfulness module alone can alter the default network, reducing impulsivity, emotional reactivity, and overall symptom severity in BPD ( 40 ). Improving mindfulness skills and enhancing self-compassion through loving-kindness meditation could reduce pervasive shame ( 46 ) and self-injurious behaviours ( 31 , 47 , 48 ). These findings suggest that mindfulness-based approaches—especially when adapted to target the unique needs of individuals with BPD and NSSI—may hold promise as scalable, adjunctive interventions. The current study evaluated the feasibility and preliminary clinical outcomes of a tailored, nine-week MBCT program designed specifically for individuals with BPD who engage in NSSI (MBCT-NSSI). 1.1. Aims This quasi-experimental study aimed to evaluate the feasibility and preliminary outcomes of a 9-week MBCT-NSSI programme. The primary objective was to assess whether the MBCT-NSSI intervention could reduce the frequency and severity of self-injury and improve key psychological mechanisms, including mindfulness, emotion regulation, and impulsivity. A secondary aim was to explore psychological predictors of dropout to better understand factors influencing group retention and engagement. The following hypotheses were formulated: H1: Participation in the MBCT-NSSI intervention will be associated with significant improvements in mindfulness, self-compassion, and adaptive emotion regulation strategies, and reductions in NSSI frequency, impulsivity, depressive symptoms, dissociation, and difficulties in emotion regulation. H2: Improvements in primary and secondary outcomes will be greater during the intervention period (T2 to T3) compared to the waiting list period (T1 to T2). H3: Treatment dropout is more likely among participants with greater psychological vulnerability at baseline (e.g., elevated depression, dissociation, and impulsivity; lower emotion regulation capacity, and self-compassion), and younger age ( 49 – 52 ). 2. Methods 2.1. Participants and procedure Adult psychiatric outpatients diagnosed with BPD and reporting NSSI within the past six months were recruited between January 2019 and June 2023 from local outpatient clinics. Exclusion criteria included acute suicidal crisis, current psychosis, manic episode, severe substance use disorder, organic brain disorder, or intellectual disability. Eligibility was assessed through clinical interviews and medical documentation. Diagnostic confirmation was based on the BPD module of the Structured Clinical Interview for DSM-IV Axis II Disorders ( 53 , 54 ), conducted by trained clinical psychologists under supervision. In addition, a motivational interview and a semi-structured NSSI interview were administered to assess current self-harm behaviours and treatment readiness. All participants provided written informed consent prior to participation, per the Declaration of Helsinki, and the study received institutional ethical approval. Although formal power analysis is not typically required for feasibility studies, a sample size estimation based on Viechtbauer et al. ( 55 ) indicated that a minimum of 45 participants would be sufficient to detect medium effects with 90% confidence. This threshold was surpassed. Of the 158 individuals screened, 120 met the inclusion criteria and completed baseline assessments. A total of 50 participants completed the full intervention and post-assessments, constituting the final sample. The average age in the eligible sample (N = 120) was 27,68 years (SD = 7.78); the sample included 111 women (92.5%) and nine men (7.5%). Most participants (75.83%, N = 91) had at least one comorbid diagnosis, and 23.17% had two or more (see Table 1 ). More than half (57.1%) were receiving psychiatric medication at the time of the study. Previous suicide attempts were reported by 44.2%, and 23.8% reported suicide in a first-degree relative. Table 1 Prevalence of comorbid disorders in the BPD sample Comorbid diagnosis (ICD-10) % ∑% Depression Bipolar (F31.3, F31.6, F31.8) 13.33 43.33 Unipolar (F32.0, F32.1, F32.2, F32.8) 20.00 Recurrent/persistent (F33.0, F33.1, F34.8) 10.00 Neurotic, stress-related, and somatoform disorders Mixed anxiety and depressive disorder (F41.2) 20.00 40.83 Anxiety disorders (F40.0-F41.8, without F41.2) 12.50 Obsessive-compulsive disorder (F42.0-F42.2) 2.50 Post-traumatic stress disorder (F43.1) 5.83 Eating disorders (F50.0, F50.2, F50.8) 11.67 11.67 Comorbid personality disorder 18.33 18.33 Other (F19.1 in remission) 4.17 4.17 2.2. Study design The study employed a nonrandomised pre–post design with a repeated-measures waitlist control period, which served only as a within-subject comparator , not an independent control group. Reporting followed the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) 2024 checklist to ensure methodological transparency and reproducibility. Assessments were conducted at three time points: baseline, 8–12 weeks before the intervention (T1); pre-intervention (T2); and post-intervention (T3). Only a small number of participants (n = 7) completed a follow-up at 6 months, which was insufficient for statistical analysis and was thus excluded. The design did not include a control group. Participant recruitment, inclusion, and attrition are illustrated in Fig. 1 , which follows CONSORT-adapted guidelines for nonrandomised trials. 2.3. Intervention The participants attended a 9-week MBCT-NSSI group intervention, adapted from the MBCT suicide prevention protocol by Williams et al. ( 39 ). Each 90-minute session was co-facilitated by clinical psychologists trained in MBCT. The first two authors and the last author served as group leaders; the last author also supervised all intervention groups to ensure treatment fidelity and adherence to the MBCT protocol. The programme incorporated psychoeducation, formal and informal mindfulness practices, structured homework assignments, and action plans. Two sessions included loving-kindness meditation, based on its potential benefits for self-compassion and emotion regulation. The participants received a workbook containing educational materials, meditation logs, and weekly assignments. Weekly reminder emails provided audio/video guidance for home practice. Session content included mindfulness of thoughts/emotions, experiential avoidance, self-compassion, and relapse prevention. The final session focused on consolidating skills and future planning ( 29 ). 2.4. Measures Assessments included 1) a demographic and clinical questionnaire (completed at T1 only); 2) a semi-structured NSSI interview (T1 and T3); and 3) a battery of validated self-report scales assessing psychological mechanisms (T1, T2, T3). NSSI was assessed via structured clinical interview questions adapted from Williams et al. (2015), covering types and frequency over the past 6 months (T1) and during the intervention period (T3). Frequency responses were categorised as follows: ( 1 ) several times a year , ( 2 ) approximately monthly (more than 10 times a year) , ( 3 ) approximately weekly , and ( 4 ) daily or more frequent . To allow for more accurate detection of change, a fifth category— (0) no self-injury since the start of the group —was created for post-intervention analysis (T3). Because all participants met the inclusion criteria requiring recent NSSI, no participant reported no self-injury in the past three months at baseline (T1). This modification ensured that participants with low-frequency baseline NSSI who completely ceased the behaviour after the intervention were accurately captured in the analyses. The following self-administered questionnaires were included in the statistical data analysis: General datasheet : questions related to demographic information, psychiatric history, number and method of former suicide attempts (only at T1). Rosenberg Self-Esteem Scale (RSES-H) : is a 10-item scale that measures global self-worth on a 4-point Likert scale ranging from 0 (strongly disagree) to 3 (strongly agree). We used the scale as unidimensional ( 56 , 57 ). Five-Facet Mindfulness Questionnaire (FFMQ) : A 39-item self-report questionnaire used to measure mindfulness level as a personality trait ( 46 ). The five subscales of the questionnaire are: observing, describing, acting with awareness, nonjudging of inner experience , and nonreactivity to inner experience . The adapted Hungarian ( 58 ) version is under the standardisation process. Beck Depression Inventory – Shortened version (BDI-S) : a 9-item self-measure scale that measures the severity of depression ( 59 , 60 ). Beck Hopelessness Scale – Shortened version (BHS-S) : 4-item shortened scale of the original Beck Hopelessness Scale for measuring hopelessness ( 61 , 62 ). Barratt Impulsivity Scale-Shortened (BIS-8) : an 8-item self-report questionnaire to measure impulsivity on a four-point Likert scale ( 63 , 64 ). Dissociative Experiences Scale (DES) : a 28-item self-report questionnaire measuring the frequency of dissociative experiences on a scale of 0-100 ( 65 , 66 ). Cognitive Emotion-Regulation Questionnaire (CERQ) : A 36-item scale evaluating nine cognitive strategies for emotion regulation. Subscales are categorised as adaptive (e.g., putting into perspective, positive refocusing , and acceptance ) and maladaptive (e.g., s elf-blame, rumination ) ( 67 – 69 ). Self-compassion Scale (SCS) : A 26-item measure assessing three bipolar components: self-judgement vs. self-kindness, isolation vs. common humanity , and over-identification vs. mindfulness ( 70 , 71 ). Structured Clinical Interview for DSM-IV Axis II Disorders, Borderline Personality Disorder subscale (SCID-II-BPD) : used to confirm BPD diagnosis and assess symptom severity ( 53 , 54 ). 2.5. Statistical analysis All analyses were performed using IBM SPSS Statistics, version 28. Statistical significance was defined as p < .05 (two-tailed). Bonferroni correction was applied to pairwise comparisons and regression analyses to control for multiple testing. Primary outcomes were NSSI frequency, number of NSSI methods used, and trait mindfulness (FFMQ). Secondary outcomes were self-compassion (SCS), self-esteem (RSES), impulsivity (BIS-8), depression (BDI-S), dissociation (DES), and cognitive emotion regulation (CERQ). Continuous outcomes (e.g., RSES, FFMQ, BDI) were analysed using linear mixed-effects models (LMM) with random intercepts, an AR( 1 ) covariance structure, and time as the fixed factor. Little’s MCAR test indicated that data were consistent with a completely random missingness pattern, χ²(139) = 76.01, p = 1.00. Accordingly, LMM were estimated by maximum-likelihood (ML), which yields unbiased parameter estimates under the missing-at-random (MAR) assumption. Ordinal outcomes (e.g., NSSI frequency) were analysed using the Wilcoxon signed-rank test. The exact duration of the waitlist period was not systematically recorded for each participant; therefore, the analyses could not statistically control variability in waiting time (8–12 weeks). Dropout was defined as failure to complete post-intervention assessments. To identify baseline predictors of dropout, binary logistic regression models were fitted with completion status as the dependent variable. Psychological predictors (e.g., mindfulness, self-compassion, depression, emotion-regulation strategies) were analysed separately from sociodemographic variables (e.g., age, sex, number of comorbid diagnoses) to reduce model complexity and potential overfitting. Multicollinearity was assessed via Pearson’s correlations and variance-inflation factors (VIFs). Because hopelessness was highly correlated with depression (r = .68), it was excluded from multivariate models. All remaining predictors showed acceptable collinearity (r < .51, VIF = 1.03–1.77). No corrections for multiple testing were applied in the dropout analyses; these findings are therefore interpreted as exploratory. 3. Results 3.1. Baseline characteristics (T1) All scales demonstrated acceptable internal consistency (Cronbach’s α > .70), consistent with guidelines for early-stage studies ( 72 ). Participants reported elevated depressive symptoms, hopelessness, impulsivity, and dissociation, along with reduced mindfulness, self-esteem, and self-compassion (Table 2 ). Table 2 Healthy standard values/cut-off points and descriptive statistics for each psychometric instrument at the baseline assessment (T1) Measures (N = 120) Mean (SE) Range Healthy standards/cut-offs RSES 10.49 (.51) 0–30 > 15 ( 57 ) FFMQ 105.32 (1.48) 39 − 195 M = 133.80, SD = 21.58 ( 64 ) CERQ_ad 51.72 (1.25) 20–100 M = 64.57, SD = 10.33 ( 69 ) CERQ_mad 50.53 (1.02) 16–90 M = 39.04, SD = 8.01 ( 69 ) BDI-S 21.78 (.48) 9–36 < 19 ( 59 ) BHS-S 10.25 (.34) 4–16 < 9 ( 62 ) BIS-8-S 20.65 (.39) 8–32 M = 15.46, SD = 4.98 ( 64 ) DES 766.63 (42.95) 0–2800 - SCS 53.36 (1.42) 26–130 M = 70.31, SD = 12.11 ( 71 ) Notes : RSES = Rosenberg Self-Esteem Scale, FFMQ = Five-Facet Mindfulness Questionnaire, CERQ = Cognitive Emotion Regulation Questionnaire, CERQ_ad = CERQ adaptive strategies subscale, CERQ_mad = CERQ maladaptive strategies subscale, BDI-S = Beck Depression Inventory Shortened, BHS-S = Beck Hopelessness Inventory Shortened, BIS-8-S = Barratt Impulsivity Scale Shortened, DES = Dissociative Experience Scale, SCS = Self-Compassion Scale Before the intervention, 84% of the participants engaged in NSSI at least monthly, with 18% reporting daily and 22% weekly NSSI. 56% of the participants engaged in multi-method NSSI, and 19% in three or more methods. Skin-cutting (54%) and self-hitting (44%) were the most common methods. Trait mindfulness (FFMQ) significantly correlated with all the clinical scales in the expected direction. The most relevant correlations emerged positively with self-esteem (r = .464, p < .001), self-compassion (r = .403, p < .001), and negatively with depression (r = –.390, p < .001). Among the subscales, nonreactivity and nonjudging demonstrated the most consistent associations with protective psychological factors (e.g., self-compassion, self-esteem, and adaptive cognitive emotion regulation), whereas acting with awareness showed strong negative correlations with risk-related outcomes, particularly impulsivity and dissociation (Table 3 ). Table 3 Correlations between mindfulness subscales and other psychometric scales Scale SCS (N = 117) RSES CERQ_ ad CERQ_mad BDI-S BHS-S BIS-8-S DES FFMQ r .403 .464 .258 − .233 − .390 − .315 − .320 − .339 p < .001 < .001 .005 .010 < .001 < .001 < .001 < .001 FFMQ_o r .124 .030 .206 .098 .111 .005 − .006 .277 p .184 .744 .024 .288 .228 .959 .952 .002 FFMQ_d r .004 .203 .058 .120 − .156 − .179 − .140 − .283 p .967 .026 .527 .194 .089 .051 .128 .002 FFMQ_a r .105 .358 .017 − .248 − .297 − .191 − .438 − .391 p .258 < .001 .852 .006 .001 .036 < .001 < .001 FFMQ_nj r .410 .403 .095 − .399 − .381 − .294 − .158 − .364 p < .001 < .001 .300 < .001 < .001 .001 .084 < .001 FFMQ_nr r .532 .246 .406 − .262 − .349 − .171 − .110 − .070 p < .001 .007 < .001 .004 < .001 .061 .232 .447 Notes : N = 120. FFMQ = Five-Facet Mindfulness Questionnaire, FFMQ_o = FFMQ observing subscale, FFMQ_d = FFMQ describing subscale, FFMQ_a = FFMQ acting with awareness subscale, FFMQ_nj = FFMQ nonjudging subscale, FFMQ_nr = FFMQ nonreactivity subscale, SCS = Self-Compassion Scale, RSES = Rosenberg Self-Esteem Scale, CERQ = Cognitive Emotion Regulation Questionnaire, CERQ_ad = CERQ adaptive strategies subscale, CERQ_mad = CERQ maladaptive strategies subscale, BDI-S = Beck Depression Inventory Shortened, BHS-S = Beck Hopelessness Inventory Shortened, BIS-8 = Barratt Impulsivity Scale Shortened, DES = Dissociative Experience Scale 3.2. Changes in outcomes over time 3.2.1 Non-suicidal self-injury (NSSI) NSSI frequency rates decreased significantly following the MBCT-NSSI intervention, compared to baseline (Wilcoxon’s Z( 49 )=-5.639, p < .001, N decrease =36, N unchanged =14). Post-intervention, only 2% of participants reported daily NSSI, 6% weekly, 38% monthly, and 54% less frequently than monthly. Notably, eight participants who engaged in low-frequency self-harm at baseline reported no NSSI during the intervention. Although the follow-up period was brief, the observed trend towards a reduction in NSSI was clear and might have contributed to an underestimation of longer-term changes. 