by Michael D. Anestis, Ph.D.
On a number of occasions, I've written about dialectical behavior therapy (DBT) and mentioned that I would love to see outcome data that are more specific to the stated goals of each module (e.g., does the emotion regulation module predict increases in the use of adaptive emotion regulation skills). In a study published in the current issue of Behaviour Research and Therapy, Joaquim Soler and colleagues (2012) discussed some data that, in some ways, actually did this. In this particular study, patients diagnosed with borderline personality disorder (BPD) received either general psychiatric management (GPM; n = 19) or GPM and the mindfulness module of DBT (DBT-M; n = 40). The stated goal of the authors was to determine the degree to which DBT-M results in improvement in various aspects of attention (click here for an article on mindfulness in general and the role of attention in the construct).
A couple of points are worth noting here. First, this is not a test of DBT. Although the therapists were extensively trained in DBT, they did not utilize the entire treatment protocol. The DBT-M+GPM group received eight 120 minute psychotherapy sessions in groups of 9-11 and these sessions focused on mindfulness skills only. Second, the treatment also incorporated mindfulness skills from the distress tolerance module (e.g., mindful focus on breath), thereby altering the mindfulness module itself. Third, participants were not randomized to treatment, but rather referred consecutively.
The authors' first hypothesis was that patients in the DBT-M group would exhibit greater improvements in attention related variables measured by the continuous performance task (CPT-II). This, in fact, turned out to be the case with respect to a number of attention-related variables (e.g., commission errors). Interestingly, patients in the GPM group, on average, significantly worsened on measures of inattention and impulsivity whereas individuals in the DBT-M group typically improved significantly on impulsivity (e.g., reduced commission errors, slower responses, lower scores on impulsivity index of CPM).
The authors' second hypothesis was that minutes spend practicing mindfulness skills between sessions would predict improvement on a number of clinical outcomes (depression, general psychopathological symptoms, self-reported mindfulness, various negative mood states). The authors found that minutes spent practicing mindfulness skills predicted greater improvement in overall depression, general psychopathological symptoms, depressed mood state, confused mood state, total mood distortion, and the non-reactivity to inner experience scale of the Five Factor Mindfulness Questionnaire. In some ways, these are strong findings, as improvement in these areas are definitively a good thing. That being said, it's unclear that these individuals improved more in these areas than did individuals in the GPM condition alone and, furthermore, a number of scales did not reach significance in this model, including several subscales of mindfulness specific measures, which seems a bit odd.
So...what can we take away from this? I see this as decent preliminary evidence that the mindfulness module of DBT actually does impact attention, an important consideration given how central attention is to mindfulness. That being said, I also want to see these results in the context of an RCT in which participants receive actual DBT. Furthermore, I'd want to see the pattern of significant and non-significant results replicated across samples because, when you run this many analyses and have a scattering of results that work out and some that don't, it's difficult not to wonder to what degree that same pattern would actually emerge when tested again.
Dr. Anestis is a post-doctoral fellow with the Military Suicide Research Consortium
Articles cited in this post:
Soler, J., Valdeperez, A., Feliu-Soler, A., Pascual, J.C., Portella, M.J., Martin-Blanco, A., Alvarez, E., & Perez, V. (2012). Effects of the dialectical behavioral therapy-mindfulness module on attention in patients with borderline personality disorder. Beahviour Research and Therapy, 50, 150-157.