(PS12-B45) The Road to Skill Use: Do Baseline Measurements Predict the Use of DBT Skills During Treatment?

Dialectical Behavior Therapy (DBT; Linehan, 1993; Linehan, 2006) is an evidence-based psychotherapy treatment originally developed for chronic suicidality and borderline personality disorder focused on the dialectic of acceptance and change. A key aspect of DBT involves teaching behavioral skills across four main skill dimensions: emotion regulation, mindfulness, distress tolerance, and interpersonal effectiveness. Few DBT studies include direct assessment of skill use (Rudge et al., 2020; Valentine et al., 2015), and those that do often include skill use as a predictor of treatment outcomes (e.g., Barnicot et al., 2015). Limited research has been conducted specifically on antecedents of the use of specific skills within DBT treatment. The present research examines how skill use changes over the course of DBT and how baseline measurements of the four skill dimensions predict skill use over the course of DBT.

Participants (N = 45) were clients in a DBT graduate training clinic and completed baseline measures of emotion dysregulation (Difficulties in Emotion Regulation Scale; Gratz & Roemer, 2004), distress tolerance (Distress Tolerance Scale; Simons & Gaher, 2005), mindfulness (The Mindful Attention Awareness Scale; Brown & Ryan, 2003), and interpersonal problems (Inventory of Interpersonal Problems; Horowitz et al., 1988). Skill use during treatment was assessed using DBT diary card responses. Consistent with our hypothesis, using Bayesian multilevel modeling, we found a reliable decrease in distress tolerance skill use over treatment, β = -.17, 95% CI [-0.32, -0.02]. Contrary to our hypothesis, we also found a reliable decrease in mindfulness skill use over the course of treatment, β = -.14, 95% CI [-0.27, -0.01]. We did not find reliable effects for emotion regulation or interpersonal effectiveness skill use change over the course of DBT. Using extracted slopes from the multilevel model, we found that, consistent with our hypothesis, higher baseline emotion dysregulation predicted less emotion regulation skill use over the course of treatment, β = -.37, t = -2.26, p = .02. Inconsistent with our hypothesis, we found that baseline mindfulness did not predict mindfulness skill use, baseline distress tolerance did not predict distress tolerance skill use, and that more baseline interpersonal problems did not predict interpersonal skill use over the course of DBT.

Findings indicate that baseline difficulties or strengths relating to the DBT skills modules may not correspond to the use of those skills during treatment with the exception of emotion dysregulation. This study highlights the importance of addressing emotion dysregulation as a key target in DBT; prioritizing this area of treatment for individuals high in baseline emotion dysregulation may be important in promoting the use of emotion regulation skills.