3.2.2 Primary outcomes LMM were conducted to assess change across three time points: baseline (T1), pre-intervention (T2), and post-intervention (T3). The estimated marginal means (95% CIs), F-Tests, and pairwise comparisons from LMM are presented in Table 4 . A Bonferroni correction for nine comparisons set the significance at p < .0056. Mindfulness (FFMQ) and self-compassion (SCS) increased significantly following MBCT-NSSI (both p < .001), each reflecting large post-intervention effects (d = 0.84 and 0.80), with no change during the waiting period (p = .954, p = .754). Self-esteem (RSES) also improved significantly from T2 to T3 (p .0056). Adaptive emotion-regulation strategies (CERQ-ad) remained stable across assessments. In contrast, maladaptive strategies (CERQ-mad) did not show a significant change during the waiting period (p = .263), followed by a significant post-intervention decrease (p = .002, d = 0.47). 3.2.3 Secondary outcomes Secondary outcomes also demonstrated significant time effects (see Table 4 ). Depressive symptoms (BDI-S) declined across assessments, with no change during the waiting period (p = .245) but a moderate reduction from T2 to T3 (d = 0.50, p < .001). Hopelessness (BHS-S) similarly decreased following MBCT-NSSI (p = .001, d = 0.46). Impulsivity (BIS-8-S) exhibited significant changes over time (p < .001), with an increase observed during the waiting period (d = 0.56), followed by a notable decrease following the intervention (d = 0.69), resulting in a net reduction at post-treatment. Dissociative symptoms (DES) also declined over time (p = .006). Although the T2–T3 difference did not meet the Bonferroni-adjusted significance threshold (p = .047 > .0056), the downwards trajectory across all assessments indicates consistent improvement. Table 4 Linear mixed models (LMM) results for primary and secondary outcomes Measures Mean (95% CI) F(df) p Bonferroni pairwise comparison T1 (N = 120) T2 (N = 72) T3 (N = 50) p (T1-T2) d p (T2-T3) d RSES 10.49 (9.49–11.49) 11.55 (10.43–12.67) 13.62 (12.35–14.89) 15.56 (2, 93.7) < .001 .039 — < .001 0.67 FFMQ 105.32 (102.39–108.24) 106.69 (103.35–110.03) 120.17 (116.30–124.05) 38.82 (2, 100.5) < .001 .954 — < .001 0.84 CERQ_ad 51.72 (49.26–54.18) 50.72 (47.93–53.51) 53.19 (49.92–56.45) 1.94 (2, 95.1) .150 1.000 — .194 — CERQ_mad 50.53 (48.51–52.56) 51.91 (49.67–54.15) 48.61 (46.04–51.19) 6.80 (2, 97.9) .002 .263 — .002 0.47 BDI-S 21.78 (20.84–22.73) 21.11 (20.06–22.16) 19.06 (17.86–20.25) 13.69 (2, 90.0) < .001 .245 — < .001 0.50 BHS-S 10.25 (9.59–10.91) 10.13 (9.41–10.84) 9.12 (8.32–9.92) 7.82 (2, 93.5) .001 1.000 — .001 0.46 BIS-8-S 20.65 (19.87–21.43) 21.70 (20.86–22.54) 19.69 (18.77–20.62) 22.18 (2, 90.0) < .001 < .001 0.56 < .001 0.69 DES 766.63 (681.66–851.59) 717.79 (627.65–807.92) 644.94 (545.99–743.89) 5.48 (2, 91.1) .006 .154 — .047 — SCS 53.36 (50.56–56.16) 55.04 (51.77–58.31) 63.79 (59.92–67.67) 15.14 (2, 132.3) < .001 .754 — < .001 0.80 Notes : RSES = Rosenberg Self-Esteem Scale, FFMQ = Five-Facet Mindfulness Questionnaire, CERQ = Cognitive Emotion Regulation Questionnaire, CERQ_ad = CERQ adaptive strategies subscale, CERQ_mad = CERQ maladaptive strategies subscale, BDI-S = Beck Depression Inventory Shortened, BHS-S = Beck Hopelessness Inventory Shortened, BIS-8-S = Barratt Impulsivity Scale Shortened, DES = Dissociative Experience Scale, SCS = Self-Compassion Scale. d = Cohen’s d effect size for pairwise comparisons (T1–T2, T2–T3) Missing effect sizes (—) indicate non-significant comparisons, or d was not computed due to lack of significance. Bonferroni correction for multiple tests was used; p < .0056 was considered significant. 3.3. Dropout predictors To reduce model complexity and the risk of overfitting, baseline predictors of dropout were analysed in two separate binary logistic regression models using the Wald backward stepwise method: one including eight psychological predictors (mindfulness, self-compassion, depression, hopelessness, impulsivity, adaptive and maladaptive emotion regulation, dissociation), and another including five sociodemographic/clinical predictors (age, sex, number of comorbid diagnoses, history of suicide attempts, and suicide in the close family). Given the number of predictors, a Bonferroni correction was applied within each model, resulting in adjusted significance thresholds of p < .00625 and p < .01, respectively. In the psychological model, the overall fit was acceptable (Hosmer–Lemeshow χ²( 8 ) = 8.25, p = .409; Nagelkerke R² = .305). Using the Wald backward stepwise method, after Bonferroni correction, three variables remained significant predictors of dropout (Table 5 ): higher impulsivity (BIS-8-S; OR = 1.20, 95% CI = 1.08–1.35), greater use of maladaptive cognitive emotion regulation strategies (CERQ_mad; OR = 1.08, 95% CI = 1.03–1.12), and, unexpectedly, higher self-compassion (SCS; OR = 1.06, 1.02–1.11). Adaptive cognitive emotion regulation strategies (CERQ_ad) showed a trend (p = .008) but did not meet the corrected threshold. In the sociodemographic model, the model fit was acceptable (Hosmer–Lemeshow χ²( 7 ) = 11.26, p = .128; Nagelkerke R² = .224). Only one variable, fewer comorbid diagnoses , significantly predicted dropout (OR = .40, 95% CI = .23 − .69) after correction (Table 5 ). Younger age (p = .039) and history of suicide attempts (p = .061) showed non-significant trends. Due to the number of predictors tested and the small sample size, results should be interpreted with caution. Table 5 Binary logistic regression predicting intervention dropout Predictor B SE Wald OR (Exp(B)) 95% CI for OR p Psychological predictors model CERQ_ad -0.051 0.019 7.02 0.95 0.92–0.99 .008 CERQ_mad 0.073 0.024 9.56 1.08 1.03–1.12 .002 BIS-8-S 0.186 0.056 12.34 1.20 1.08–1.35 .001 SCS 0.059 0.021 8.02 1.06 1.02–1.11 .005 Sociodemographic and clinical characteristics predictors model Age -0.056 0.027 4.28 0.95 0.90–1.00 .039 Number of comorbid diagnoses -0.929 0.286 10.56 0.40 0.23–0.69 < .001 Former suicide attempts 0.823 0.440 3.52 2.28 0.96–5.38 .061 Notes : Psychological predictor model fit: Cox & Snell R² = .227, Nagelkerke R² = .305; Hosmer–Lemeshow χ²( 8 ) = 8.25, p = .409. Bonferroni correction for multiple tests was used; p < .0063 can be considered significant. Sociodemographic and clinical characteristics predictors model: Cox & Snell R² = .168, Nagelkerke R² = .224; Hosmer–Lemeshow χ²( 7 ) = 11.26, p = .128. Bonferroni correction for multiple tests was used; p < .01 can be considered significant. CERQ = Cognitive Emotion Regulation Questionnaire, CERQ_ad = CERQ adaptive strategies subscale, CERQ_mad = CERQ maladaptive strategies subscale, BIS-8-S = Barratt Impulsivity Scale Shortened, SCS = Self-Compassion Scale 4. Discussion This quasi-experimental controlled time-series study evaluated the feasibility and preliminary outcomes of a mindfulness-based cognitive therapy intervention tailored for individuals with borderline personality disorder (MBCT-NSSI). The core characteristics of BPD include being overwhelmed and carried away by emotions and impulses, and the pervasive lability and shame that accompany them. Mindfulness-based approaches address these vulnerabilities by enhancing present-moment awareness, non-judgmental acceptance, and self-regulation ( 36 , 37 ). Therefore, MBCT might be especially appropriate for BPD. To our knowledge, this is the first controlled trial specifically targeting non-suicidal self-injury (NSSI) in BPD using a structured MBCT protocol. We investigated whether MBCT-NSSI could reduce self-injury and improve core psychological mechanisms such as mindfulness, emotion regulation, and impulsivity (H1); whether these improvements were specific to the intervention period compared to a waiting list phase (H2); and whether baseline psychological or clinical factors predict treatment dropout (H3). 4.1. Baseline clinical profile The participants in the present study exhibited low self-esteem, self-compassion, and mindfulness, alongside elevated depression, impulsivity, and dissociation—well-established risk factors for NSSI in BPD patients ( 25 , 73 – 75 ). Low scores on the mindfulness scale and subscales support the mindfulness deficit theory ( 32 – 34 ), which posits that reduced attentional and regulatory capacity contribute to maladaptive behaviours like NSSI. In addition to this clinical baseline profile of participants, the severity and frequency of self-harm in the sample were considerable: more than half of the participants engaged in multiple methods of NSSI, and 44% reported self-harming at least weekly. Given that NSSI is a strong predictor of future suicidal behaviour (OR = 4.27, 95% CI = 2.56–7.10) ( 8 ), and that repetitive, multi-method NSSI is associated with an increased risk of later suicide attempts ( 75 , 76 ), these baseline findings underscore the urgent need for accessible, targeted interventions in this population. 4.2. Hypothesis 1: improvements following MBCT-NSSI In line with our first hypothesis, participation in the MBCT-NSSI intervention was associated with significant improvements in several key clinical and psychological domains. Most notably, participants reported a marked reduction in NSSI frequency post-intervention, with the majority decreasing the frequency of self-harm to monthly or less frequent occurrences. Considering that NSSI is a highly resistant and high-risk symptom of BPD, even a moderate reduction represents a clinically meaningful change. Beyond behavioural outcomes, significant improvements were observed in several targeted psychological capacities between T2 (pre-intervention) and T3 (post-intervention), following the active treatment phase. Participants showed statistically and clinically significant increases in mindfulness, self-compassion, and self-esteem, along with reductions in depressive symptoms, hopelessness, and impulsivity. These effects were absent in most cases and, when present, were much reduced during the waiting period (T1–T2), suggesting a treatment-specific change. The observed increase in psychological protective factors (e.g., mindfulness, self-compassion, self-esteem) aligns with the broader literature on mindfulness-based interventions, which have been shown to promote emotion regulation, reduce reactivity, and enhance self-related processes ( 40 – 46 ). However, the findings related to emotion regulation strategies were more nuanced. While maladaptive cognitive emotion regulation strategies (CERQ_mad) decreased significantly from pre- to post-intervention, adaptive strategies (CERQ_ad) did not improve. This asymmetry may reflect the nature of MBCT, which emphasises the cultivation of meta-awareness and non-judgmental acceptance rather than teaching explicit cognitive reappraisal techniques. It is possible that reductions in maladaptive responses occurred through enhanced awareness and decentering, without a corresponding increase in overt use of adaptive strategies. Alternatively, the lack of significant change in adaptive strategies may reflect limitations of the CERQ measure in capturing the more experiential and non-cognitive regulatory shifts promoted by MBIs. Dissociation showed a downward trend across the three assessment points, with significant overall time effects but only trend-level changes from pre- to post-intervention after Bonferroni correction. This pattern should be interpreted cautiously but is encouraging, given that dissociation has been described as one of the most challenging symptoms in BPD and is often associated with poor treatment response ( 49 ). Qualitative feedback suggested that grounding exercises and heightened body awareness were perceived as particularly helpful in reducing dissociative episodes. However, in many cases, participants often began consistently home-practising mindfulness only midway through the programme and maintaining practice after the intervention was also an issue. Due to the robust nature of dissociation, it is plausible that earlier or more intensive home practices may be necessary to achieve more robust effects. These findings support the recommendation to reinforce at-home practice from the outset of the intervention. Overall, the observed reductions in clinical symptoms and maladaptive emotion regulation strategies, along with increases in self-compassion and self-esteem, are particularly relevant given the well-established protective role of these factors against self-injury. These findings suggest that MBCT-NSSI may target core maintenance mechanisms of NSSI in individuals with BPD. While not all hypothesised changes reached statistical significance, the pattern of results indicates meaningful therapeutic gains in a clinically complex and high-risk population. 4.3. Hypothesis 2: control condition changes Our second hypothesis (H2) was supported, as improvements were substantially greater during the intervention phase (T2–T3) than during the waiting list period (T1–T2). While minimal or no positive changes were observed during the waiting period—indeed, impulsivity and maladaptive emotion regulation strategies showed signs of deterioration—participants demonstrated significant improvements in several domains following the MBCT-NSSI intervention. Specifically, reductions were observed in NSSI frequency, depression, and impulsivity, alongside increases in mindfulness, self-esteem, and self-compassion. This pattern of results suggests that the observed changes are unlikely to be explained by time effects, regression to the mean, or repeated measurement, and instead point to the specific impact of the intervention. 4.4. Hypothesis 3: dropout predictors To examine predictors of dropout, two logistic regression models were tested separately for psychological and sociodemographic variables, with Bonferroni correction applied to control for multiple comparisons. In the psychological model, higher impulsivity, greater use of maladaptive emotion regulation strategies, and—unexpectedly—higher self-compassion significantly predicted dropout. The associations with impulsivity and maladaptive regulation are consistent with prior findings suggesting that individuals with greater emotional dysregulation may struggle to engage in structured, especially group-based, interventions ( 77 ). The association with self-compassion, although statistically significant, runs counter to theoretical expectations and should be interpreted with caution. It may reflect suppression effects, distorted self-reporting, or state-related fluctuations in self-concept, which are common in BPD populations ( 78 , 79 ). In the sociodemographic model, fewer comorbid diagnoses predicted dropout. This result may reflect that individuals with more complex clinical histories are more treatment-engaged due to a higher need or prior exposure to care. Other variables, such as younger age and suicidal history, showed trend-level effects but did not reach significance after correction. While the dropout rate of the active phase (28.6%) aligns with previous findings in BPD samples ( 37 , 77 , 80 , 81 ), the overall rate was much higher, 58,3%. Furthermore, both models showed modest explanatory power (Nagelkerke R² = .305 and .224, respectively). Suggesting that additional unmeasured factors—such as therapeutic alliance, the outpatient setting’s structure, trauma history, educational level, or overall functioning—may play a more substantial role in treatment retention ( 52 , 77 , 82 ). In summary, these findings provide initial insights into potential predictors of dropout in MBCT for BPD. However, they should be interpreted cautiously due to the limited sample size, high dropout rate, and the risk of Type I error despite adjustments for multiple comparisons. 4.5. Clinical implications The findings of this study suggest that brief, group-based mindfulness-based cognitive therapy (MBCT-NSSI), adapted for individuals with borderline personality disorder (BPD), may be a promising adjunctive intervention for reducing self-injurious behaviour and improving several related psychological outcomes. Significant reductions in NSSI frequency, depression, impulsivity, and hopelessness, alongside improvements in mindfulness skills, self-esteem, and self-compassion, were observed following the intervention period—but not during the waiting list phase—indicating treatment-specific effects. While changes in dissociation and adaptive cognitive emotion regulation strategies were limited, the intervention appeared to primarily reduce maladaptive processes such as impulsivity, self-criticism, and catastrophic thinking—mechanisms often implicated in maintaining NSSI. These effects align with the theoretical goals of MBCT, which aim to increase metacognitive awareness and acceptance. Given the short duration of the intervention (nine sessions), these changes are clinically meaningful, particularly considering the complexity and high-risk profile of the sample. In contexts with limited access to long-term therapy, MBCT-NSSI may serve as a feasible, lower-intensity treatment option or preparatory intervention, potentially improving psychological readiness for more intensive care. However, the high overall dropout rate, especially before program initiation, underscores the need for careful pre-treatment screening, enhanced motivational strategies, and perhaps additional engagement supports—particularly for younger patients and those with elevated impulsivity or emotion regulation difficulties. Although dropout during active treatment was comparable to other BPD interventions, future implementations should prioritise strategies to improve retention and continuity, especially in outpatient settings. Finally, while these findings support the clinical utility of MBCT-NSSI, the absence of a randomised controlled design, follow-up data, and an active control group limits the strength of the conclusions. Replication in larger, more diverse samples—with extended follow-up—is needed to determine the effects' sustainability, generalisability, and how MBCT-NSSI compares to other brief interventions for self-harming individuals with BPD. 4.6. Limitations Several limitations should be considered when interpreting the findings. The study employed a quasi-experimental, non-randomised design without an active control group, which limits causal inference and increases susceptibility to confounding variables. The reliance on self-report measures may have introduced bias, particularly in a population characterised by instability in self-concept, which can affect the reliability of responses. Although the assessment time points were structured, the lack of a follow-up assessment precludes conclusions about the durability of the effects. Moreover, the exact duration of the waitlist period was not systematically recorded and therefore could not be statistically controlled. Another limitation of the study is the lack of a blinding procedure. Several authors (the first two and the last) also acted as group facilitators, and the last author served as the supervisor of all the groups. Although this may raise concerns about researcher allegiance, verifying the statistical analyses by independent authors mitigated potential analytic bias. Additionally, while Bonferroni correction was applied to reduce Type I error, the overall sample size—particularly for the dropout analyses—was modest relative to the number of predictors tested, increasing the risk of Type II error or overfitting. Finally, the study was conducted in a single clinical setting with primarily treatment-seeking individuals, which may limit the generalisability of the results to broader BPD or NSSI populations. 4.7. Conclusion Taken together, this quasi-experimental study provides preliminary evidence that a brief, adapted MBCT-NSSI intervention can reduce self-injurious behaviour and improve psychological functioning in individuals with BPD. Significant improvements were observed in the frequency of NSSI and mindfulness (primary outcomes), as well as in self-compassion and key clinical symptoms (secondary outcomes), particularly during the active treatment phase. Although dropout rates were high, several psychological and clinical factors predicted engagement, offering guidance for future tailoring of interventions. While a 9-week MBCT-NSSI training is not a substitute for long-term psychotherapy tailored to personality disorders, these findings support the feasibility and potential value of structured, mindfulness-based interventions as supplementary support for this high-risk population. Replication in larger, controlled trials with follow-up assessments will be essential to establish sustained effects and optimise clinical utility. Abbreviations BDI-S: Beck Depression Inventory Shortened. BHS-S: Beck Hopelessness Inventory Shortened. BIS-8-S: Barratt Impulsivity Scale Shortened. BPD: borderline personality disorder. CERQ: Cognitive Emotion Regulation Questionnaire, CERQ_ad: CERQ adaptive strategies subscale. CERQ_mad: CERQ maladaptive strategies subscale. CONSORT: Consolidated Standards of Reporting Trials. DBT: Dialectical Behaviour Therapy. DES: Dissociative Experience Scale. FFMQ: Five-Facet Mindfulness Questionnaire. FFMQ_a: FFMQ acting with awareness subscale. FFMQ_d: FFMQ describing subscale. FFMQ_nj: FFMQ nonjudging subscale. FFMQ_nr: FFMQ nonreactivity subscale. FFMQ_o: FFMQ observing subscale. LMM: Linear mixed-effects models. MAR: missing-at-random assumption. MBCT: mindfulness-based cognitive therapy. MBCT-NSSI: the 9-week group-based mindfulness-based cognitive therapy program tailored to reduce NSSI. MBI: Mindfulness-based interventions. ML: maximum-likelihood. NSSI: Non-suicidal self-injury. RSES: Rosenberg Self-Esteem Scale. SCID-II-BPD: Structured Clinical Interview for DSM‐IV Axis II Disorders, Borderline Personality Disorder subscale. SCS: Self-Compassion Scale. TREND: Transparent Reporting of Evaluations with Nonrandomized Designs. VIF: variance-inflation factors. Declarations Ethics approval and consent to participate : The Regional and Institutional Committee of Science and Research Ethics of Semmelweis University approved the research procedure (Number: 240/2018). According to the Declaration of Helsinki, all participants provided written informed consent prior to participating. Consent for publication : None. Availability of data and materials : Reporting followed the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) 2024 guidelines. The completed TREND checklist is available in Supplementary Material 1. The de-identified dataset and supporting documentation are available via the Open Science Framework (OSF): https://osf.io/z94ym. The study was retrospectively registered at https://doi.org/10.17605/OSF.IO/ZUR84 on May 16, 2025. Competing interests: Not applicable. Funding : This research was funded by the Higher Education Institutional Excellence Program of the Ministry for Innovation and Technology in Hungary, within the framework of the Neurology thematic program at Semmelweis University, TKP/2021. Authors’ Contribution: KSz, ZGÁ, and PFD conceived the study and developed the theoretical framework. KSz and ZGÁ collected the data. KSz, SzT, and MM analysed the data. PFD supervised the project. All the authors discussed the results and contributed to the final manuscript. Acknowledgment: We thank our colleagues for their insightful feedback, and our dedicated research assistants (Emese Misák, Dorottya Sal, Barbara Kulig) for their invaluable support in organizing the study. We are also deeply thankful to all the participants in our pilot research, from whom we gleaned significant insights into the intricate issue of self-harm. References Paris J. Suicidality in Borderline Personality Disorder. Medicina. 2019;55(6):223. APA. 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Soler J, Valdepérez A, Feliu-Soler A, Pascual JC, Portella MJ, Martín-Blanco A, et al. Effects of the dialectical behavioral therapy-mindfulness module on attention in patients with borderline personality disorder. Behav Res Ther. 2012;50(2):150–7. Arntz A, Mensink K, Cox WR, Verhoef REJ, van Emmerik AAP, Rameckers SA, et al. Dropout from psychological treatment for borderline personality disorder: a multilevel survival meta-analysis. Psychol Med. 2023;53(3):668–86. Additional Declarations No competing interests reported. Supplementary Files Suppl1MBCTNSSIBPDED202501030.pdf Cite Share Download PDF Status: Published Journal Publication published 09 Mar, 2026 Read the published version in Borderline Personality Disorder and Emotion Dysregulation → Version 1 posted Editorial decision: Revision requested 31 Dec, 2025 Reviews received at journal 16 Dec, 2025 Reviews received at journal 13 Dec, 2025 Reviewers agreed at journal 28 Nov, 2025 Reviewers agreed at journal 25 Nov, 2025 Reviewers invited by journal 25 Nov, 2025 Editor assigned by journal 18 Nov, 2025 Submission checks completed at journal 18 Nov, 2025 First submitted to journal 30 Oct, 2025 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. 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1","display":"","copyAsset":false,"role":"figure","size":41337,"visible":true,"origin":"","legend":"\u003cp\u003eParticipant flow through the study based on CONSORT-adapted guidelines for nonrandomised trials\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7989892/v1/a2a51ff185ab319d8273926b.png"},{"id":104739691,"identity":"82cea70a-133e-4f7a-80d8-8b4c9e257a23","added_by":"auto","created_at":"2026-03-16 16:12:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1632813,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7989892/v1/f857665d-f860-4399-af58-0f07815c3f34.pdf"},{"id":97129137,"identity":"7d0bad5d-5a65-42b1-b123-c41b07bf0fe8","added_by":"auto","created_at":"2025-12-01 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Introduction","content":"\u003cp\u003e\u003cem\u003e\u0026ldquo;You can\u0026rsquo;t stop the waves, but you can learn to surf.\u0026rdquo;\u003c/em\u003e This quote by Jon Kabat-Zinn not only captures the core philosophy of mindfulness but also reflects the lived experience of individuals with borderline personality disorder (BPD), whose lives are often shaped by emotional turbulence. BPD is a complex psychiatric condition characterised by enduring difficulties in emotion regulation, impulsivity, self-image, and interpersonal functioning. It is frequently associated with high rates of psychiatric comorbidity, functional impairment, and increased use of healthcare services (\u003cspan additionalcitationids=\"CR2 CR3 CR4\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAmong the most concerning behaviours associated with BPD is non-suicidal self-injury (NSSI), defined as the deliberate infliction of harm to one\u0026rsquo;s own body without suicidal intent (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). NSSI is highly prevalent in this population and has multiple functions: it may act as a maladaptive coping strategy to alleviate emotional distress, a form of self-punishment, or a compulsive behaviour with addictive features\u0026mdash;all of which are associated with elevated risk for future suicide attempts (\u003cspan additionalcitationids=\"CR9 CR10 CR11\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDespite the high level of clinical need, individuals with BPD often face substantial barriers to accessing evidence-based care. These include long waiting lists, clinician stigma, and limited availability of specialised treatments (\u003cspan additionalcitationids=\"CR14 CR15 CR16 CR17\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). While comprehensive interventions such as Dialectical Behaviour Therapy (DBT) remain the gold standard treatments for BPD (\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e), their duration and complexity often limit their accessibility and scalability in real-world clinical settings.\u003c/p\u003e\u003cp\u003eConsequently, there has been a growing interest in low-intensity, time-limited psychotherapeutic interventions that can be more widely implemented, especially within outpatient settings (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). These interventions\u0026mdash;often structured around brief group formats\u0026mdash;have the potential to engage patients earlier in their treatment trajectory, reduce risk, and build foundational skills prior to or alongside longer-term therapies.\u003c/p\u003e\u003cp\u003eEmotion dysregulation has been consistently identified as a central mechanism underpinning both BPD symptoms and NSSI (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Theoretical models implicate deficits in self-regulation, impulsivity, experiential avoidance, and low self-compassion in the onset and maintenance of NSSI (\u003cspan additionalcitationids=\"CR28 CR29 CR30\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). According to the mindfulness deficit theory, individuals with BPD experience heightened impulsivity and emotion dysregulation due to reduced mindfulness capacity, resulting in greater reliance on maladaptive coping strategies such as substance use or self-injury (\u003cspan additionalcitationids=\"CR33\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Recent findings further support this model, with trait mindfulness shown to negatively correlate with BPD symptom severity (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e), underscoring its relevance as a treatment target.\u003c/p\u003e\u003cp\u003eMindfulness-based interventions (MBIs) aim to improve emotional functioning by cultivating present-moment awareness, non-judgmental acceptance, and behavioural flexibility (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Mindfulness-based cognitive therapy (MBCT), originally developed to prevent relapse in depression, has demonstrated efficacy in reducing depressive symptoms and suicidal ideation (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). However, only a few studies have directly examined the effects of MBCT programmes specifically designed to reduce NSSI or improve emotion regulation among individuals with BPD (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eRecent findings have shown that short-term MBIs can significantly improve psychological distress and emotion regulation among individuals with NSSI in a non-clinical sample, with effects sustained at follow-up (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). Developing mindfulness skills is also essential in DBT: mindfulness skills directly address impulsivity (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e) and promote self-injury inhibition (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e). Even the mindfulness module alone can alter the default network, reducing impulsivity, emotional reactivity, and overall symptom severity in BPD (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). Improving mindfulness skills and enhancing self-compassion through loving-kindness meditation could reduce pervasive shame (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e) and self-injurious behaviours (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThese findings suggest that mindfulness-based approaches\u0026mdash;especially when adapted to target the unique needs of individuals with BPD and NSSI\u0026mdash;may hold promise as scalable, adjunctive interventions. The current study evaluated the feasibility and preliminary clinical outcomes of a tailored, nine-week MBCT program designed specifically for individuals with BPD who engage in NSSI (MBCT-NSSI).\u003c/p\u003e\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\u003ch2\u003e1.1. Aims\u003c/h2\u003e\u003cp\u003eThis quasi-experimental study aimed to evaluate the feasibility and preliminary outcomes of a 9-week MBCT-NSSI programme. The primary objective was to assess whether the MBCT-NSSI intervention could reduce the frequency and severity of self-injury and improve key psychological mechanisms, including mindfulness, emotion regulation, and impulsivity. A secondary aim was to explore psychological predictors of dropout to better understand factors influencing group retention and engagement.\u003c/p\u003e\u003cp\u003eThe following hypotheses were formulated:\u003c/p\u003e\u003cp\u003eH1: Participation in the MBCT-NSSI intervention will be associated with significant improvements in mindfulness, self-compassion, and adaptive emotion regulation strategies, and reductions in NSSI frequency, impulsivity, depressive symptoms, dissociation, and difficulties in emotion regulation.\u003c/p\u003e\u003cp\u003eH2: Improvements in primary and secondary outcomes will be greater during the intervention period (T2 to T3) compared to the waiting list period (T1 to T2).\u003c/p\u003e\u003cp\u003eH3: Treatment dropout is more likely among participants with greater psychological vulnerability at baseline (e.g., elevated depression, dissociation, and impulsivity; lower emotion regulation capacity, and self-compassion), and younger age (\u003cspan additionalcitationids=\"CR50 CR51\" citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.1. Participants and procedure\u003c/h2\u003e\u003cp\u003eAdult psychiatric outpatients diagnosed with BPD and reporting NSSI within the past six months were recruited between January 2019 and June 2023 from local outpatient clinics. Exclusion criteria included acute suicidal crisis, current psychosis, manic episode, severe substance use disorder, organic brain disorder, or intellectual disability. Eligibility was assessed through clinical interviews and medical documentation. Diagnostic confirmation was based on the BPD module of the Structured Clinical Interview for DSM-IV Axis II Disorders (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e), conducted by trained clinical psychologists under supervision.\u003c/p\u003e\u003cp\u003eIn addition, a motivational interview and a semi-structured NSSI interview were administered to assess current self-harm behaviours and treatment readiness. All participants provided written informed consent prior to participation, per the Declaration of Helsinki, and the study received institutional ethical approval.\u003c/p\u003e\u003cp\u003eAlthough formal power analysis is not typically required for feasibility studies, a sample size estimation based on Viechtbauer et al. (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e) indicated that a minimum of 45 participants would be sufficient to detect medium effects with 90% confidence. This threshold was surpassed.\u003c/p\u003e\u003cp\u003eOf the 158 individuals screened, 120 met the inclusion criteria and completed baseline assessments. A total of 50 participants completed the full intervention and post-assessments, constituting the final sample. The average age in the eligible sample (N\u0026thinsp;=\u0026thinsp;120) was 27,68 years (SD\u0026thinsp;=\u0026thinsp;7.78); the sample included 111 women (92.5%) and nine men (7.5%). Most participants (75.83%, N\u0026thinsp;=\u0026thinsp;91) had at least one comorbid diagnosis, and 23.17% had two or more (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). More than half (57.1%) were receiving psychiatric medication at the time of the study. Previous suicide attempts were reported by 44.2%, and 23.8% reported suicide in a first-degree relative.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePrevalence of comorbid disorders in the BPD sample\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eComorbid diagnosis (ICD-10)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026sum;%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eDepression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBipolar (F31.3, F31.6, F31.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e43.33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnipolar (F32.0, F32.1, F32.2, F32.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRecurrent/persistent (F33.0, F33.1, F34.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eNeurotic, stress-related, and somatoform disorders\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMixed anxiety and depressive disorder (F41.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e40.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAnxiety disorders (F40.0-F41.8, without F41.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eObsessive-compulsive disorder (F42.0-F42.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePost-traumatic stress disorder (F43.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eEating disorders (F50.0, F50.2, F50.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eComorbid personality disorder\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18.33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eOther (F19.1 in remission)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.2. Study design\u003c/h2\u003e\u003cp\u003eThe study employed a nonrandomised pre\u0026ndash;post design with a repeated-measures waitlist control period, which served only as a \u003cem\u003ewithin-subject comparator\u003c/em\u003e, not an independent control group. Reporting followed the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) 2024 checklist to ensure methodological transparency and reproducibility.\u003c/p\u003e\u003cp\u003eAssessments were conducted at three time points: baseline, 8\u0026ndash;12 weeks before the intervention (T1); pre-intervention (T2); and post-intervention (T3). Only a small number of participants (n\u0026thinsp;=\u0026thinsp;7) completed a follow-up at 6 months, which was insufficient for statistical analysis and was thus excluded. The design did not include a control group. Participant recruitment, inclusion, and attrition are illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, which follows CONSORT-adapted guidelines for nonrandomised trials.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.3. Intervention\u003c/h2\u003e\u003cp\u003eThe participants attended a 9-week MBCT-NSSI group intervention, adapted from the MBCT suicide prevention protocol by Williams et al. (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Each 90-minute session was co-facilitated by clinical psychologists trained in MBCT. The first two authors and the last author served as group leaders; the last author also supervised all intervention groups to ensure treatment fidelity and adherence to the MBCT protocol. The programme incorporated psychoeducation, formal and informal mindfulness practices, structured homework assignments, and action plans. Two sessions included loving-kindness meditation, based on its potential benefits for self-compassion and emotion regulation. The participants received a workbook containing educational materials, meditation logs, and weekly assignments. Weekly reminder emails provided audio/video guidance for home practice. Session content included mindfulness of thoughts/emotions, experiential avoidance, self-compassion, and relapse prevention. The final session focused on consolidating skills and future planning (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.4. Measures\u003c/h2\u003e\u003cp\u003eAssessments included 1) a demographic and clinical questionnaire (completed at T1 only); 2) a semi-structured NSSI interview (T1 and T3); and 3) a battery of validated self-report scales assessing psychological mechanisms (T1, T2, T3).\u003c/p\u003e\u003cp\u003eNSSI was assessed via structured clinical interview questions adapted from Williams et al. (2015), covering types and frequency over the past 6 months (T1) and during the intervention period (T3). Frequency responses were categorised as follows: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) \u003cem\u003eseveral times a year\u003c/em\u003e, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) \u003cem\u003eapproximately monthly (more than 10 times a year)\u003c/em\u003e, (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) \u003cem\u003eapproximately weekly\u003c/em\u003e, and (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) \u003cem\u003edaily or more frequent\u003c/em\u003e. To allow for more accurate detection of change, a fifth category\u0026mdash; \u003cem\u003e(0) no self-injury since the start of the group\u003c/em\u003e\u0026mdash;was created for post-intervention analysis (T3). Because all participants met the inclusion criteria requiring recent NSSI, no participant reported no self-injury in the past three months at baseline (T1). This modification ensured that participants with low-frequency baseline NSSI who completely ceased the behaviour after the intervention were accurately captured in the analyses.\u003c/p\u003e\u003cp\u003eThe following self-administered questionnaires were included in the statistical data analysis:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eGeneral datasheet\u003c/b\u003e: questions related to demographic information, psychiatric history, number and method of former suicide attempts (only at T1).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eRosenberg Self-Esteem Scale (RSES-H)\u003c/b\u003e: is a 10-item scale that measures global self-worth on a 4-point Likert scale ranging from 0 (strongly disagree) to 3 (strongly agree). We used the scale as unidimensional (\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eFive-Facet Mindfulness Questionnaire (FFMQ)\u003c/b\u003e: A 39-item self-report questionnaire used to measure mindfulness level as a personality trait (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e). The five subscales of the questionnaire are: \u003cem\u003eobserving, describing, acting with awareness, nonjudging of inner experience\u003c/em\u003e, and \u003cem\u003enonreactivity to inner experience\u003c/em\u003e. The adapted Hungarian (\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e) version is under the standardisation process.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eBeck Depression Inventory \u0026ndash; Shortened version (BDI-S)\u003c/b\u003e: a 9-item self-measure scale that measures the severity of depression (\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eBeck Hopelessness Scale \u0026ndash; Shortened version (BHS-S)\u003c/b\u003e: 4-item shortened scale of the original Beck Hopelessness Scale for measuring hopelessness (\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eBarratt Impulsivity Scale-Shortened (BIS-8)\u003c/b\u003e: an 8-item self-report questionnaire to measure impulsivity on a four-point Likert scale (\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eDissociative Experiences Scale (DES)\u003c/b\u003e: a 28-item self-report questionnaire measuring the frequency of dissociative experiences on a scale of 0-100 (\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eCognitive Emotion-Regulation Questionnaire (CERQ)\u003c/b\u003e: A 36-item scale evaluating nine cognitive strategies for emotion regulation. Subscales are categorised as adaptive (e.g., \u003cem\u003eputting into perspective, positive refocusing\u003c/em\u003e, and \u003cem\u003eacceptance\u003c/em\u003e) and maladaptive (e.g., s\u003cem\u003eelf-blame, rumination\u003c/em\u003e) (\u003cspan additionalcitationids=\"CR68\" citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eSelf-compassion Scale (SCS)\u003c/b\u003e: A 26-item measure assessing three bipolar components: \u003cem\u003eself-judgement\u003c/em\u003e vs. \u003cem\u003eself-kindness, isolation\u003c/em\u003e vs. \u003cem\u003ecommon humanity\u003c/em\u003e, and \u003cem\u003eover-identification\u003c/em\u003e vs. \u003cem\u003emindfulness\u003c/em\u003e (\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eStructured Clinical Interview for DSM-IV Axis II Disorders, Borderline Personality Disorder subscale (SCID-II-BPD)\u003c/b\u003e: used to confirm BPD diagnosis and assess symptom severity (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e2.5. Statistical analysis\u003c/h2\u003e\u003cp\u003eAll analyses were performed using IBM SPSS Statistics, version 28. Statistical significance was defined as p\u0026thinsp;\u0026lt;\u0026thinsp;.05 (two-tailed). Bonferroni correction was applied to pairwise comparisons and regression analyses to control for multiple testing. Primary outcomes were NSSI frequency, number of NSSI methods used, and trait mindfulness (FFMQ). Secondary outcomes were self-compassion (SCS), self-esteem (RSES), impulsivity (BIS-8), depression (BDI-S), dissociation (DES), and cognitive emotion regulation (CERQ).\u003c/p\u003e\u003cp\u003eContinuous outcomes (e.g., RSES, FFMQ, BDI) were analysed using linear mixed-effects models (LMM) with random intercepts, an AR(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) covariance structure, and time as the fixed factor. Little\u0026rsquo;s MCAR test indicated that data were consistent with a completely random missingness pattern, χ\u0026sup2;(139)\u0026thinsp;=\u0026thinsp;76.01, p\u0026thinsp;=\u0026thinsp;1.00. Accordingly, LMM were estimated by maximum-likelihood (ML), which yields unbiased parameter estimates under the missing-at-random (MAR) assumption. Ordinal outcomes (e.g., NSSI frequency) were analysed using the Wilcoxon signed-rank test. The exact duration of the waitlist period was not systematically recorded for each participant; therefore, the analyses could not statistically control variability in waiting time (8\u0026ndash;12 weeks).\u003c/p\u003e\u003cp\u003eDropout was defined as failure to complete post-intervention assessments. To identify baseline predictors of dropout, binary logistic regression models were fitted with completion status as the dependent variable. Psychological predictors (e.g., mindfulness, self-compassion, depression, emotion-regulation strategies) were analysed separately from sociodemographic variables (e.g., age, sex, number of comorbid diagnoses) to reduce model complexity and potential overfitting. Multicollinearity was assessed via Pearson\u0026rsquo;s correlations and variance-inflation factors (VIFs). Because hopelessness was highly correlated with depression (r\u0026thinsp;=\u0026thinsp;.68), it was excluded from multivariate models. All remaining predictors showed acceptable collinearity (r\u0026thinsp;\u0026lt;\u0026thinsp;.51, VIF\u0026thinsp;=\u0026thinsp;1.03\u0026ndash;1.77). No corrections for multiple testing were applied in the dropout analyses; these findings are therefore interpreted as exploratory.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e3.1. Baseline characteristics (T1)\u003c/h2\u003e\u003cp\u003eAll scales demonstrated acceptable internal consistency (Cronbach\u0026rsquo;s α\u0026thinsp;\u0026gt;\u0026thinsp;.70), consistent with guidelines for early-stage studies (\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e). Participants reported elevated depressive symptoms, hopelessness, impulsivity, and dissociation, along with reduced mindfulness, self-esteem, and self-compassion (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eHealthy standard values/cut-off points and descriptive statistics for each psychometric instrument at the baseline assessment (T1)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMeasures\u003c/p\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;120)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eMean (SE)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eRange\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eHealthy standards/cut-offs\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRSES\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10.49 (.51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0\u0026ndash;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;15 (\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFFMQ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e105.32 (1.48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e39 \u0026minus;\u0026thinsp;195\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;133.80, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;21.58 (\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCERQ_ad\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e51.72 (1.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e20\u0026ndash;100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;64.57, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10.33 (\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCERQ_mad\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50.53 (1.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e16\u0026ndash;90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;39.04, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8.01 (\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBDI-S\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21.78 (.48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e9\u0026ndash;36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;19 (\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBHS-S\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10.25 (.34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e4\u0026ndash;16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;9 (\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBIS-8-S\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20.65 (.39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e8\u0026ndash;32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;15.46, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.98 (\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDES\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e766.63 (42.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0\u0026ndash;2800\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSCS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e53.36 (1.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e26\u0026ndash;130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;70.31, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;12.11 (\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003eNotes\u003c/b\u003e: RSES\u0026thinsp;=\u0026thinsp;Rosenberg Self-Esteem Scale, FFMQ\u0026thinsp;=\u0026thinsp;Five-Facet Mindfulness Questionnaire, CERQ\u0026thinsp;=\u0026thinsp;Cognitive Emotion Regulation Questionnaire, CERQ_ad\u0026thinsp;=\u0026thinsp;CERQ adaptive strategies subscale, CERQ_mad\u0026thinsp;=\u0026thinsp;CERQ maladaptive strategies subscale, BDI-S\u0026thinsp;=\u0026thinsp;Beck Depression Inventory Shortened, BHS-S\u0026thinsp;=\u0026thinsp;Beck Hopelessness Inventory Shortened, BIS-8-S\u0026thinsp;=\u0026thinsp;Barratt Impulsivity Scale Shortened, DES\u0026thinsp;=\u0026thinsp;Dissociative Experience Scale, SCS\u0026thinsp;=\u0026thinsp;Self-Compassion Scale\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eBefore the intervention, 84% of the participants engaged in NSSI at least monthly, with 18% reporting daily and 22% weekly NSSI. 56% of the participants engaged in multi-method NSSI, and 19% in three or more methods. Skin-cutting (54%) and self-hitting (44%) were the most common methods.\u003c/p\u003e\u003cp\u003eTrait mindfulness (FFMQ) significantly correlated with all the clinical scales in the expected direction. The most relevant correlations emerged positively with self-esteem (r\u0026thinsp;=\u0026thinsp;.464, p\u0026thinsp;\u0026lt;\u0026thinsp;.001), self-compassion (r\u0026thinsp;=\u0026thinsp;.403, p\u0026thinsp;\u0026lt;\u0026thinsp;.001), and negatively with depression (r = \u0026ndash;.390, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). Among the subscales, \u003cem\u003enonreactivity\u003c/em\u003e and \u003cem\u003enonjudging\u003c/em\u003e demonstrated the most consistent associations with protective psychological factors (e.g., self-compassion, self-esteem, and adaptive cognitive emotion regulation), whereas \u003cem\u003eacting with awareness\u003c/em\u003e showed strong negative correlations with risk-related outcomes, particularly impulsivity and dissociation (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCorrelations between mindfulness subscales and other psychometric scales\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eScale\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSCS\u003c/p\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;117)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRSES\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCERQ_ ad\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCERQ_mad\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eBDI-S\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eBHS-S\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eBIS-8-S\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eDES\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eFFMQ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003er\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e.403\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e.464\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e.258\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;.233\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;.390\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;.315\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;.320\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;.339\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e.005\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e.010\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eFFMQ_o\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003er\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.030\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e.206\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.098\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.111\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.005\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.006\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e.277\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.184\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.744\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e.024\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.288\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.228\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.959\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.952\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e.002\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eFFMQ_d\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003er\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e.203\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.058\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.156\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.179\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.140\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;.283\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.967\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e.026\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.527\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.194\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.089\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.051\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.128\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e.002\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eFFMQ_a\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003er\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.105\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e.358\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;.248\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;.297\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;.191\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;.438\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;.391\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.258\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.852\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e.006\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e.036\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eFFMQ_nj\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003er\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e.410\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e.403\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.095\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;.399\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;.381\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;.294\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.158\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;.364\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.300\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.084\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eFFMQ_nr\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003er\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e.532\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e.246\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e.406\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;.262\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;.349\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.171\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.070\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e.007\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e.004\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.061\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.232\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e.447\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"10\"\u003e\u003cb\u003eNotes\u003c/b\u003e: N\u0026thinsp;=\u0026thinsp;120. FFMQ\u0026thinsp;=\u0026thinsp;Five-Facet Mindfulness Questionnaire, FFMQ_o\u0026thinsp;=\u0026thinsp;FFMQ observing subscale, FFMQ_d\u0026thinsp;=\u0026thinsp;FFMQ describing subscale, FFMQ_a\u0026thinsp;=\u0026thinsp;FFMQ acting with awareness subscale, FFMQ_nj\u0026thinsp;=\u0026thinsp;FFMQ nonjudging subscale, FFMQ_nr\u0026thinsp;=\u0026thinsp;FFMQ nonreactivity subscale, SCS\u0026thinsp;=\u0026thinsp;Self-Compassion Scale, RSES\u0026thinsp;=\u0026thinsp;Rosenberg Self-Esteem Scale, CERQ\u0026thinsp;=\u0026thinsp;Cognitive Emotion Regulation Questionnaire, CERQ_ad\u0026thinsp;=\u0026thinsp;CERQ adaptive strategies subscale, CERQ_mad\u0026thinsp;=\u0026thinsp;CERQ maladaptive strategies subscale, BDI-S\u0026thinsp;=\u0026thinsp;Beck Depression Inventory Shortened, BHS-S\u0026thinsp;=\u0026thinsp;Beck Hopelessness Inventory Shortened, BIS-8\u0026thinsp;=\u0026thinsp;Barratt Impulsivity Scale Shortened, DES\u0026thinsp;=\u0026thinsp;Dissociative Experience Scale\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e3.2. Changes in outcomes over time\u003c/h2\u003e\u003cdiv id=\"Sec12\" class=\"Section3\"\u003e\u003ch2\u003e3.2.1 Non-suicidal self-injury (NSSI)\u003c/h2\u003e\u003cp\u003eNSSI frequency rates decreased significantly following the MBCT-NSSI intervention, compared to baseline (Wilcoxon\u0026rsquo;s Z(\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e)=-5.639, p\u0026thinsp;\u0026lt;\u0026thinsp;.001, N\u003csub\u003edecrease\u003c/sub\u003e=36, N\u003csub\u003eunchanged\u003c/sub\u003e=14). Post-intervention, only 2% of participants reported daily NSSI, 6% weekly, 38% monthly, and 54% less frequently than monthly. Notably, eight participants who engaged in low-frequency self-harm at baseline reported no NSSI during the intervention. Although the follow-up period was brief, the observed trend towards a reduction in NSSI was clear and might have contributed to an underestimation of longer-term changes.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section3\"\u003e\u003ch2\u003e3.2.2 Primary outcomes\u003c/h2\u003e\u003cp\u003eLMM were conducted to assess change across three time points: baseline (T1), pre-intervention (T2), and post-intervention (T3). The estimated marginal means (95% CIs), F-Tests, and pairwise comparisons from LMM are presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. A Bonferroni correction for nine comparisons set the significance at p\u0026thinsp;\u0026lt;\u0026thinsp;.0056.\u003c/p\u003e\u003cp\u003eMindfulness (FFMQ) and self-compassion (SCS) increased significantly following MBCT-NSSI (both p\u0026thinsp;\u0026lt;\u0026thinsp;.001), each reflecting large post-intervention effects (d\u0026thinsp;=\u0026thinsp;0.84 and 0.80), with no change during the waiting period (p\u0026thinsp;=\u0026thinsp;.954, p\u0026thinsp;=\u0026thinsp;.754). Self-esteem (RSES) also improved significantly from T2 to T3 (p\u0026thinsp;\u0026lt;\u0026thinsp;.001, d\u0026thinsp;=\u0026thinsp;0.67), whereas no significant change occurred during the waiting period after Bonferroni correction (p\u0026thinsp;=\u0026thinsp;.039\u0026thinsp;\u0026gt;\u0026thinsp;.0056).\u003c/p\u003e\u003cp\u003eAdaptive emotion-regulation strategies (CERQ-ad) remained stable across assessments. In contrast, maladaptive strategies (CERQ-mad) did not show a significant change during the waiting period (p\u0026thinsp;=\u0026thinsp;.263), followed by a significant post-intervention decrease (p\u0026thinsp;=\u0026thinsp;.002, d\u0026thinsp;=\u0026thinsp;0.47).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section3\"\u003e\u003ch2\u003e3.2.3 Secondary outcomes\u003c/h2\u003e\u003cp\u003eSecondary outcomes also demonstrated significant time effects (see Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Depressive symptoms (BDI-S) declined across assessments, with no change during the waiting period (p\u0026thinsp;=\u0026thinsp;.245) but a moderate reduction from T2 to T3 (d\u0026thinsp;=\u0026thinsp;0.50, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). Hopelessness (BHS-S) similarly decreased following MBCT-NSSI (p\u0026thinsp;=\u0026thinsp;.001, d\u0026thinsp;=\u0026thinsp;0.46).\u003c/p\u003e\u003cp\u003eImpulsivity (BIS-8-S) exhibited significant changes over time (p\u0026thinsp;\u0026lt;\u0026thinsp;.001), with an increase observed during the waiting period (d\u0026thinsp;=\u0026thinsp;0.56), followed by a notable decrease following the intervention (d\u0026thinsp;=\u0026thinsp;0.69), resulting in a net reduction at post-treatment.\u003c/p\u003e\u003cp\u003eDissociative symptoms (DES) also declined over time (p\u0026thinsp;=\u0026thinsp;.006). Although the T2\u0026ndash;T3 difference did not meet the Bonferroni-adjusted significance threshold (p\u0026thinsp;=\u0026thinsp;.047\u0026thinsp;\u0026gt;\u0026thinsp;.0056), the downwards trajectory across all assessments indicates consistent improvement.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eLinear mixed models (LMM) results for primary and secondary outcomes\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eMeasures\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eMean (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eF(df)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c10\" namest=\"c7\"\u003e\u003cp\u003eBonferroni pairwise comparison\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eT1\u003c/p\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;120)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eT2\u003c/p\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;72)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eT3\u003c/p\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep (T1-T2)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003ed\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003ep (T2-T3)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003ed\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRSES\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10.49 (9.49\u0026ndash;11.49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.55 (10.43\u0026ndash;12.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.62 (12.35\u0026ndash;14.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15.56 (2, 93.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.039\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFFMQ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e105.32 (102.39\u0026ndash;108.24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e106.69 (103.35\u0026ndash;110.03)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e120.17 (116.30\u0026ndash;124.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e38.82 (2, 100.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.954\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.84\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCERQ_ad\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e51.72 (49.26\u0026ndash;54.18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50.72 (47.93\u0026ndash;53.51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e53.19 (49.92\u0026ndash;56.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.94 (2, 95.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.150\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.194\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCERQ_mad\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50.53 (48.51\u0026ndash;52.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51.91 (49.67\u0026ndash;54.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48.61 (46.04\u0026ndash;51.19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.80 (2, 97.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e.002\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.263\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e.002\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.47\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBDI-S\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21.78 (20.84\u0026ndash;22.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.11 (20.06\u0026ndash;22.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19.06 (17.86\u0026ndash;20.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13.69 (2, 90.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.245\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBHS-S\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10.25 (9.59\u0026ndash;10.91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.13 (9.41\u0026ndash;10.84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.12 (8.32\u0026ndash;9.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.82 (2, 93.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.46\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBIS-8-S\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20.65 (19.87\u0026ndash;21.43)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.70 (20.86\u0026ndash;22.54)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19.69 (18.77\u0026ndash;20.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e22.18 (2, 90.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.69\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDES\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e766.63 (681.66\u0026ndash;851.59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e717.79 (627.65\u0026ndash;807.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e644.94 (545.99\u0026ndash;743.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.48 (2, 91.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.006\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.154\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.047\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSCS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e53.36 (50.56\u0026ndash;56.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55.04 (51.77\u0026ndash;58.31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e63.79 (59.92\u0026ndash;67.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15.14 (2, 132.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.754\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"10\"\u003e\u003cb\u003eNotes\u003c/b\u003e: RSES\u0026thinsp;=\u0026thinsp;Rosenberg Self-Esteem Scale, FFMQ\u0026thinsp;=\u0026thinsp;Five-Facet Mindfulness Questionnaire, CERQ\u0026thinsp;=\u0026thinsp;Cognitive Emotion Regulation Questionnaire, CERQ_ad\u0026thinsp;=\u0026thinsp;CERQ adaptive strategies subscale, CERQ_mad\u0026thinsp;=\u0026thinsp;CERQ maladaptive strategies subscale, BDI-S\u0026thinsp;=\u0026thinsp;Beck Depression Inventory Shortened, BHS-S\u0026thinsp;=\u0026thinsp;Beck Hopelessness Inventory Shortened, BIS-8-S\u0026thinsp;=\u0026thinsp;Barratt Impulsivity Scale Shortened, DES\u0026thinsp;=\u0026thinsp;Dissociative Experience Scale, SCS\u0026thinsp;=\u0026thinsp;Self-Compassion Scale. d\u0026thinsp;=\u0026thinsp;Cohen\u0026rsquo;s d effect size for pairwise comparisons (T1\u0026ndash;T2, T2\u0026ndash;T3)\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eMissing effect sizes (\u0026mdash;) indicate non-significant comparisons, or d was not computed due to lack of significance.\u003c/p\u003e\u003cp\u003eBonferroni correction for multiple tests was used; p\u0026thinsp;\u0026lt;\u0026thinsp;.0056 was considered significant.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e3.3. Dropout predictors\u003c/h2\u003e\u003cp\u003eTo reduce model complexity and the risk of overfitting, baseline predictors of dropout were analysed in two separate binary logistic regression models using the Wald backward stepwise method: one including eight psychological predictors (mindfulness, self-compassion, depression, hopelessness, impulsivity, adaptive and maladaptive emotion regulation, dissociation), and another including five sociodemographic/clinical predictors (age, sex, number of comorbid diagnoses, history of suicide attempts, and suicide in the close family). Given the number of predictors, a Bonferroni correction was applied within each model, resulting in adjusted significance thresholds of p\u0026thinsp;\u0026lt;\u0026thinsp;.00625 and p\u0026thinsp;\u0026lt;\u0026thinsp;.01, respectively.\u003c/p\u003e\u003cp\u003eIn the psychological model, the overall fit was acceptable (Hosmer\u0026ndash;Lemeshow χ\u0026sup2;(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;8.25, p\u0026thinsp;=\u0026thinsp;.409; Nagelkerke R\u0026sup2; = .305). Using the Wald backward stepwise method, after Bonferroni correction, three variables remained significant predictors of dropout (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e): higher impulsivity (BIS-8-S; OR\u0026thinsp;=\u0026thinsp;1.20, 95% CI\u0026thinsp;=\u0026thinsp;1.08\u0026ndash;1.35), greater use of maladaptive cognitive emotion regulation strategies (CERQ_mad; OR\u0026thinsp;=\u0026thinsp;1.08, 95% CI\u0026thinsp;=\u0026thinsp;1.03\u0026ndash;1.12), and, unexpectedly, higher self-compassion (SCS; OR\u0026thinsp;=\u0026thinsp;1.06, 1.02\u0026ndash;1.11). Adaptive cognitive emotion regulation strategies (CERQ_ad) showed a trend (p\u0026thinsp;=\u0026thinsp;.008) but did not meet the corrected threshold.\u003c/p\u003e\u003cp\u003eIn the sociodemographic model, the model fit was acceptable (Hosmer\u0026ndash;Lemeshow χ\u0026sup2;(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;11.26, p\u0026thinsp;=\u0026thinsp;.128; Nagelkerke R\u0026sup2; = .224). Only one variable, \u003cem\u003efewer comorbid diagnoses\u003c/em\u003e, significantly predicted dropout (OR\u0026thinsp;=\u0026thinsp;.40, 95% CI\u0026thinsp;=\u0026thinsp;.23 \u0026minus;\u0026thinsp;.69) after correction (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Younger age (p\u0026thinsp;=\u0026thinsp;.039) and history of suicide attempts (p\u0026thinsp;=\u0026thinsp;.061) showed non-significant trends.\u003c/p\u003e\u003cp\u003eDue to the number of predictors tested and the small sample size, results should be interpreted with caution.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBinary logistic regression predicting intervention dropout\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePredictor\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eWald\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eOR (Exp(B))\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e95% CI for OR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePsychological predictors model\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCERQ_ad\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.051\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.92\u0026ndash;0.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e.008\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCERQ_mad\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.073\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.03\u0026ndash;1.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e.002\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBIS-8-S\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.056\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.08\u0026ndash;1.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSCS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.059\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.02\u0026ndash;1.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e.005\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSociodemographic and clinical characteristics predictors model\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.056\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.027\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.90\u0026ndash;1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.039\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of comorbid diagnoses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.929\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.286\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.23\u0026ndash;0.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFormer suicide attempts\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.823\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.440\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.96\u0026ndash;5.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.061\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cb\u003eNotes\u003c/b\u003e: Psychological predictor model fit: Cox \u0026amp; Snell R\u0026sup2; = .227, Nagelkerke R\u0026sup2; = .305; Hosmer\u0026ndash;Lemeshow χ\u0026sup2;(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;8.25, p\u0026thinsp;=\u0026thinsp;.409. Bonferroni correction for multiple tests was used; p\u0026thinsp;\u0026lt;\u0026thinsp;.0063 can be considered significant.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSociodemographic and clinical characteristics predictors model: Cox \u0026amp; Snell R\u0026sup2; = .168, Nagelkerke R\u0026sup2; = .224; Hosmer\u0026ndash;Lemeshow χ\u0026sup2;(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;11.26, p\u0026thinsp;=\u0026thinsp;.128. Bonferroni correction for multiple tests was used; p\u0026thinsp;\u0026lt;\u0026thinsp;.01 can be considered significant.\u003c/p\u003e\u003cp\u003eCERQ\u0026thinsp;=\u0026thinsp;Cognitive Emotion Regulation Questionnaire, CERQ_ad\u0026thinsp;=\u0026thinsp;CERQ adaptive strategies subscale, CERQ_mad\u0026thinsp;=\u0026thinsp;CERQ maladaptive strategies subscale, BIS-8-S\u0026thinsp;=\u0026thinsp;Barratt Impulsivity Scale Shortened, SCS\u0026thinsp;=\u0026thinsp;Self-Compassion Scale\u003c/p\u003e\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis quasi-experimental controlled time-series study evaluated the feasibility and preliminary outcomes of a mindfulness-based cognitive therapy intervention tailored for individuals with borderline personality disorder (MBCT-NSSI). The core characteristics of BPD include being overwhelmed and carried away by emotions and impulses, and the pervasive lability and shame that accompany them. Mindfulness-based approaches address these vulnerabilities by enhancing present-moment awareness, non-judgmental acceptance, and self-regulation (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Therefore, MBCT might be especially appropriate for BPD. To our knowledge, this is the first controlled trial specifically targeting non-suicidal self-injury (NSSI) in BPD using a structured MBCT protocol. We investigated whether MBCT-NSSI could reduce self-injury and improve core psychological mechanisms such as mindfulness, emotion regulation, and impulsivity (H1); whether these improvements were specific to the intervention period compared to a waiting list phase (H2); and whether baseline psychological or clinical factors predict treatment dropout (H3).\u003c/p\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003e4.1. Baseline clinical profile\u003c/h2\u003e\u003cp\u003eThe participants in the present study exhibited low self-esteem, self-compassion, and mindfulness, alongside elevated depression, impulsivity, and dissociation\u0026mdash;well-established risk factors for NSSI in BPD patients (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan additionalcitationids=\"CR74\" citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e). Low scores on the mindfulness scale and subscales support the mindfulness deficit theory (\u003cspan additionalcitationids=\"CR33\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e), which posits that reduced attentional and regulatory capacity contribute to maladaptive behaviours like NSSI.\u003c/p\u003e\u003cp\u003eIn addition to this clinical baseline profile of participants, the severity and frequency of self-harm in the sample were considerable: more than half of the participants engaged in multiple methods of NSSI, and 44% reported self-harming at least weekly. Given that NSSI is a strong predictor of future suicidal behaviour (OR\u0026thinsp;=\u0026thinsp;4.27, 95% CI\u0026thinsp;=\u0026thinsp;2.56\u0026ndash;7.10) (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), and that repetitive, multi-method NSSI is associated with an increased risk of later suicide attempts (\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e), these baseline findings underscore the urgent need for accessible, targeted interventions in this population.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003e4.2. Hypothesis 1: improvements following MBCT-NSSI\u003c/h2\u003e\u003cp\u003eIn line with our first hypothesis, participation in the MBCT-NSSI intervention was associated with significant improvements in several key clinical and psychological domains. Most notably, participants reported a marked reduction in NSSI frequency post-intervention, with the majority decreasing the frequency of self-harm to monthly or less frequent occurrences. Considering that NSSI is a highly resistant and high-risk symptom of BPD, even a moderate reduction represents a clinically meaningful change.\u003c/p\u003e\u003cp\u003eBeyond behavioural outcomes, significant improvements were observed in several targeted psychological capacities between T2 (pre-intervention) and T3 (post-intervention), following the active treatment phase. Participants showed statistically and clinically significant increases in mindfulness, self-compassion, and self-esteem, along with reductions in depressive symptoms, hopelessness, and impulsivity. These effects were absent in most cases and, when present, were much reduced during the waiting period (T1\u0026ndash;T2), suggesting a treatment-specific change. The observed increase in psychological protective factors (e.g., mindfulness, self-compassion, self-esteem) aligns with the broader literature on mindfulness-based interventions, which have been shown to promote emotion regulation, reduce reactivity, and enhance self-related processes (\u003cspan additionalcitationids=\"CR41 CR42 CR43 CR44 CR45\" citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHowever, the findings related to emotion regulation strategies were more nuanced. While maladaptive cognitive emotion regulation strategies (CERQ_mad) decreased significantly from pre- to post-intervention, adaptive strategies (CERQ_ad) did not improve. This asymmetry may reflect the nature of MBCT, which emphasises the cultivation of meta-awareness and non-judgmental acceptance rather than teaching explicit cognitive reappraisal techniques. It is possible that reductions in maladaptive responses occurred through enhanced awareness and decentering, without a corresponding increase in overt use of adaptive strategies. Alternatively, the lack of significant change in adaptive strategies may reflect limitations of the CERQ measure in capturing the more experiential and non-cognitive regulatory shifts promoted by MBIs.\u003c/p\u003e\u003cp\u003eDissociation showed a downward trend across the three assessment points, with significant overall time effects but only trend-level changes from pre- to post-intervention after Bonferroni correction. This pattern should be interpreted cautiously but is encouraging, given that dissociation has been described as one of the most challenging symptoms in BPD and is often associated with poor treatment response (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eQualitative feedback suggested that grounding exercises and heightened body awareness were perceived as particularly helpful in reducing dissociative episodes. However, in many cases, participants often began consistently home-practising mindfulness only midway through the programme and maintaining practice after the intervention was also an issue. Due to the robust nature of dissociation, it is plausible that earlier or more intensive home practices may be necessary to achieve more robust effects. These findings support the recommendation to reinforce at-home practice from the outset of the intervention.\u003c/p\u003e\u003cp\u003eOverall, the observed reductions in clinical symptoms and maladaptive emotion regulation strategies, along with increases in self-compassion and self-esteem, are particularly relevant given the well-established protective role of these factors against self-injury. These findings suggest that MBCT-NSSI may target core maintenance mechanisms of NSSI in individuals with BPD. While not all hypothesised changes reached statistical significance, the pattern of results indicates meaningful therapeutic gains in a clinically complex and high-risk population.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003e4.3. Hypothesis 2: control condition changes\u003c/h2\u003e\u003cp\u003eOur second hypothesis (H2) was supported, as improvements were substantially greater during the intervention phase (T2\u0026ndash;T3) than during the waiting list period (T1\u0026ndash;T2). While minimal or no positive changes were observed during the waiting period\u0026mdash;indeed, impulsivity and maladaptive emotion regulation strategies showed signs of deterioration\u0026mdash;participants demonstrated significant improvements in several domains following the MBCT-NSSI intervention. Specifically, reductions were observed in NSSI frequency, depression, and impulsivity, alongside increases in mindfulness, self-esteem, and self-compassion. This pattern of results suggests that the observed changes are unlikely to be explained by time effects, regression to the mean, or repeated measurement, and instead point to the specific impact of the intervention.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003e4.4. Hypothesis 3: dropout predictors\u003c/h2\u003e\u003cp\u003eTo examine predictors of dropout, two logistic regression models were tested separately for psychological and sociodemographic variables, with Bonferroni correction applied to control for multiple comparisons.\u003c/p\u003e\u003cp\u003eIn the psychological model, higher impulsivity, greater use of maladaptive emotion regulation strategies, and\u0026mdash;unexpectedly\u0026mdash;higher self-compassion significantly predicted dropout. The associations with impulsivity and maladaptive regulation are consistent with prior findings suggesting that individuals with greater emotional dysregulation may struggle to engage in structured, especially group-based, interventions (\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e). The association with self-compassion, although statistically significant, runs counter to theoretical expectations and should be interpreted with caution. It may reflect suppression effects, distorted self-reporting, or state-related fluctuations in self-concept, which are common in BPD populations (\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn the sociodemographic model, fewer comorbid diagnoses predicted dropout. This result may reflect that individuals with more complex clinical histories are more treatment-engaged due to a higher need or prior exposure to care. Other variables, such as younger age and suicidal history, showed trend-level effects but did not reach significance after correction.\u003c/p\u003e\u003cp\u003eWhile the dropout rate of the active phase (28.6%) aligns with previous findings in BPD samples (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e, \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e, \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e), the overall rate was much higher, 58,3%. Furthermore, both models showed modest explanatory power (Nagelkerke R\u0026sup2; = .305 and .224, respectively). Suggesting that additional unmeasured factors\u0026mdash;such as therapeutic alliance, the outpatient setting\u0026rsquo;s structure, trauma history, educational level, or overall functioning\u0026mdash;may play a more substantial role in treatment retention (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e, \u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn summary, these findings provide initial insights into potential predictors of dropout in MBCT for BPD. However, they should be interpreted cautiously due to the limited sample size, high dropout rate, and the risk of Type I error despite adjustments for multiple comparisons.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003e4.5. Clinical implications\u003c/h2\u003e\u003cp\u003eThe findings of this study suggest that brief, group-based mindfulness-based cognitive therapy (MBCT-NSSI), adapted for individuals with borderline personality disorder (BPD), may be a promising adjunctive intervention for reducing self-injurious behaviour and improving several related psychological outcomes. Significant reductions in NSSI frequency, depression, impulsivity, and hopelessness, alongside improvements in mindfulness skills, self-esteem, and self-compassion, were observed following the intervention period\u0026mdash;but not during the waiting list phase\u0026mdash;indicating treatment-specific effects.\u003c/p\u003e\u003cp\u003eWhile changes in dissociation and adaptive cognitive emotion regulation strategies were limited, the intervention appeared to primarily reduce maladaptive processes such as impulsivity, self-criticism, and catastrophic thinking\u0026mdash;mechanisms often implicated in maintaining NSSI. These effects align with the theoretical goals of MBCT, which aim to increase metacognitive awareness and acceptance.\u003c/p\u003e\u003cp\u003eGiven the short duration of the intervention (nine sessions), these changes are clinically meaningful, particularly considering the complexity and high-risk profile of the sample. In contexts with limited access to long-term therapy, MBCT-NSSI may serve as a feasible, lower-intensity treatment option or preparatory intervention, potentially improving psychological readiness for more intensive care.\u003c/p\u003e\u003cp\u003eHowever, the high overall dropout rate, especially before program initiation, underscores the need for careful pre-treatment screening, enhanced motivational strategies, and perhaps additional engagement supports\u0026mdash;particularly for younger patients and those with elevated impulsivity or emotion regulation difficulties. Although dropout during active treatment was comparable to other BPD interventions, future implementations should prioritise strategies to improve retention and continuity, especially in outpatient settings.\u003c/p\u003e\u003cp\u003eFinally, while these findings support the clinical utility of MBCT-NSSI, the absence of a randomised controlled design, follow-up data, and an active control group limits the strength of the conclusions. Replication in larger, more diverse samples\u0026mdash;with extended follow-up\u0026mdash;is needed to determine the effects' sustainability, generalisability, and how MBCT-NSSI compares to other brief interventions for self-harming individuals with BPD.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003e4.6. Limitations\u003c/h2\u003e\u003cp\u003eSeveral limitations should be considered when interpreting the findings. The study employed a quasi-experimental, non-randomised design without an active control group, which limits causal inference and increases susceptibility to confounding variables. The reliance on self-report measures may have introduced bias, particularly in a population characterised by instability in self-concept, which can affect the reliability of responses. Although the assessment time points were structured, the lack of a follow-up assessment precludes conclusions about the durability of the effects. Moreover, the exact duration of the waitlist period was not systematically recorded and therefore could not be statistically controlled.\u003c/p\u003e\u003cp\u003eAnother limitation of the study is the lack of a blinding procedure. Several authors (the first two and the last) also acted as group facilitators, and the last author served as the supervisor of all the groups. Although this may raise concerns about researcher allegiance, verifying the statistical analyses by independent authors mitigated potential analytic bias.\u003c/p\u003e\u003cp\u003eAdditionally, while Bonferroni correction was applied to reduce Type I error, the overall sample size\u0026mdash;particularly for the dropout analyses\u0026mdash;was modest relative to the number of predictors tested, increasing the risk of Type II error or overfitting. Finally, the study was conducted in a single clinical setting with primarily treatment-seeking individuals, which may limit the generalisability of the results to broader BPD or NSSI populations.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec23\" class=\"Section2\"\u003e\u003ch2\u003e4.7. Conclusion\u003c/h2\u003e\u003cp\u003eTaken together, this quasi-experimental study provides preliminary evidence that a brief, adapted MBCT-NSSI intervention can reduce self-injurious behaviour and improve psychological functioning in individuals with BPD. Significant improvements were observed in the frequency of NSSI and mindfulness (primary outcomes), as well as in self-compassion and key clinical symptoms (secondary outcomes), particularly during the active treatment phase. Although dropout rates were high, several psychological and clinical factors predicted engagement, offering guidance for future tailoring of interventions.\u003c/p\u003e\u003cp\u003eWhile a 9-week MBCT-NSSI training is not a substitute for long-term psychotherapy tailored to personality disorders, these findings support the feasibility and potential value of structured, mindfulness-based interventions as supplementary support for this high-risk population.\u003c/p\u003e\u003cp\u003eReplication in larger, controlled trials with follow-up assessments will be essential to establish sustained effects and optimise clinical utility.\u003c/p\u003e\u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBDI-S: Beck Depression Inventory Shortened. BHS-S: Beck Hopelessness Inventory Shortened. BIS-8-S: Barratt Impulsivity Scale Shortened. BPD: borderline personality disorder. CERQ: Cognitive Emotion Regulation Questionnaire, CERQ_ad: CERQ adaptive strategies subscale. CERQ_mad: CERQ maladaptive strategies subscale. CONSORT: Consolidated Standards of Reporting Trials. DBT: Dialectical Behaviour Therapy. DES: Dissociative Experience Scale. FFMQ: Five-Facet Mindfulness Questionnaire. FFMQ_a: FFMQ acting with awareness subscale. FFMQ_d: FFMQ describing subscale. FFMQ_nj: FFMQ nonjudging subscale. FFMQ_nr: FFMQ nonreactivity subscale. FFMQ_o: FFMQ observing subscale. LMM: Linear mixed-effects models. MAR: missing-at-random assumption. MBCT: mindfulness-based cognitive therapy. MBCT-NSSI: the 9-week group-based mindfulness-based cognitive therapy program tailored to reduce NSSI. MBI: Mindfulness-based interventions. ML: maximum-likelihood. NSSI: Non-suicidal self-injury. RSES: Rosenberg Self-Esteem Scale. SCID-II-BPD: Structured Clinical Interview for DSM‐IV Axis II Disorders, Borderline Personality Disorder subscale. SCS: Self-Compassion Scale. TREND: Transparent Reporting of Evaluations with Nonrandomized Designs. VIF: variance-inflation factors.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e: The Regional and Institutional Committee of Science and Research Ethics of Semmelweis University approved the research procedure (Number: 240/2018). According to the Declaration of Helsinki, all participants provided written informed consent prior to participating.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e: None.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e: Reporting followed the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) 2024 guidelines. The completed TREND checklist is available in Supplementary Material 1. The de-identified dataset and supporting documentation are available via the Open Science Framework (OSF): https://osf.io/z94ym. The study was retrospectively registered at https://doi.org/10.17605/OSF.IO/ZUR84 on May 16, 2025.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: This research was funded by the Higher Education Institutional Excellence Program of the Ministry for Innovation and Technology in Hungary, within the framework of the Neurology thematic program at Semmelweis University, TKP/2021.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contribution:\u003c/strong\u003e KSz, ZG\u0026Aacute;, and PFD conceived the study and developed the theoretical framework. KSz and ZG\u0026Aacute; collected the data. KSz, SzT, and MM analysed the data. PFD supervised the project. All the authors discussed the results and contributed to the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment:\u0026nbsp;\u003c/strong\u003eWe thank our colleagues for their insightful feedback, and our dedicated research assistants (Emese Mis\u0026aacute;k, Dorottya Sal, Barbara Kulig) for their invaluable support in organizing the study. We are also deeply thankful to all the participants in our pilot research, from whom we gleaned significant insights into the intricate issue of self-harm.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eParis J. Suicidality in Borderline Personality Disorder. Medicina. 2019;55(6):223.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAPA. Diagnostic and statistical manual of mental disorders: DSM-5: American Psychiatric Publishing, Inc. 2013. xliv, 947 p.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShah R, Zanarini MC. 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Psychiatry Res. 2015;230(1):28\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMerza K, Papp G, Moln\u0026aacute;r J, Szab\u0026oacute; IK. Characteristics and Development of Nonsuicidal Super Self-Injury among Borderline Inpatients. Psychiatr Danub. 2017;29(4):480\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDe Salve F, Rossi C, Gioacchini E, Messina I, Oasi O. Dropout in Psychotherapy for Personality Disorders: A Systematic Review of Predictors. Clin Psychol Psychother. 2025;32(3):e70080.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBalsis S, Loehle-Conger E, Busch AJ, Ungredda T, Oltmanns TF. Self and informant report across the borderline personality disorder spectrum. Personal Disord. 2018;9(5):429\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWinter D, Herbert C, Koplin K, Schmahl C, Bohus M, Lis S. 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Psychol Med. 2023;53(3):668\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e\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":"Borderline personality disorder, self-mutilation, mindfulness, emotional regulation, self-compassion, suicide prevention","lastPublishedDoi":"10.21203/rs.3.rs-7989892/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7989892/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eNon-suicidal self-injury (NSSI) is highly prevalent among individuals with borderline personality disorder (BPD) and is one of the most robust predictors of future suicide attempts and suicide deaths. Access to comprehensive treatments such as dialectical behaviour therapy remains limited.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis exploratory study evaluated the feasibility and preliminary outcomes of a brief, group-based mindfulness-based cognitive therapy program tailored to reduce NSSI (MBCT-NSSI) and improve associated psychological processes. Using a nonrandomised pre\u0026ndash;post design with a within-subject waitlist control comparator, assessments were conducted at three time points: 8\u0026ndash;12 weeks pre-intervention (T1) (n\u0026thinsp;=\u0026thinsp;120), immediately pre-intervention (T2) (n\u0026thinsp;=\u0026thinsp;72), and post-intervention (T3) (n\u0026thinsp;=\u0026thinsp;50). Outpatients diagnosed with BPD and recent NSSI were recruited from psychiatric clinics to participate in a 9-week MBCT-NSSI group programme. Exclusion criteria included current psychosis, manic episodes, severe substance use, and acute suicide risk. Primary outcomes were NSSI frequency and mindfulness. Secondary outcomes included self-compassion, self-esteem, impulsivity, depression, dissociation, and emotion regulation. Within-subject changes were analysed via linear mixed modelling and Wilcoxon signed-rank tests. Binary logistic regression identified predictors of dropout among eligible participants. No blinding or randomisation procedures were applied.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eParticipants who completed the MBCT-NSSI intervention (N\u0026thinsp;=\u0026thinsp;50) presented significant reductions in NSSI frequency, depressive symptoms, hopelessness, impulsivity, and maladaptive emotion regulation, alongside improvements in mindfulness, self-compassion, and self-esteem. These changes were observed primarily during the intervention phase and not during the waiting-list period, suggesting treatment-specific effects. Dissociative symptoms showed a non-significant trend toward improvement. Dropout among eligible patients (N\u0026thinsp;=\u0026thinsp;120) was associated with higher impulsivity, maladaptive regulation, and, unexpectedly, higher self-compassion, whereas fewer comorbid diagnoses predicted lower treatment retention.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eMBCT-NSSI may be a feasible and effective adjunctive intervention for individuals with BPD who engage in NSSI, improving emotion regulation and reducing self-harm frequency. These findings support further investigations via controlled trials and longer follow-up periods.\u003c/p\u003e\u003ch2\u003eTrial registration:\u003c/h2\u003e\u003cp\u003eNot applicable. The study was a nonrandomized, quasi-experimental pre\u0026ndash;post design without a control condition, and therefore does not meet the ICMJE definition of a clinical trial. The study was retrospectively registered on the Open Science Framework (OSF) at \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.17605/OSF.IO/ZUR84\u003c/span\u003e\u003cspan address=\"10.17605/OSF.IO/ZUR84\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/p\u003e","manuscriptTitle":"Evaluating a brief MBCT programme for non-suicidal self-injury in individuals with BPD: A quasi-experimental, nonrandomised pre–post design pilot study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-01 08:37:38","doi":"10.21203/rs.3.rs-7989892/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-31T16:15:35+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-16T14:20:45+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-13T18:55:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"325954856411649909786679675201648323029","date":"2025-11-28T23:16:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"206362318555588670691835996732300818810","date":"2025-11-25T21:49:48+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-25T11:49:52+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-18T12:44:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-18T06:13:14+00:00","index":"","fulltext":""},{"type":"submitted","content":"Borderline Personality Disorder and Emotion Dysregulation","date":"2025-10-30T13:13:23+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":"96ff5fe7-801e-48fd-ac52-a182caef599b","owner":[],"postedDate":"December 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-16T16:07:43+00:00","versionOfRecord":{"articleIdentity":"rs-7989892","link":"https://doi.org/10.1186/s40479-026-00337-3","journal":{"identity":"borderline-personality-disorder-and-emotion-dysregulation","isVorOnly":false,"title":"Borderline Personality Disorder and Emotion Dysregulation"},"publishedOn":"2026-03-09 16:00:07","publishedOnDateReadable":"March 9th, 2026"},"versionCreatedAt":"2025-12-01 08:37:38","video":"","vorDoi":"10.1186/s40479-026-00337-3","vorDoiUrl":"https://doi.org/10.1186/s40479-026-00337-3","workflowStages":[]},"version":"v1","identity":"rs-7989892","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7989892","identity":"rs-7989892","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}