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Cited by 80Personality Disorders and PsychopathologyPsychotherapy Techniques and ApplicationsAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Impact of dialectical behavior therapy versus community treatment by experts on emotional experience, expression, and acceptance in borderline personality disorder

Open access
Neacsiu, Andrada D., Lungu, Anita, Harned, Melanie S., Rizvi, Shireen L., Linehan, Marsha M.·2014·Behaviour Research and Therapy
DOI 10.1016/j.brat.2013.12.004PMC PMC3955205
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Abstract

Evidence suggests that heightened negative affectivity is a prominent feature of Borderline Personality Disorder (BPD) that often leads to maladaptive behaviors. Nevertheless, there is little research examining treatment effects on the experience and expression of specific negative emotions. Dialectical Behavior Therapy (DBT) is an effective treatment for BPD, hypothesized to reduce negative affectivity (Linehan, 1993a). The present study analyzes secondary data from a randomized controlled trial with the aim to assess the unique effectiveness of DBT when compared to Community Treatment by Experts (CTBE) in changing the experience, expression, and acceptance of negative emotions. Suicidal and/or self-injuring women with BPD (n=101) were randomly assigned to DBT or CTBE for one year of treatment and one year of follow-up. Several indices of emotional experience and expression were assessed. Results indicate that DBT decreased experiential avoidance and expressed anger significantly more than CTBE. No differences between DBT and CTBE were found in improving guilt, shame, anxiety, or anger suppression, trait, and control. These results suggest that DBT has unique effects on improving the expression of anger and experiential avoidance, whereas changes in the experience of specific negative emotions may be accounted for by general factors associated with expert therapy. Implications of the findings are discussed. © 2013.

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Crossref · 10.1016/j.brat.2013.12.004

Cites

83 of 83 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

12 of 62 cited sources checked · 4 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Amygdala activation returned to baseline more slowly in the BPD group.

    “In addition, the activation in the amygdala took longer to return to baseline in the BPD group”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Hazlett, et al., 2012 source
  • Premisecitation

    Experiential avoidance makes treatment progress more difficult.

    “and makes progress in treatment more difficult (Berking, Neacsiu, Comtois, & Linehan, 2009).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Berking, Neacsiu, Comtois, & Linehan, 2009 source

      The Abstract conclusion says the findings are consistent with experiential avoidance impeding the reduction of depression during treatment for borderline personality disorder. The claim broadens this to treatment progress generally; the Discussion says outcomes other than depression and other BPD populations still need investigation. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
  • Premisecitation

    DBT has unique effects beyond non-behavioral expert therapy in reducing suicide attempts, medical severity of suicidal and self-harming acts, use of crisis services, inpatient hospitalizations, and treatment drop-out.

    “Findings from the main outcome study indicate that DBT has unique effects that extend beyond those of non-behavioral expert therapy in reducing suicide attempts, medical severity of suicidal and self harming acts, use of crisis services, inpatient hospitalizations, and treatment drop-out (Linehan et al., 2006).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Linehan et al., 2006 source
  • Premisecitation

    Adults with BPD showed greater amygdala activation to emotional but not neutral pictures than non-clinical and matched schizotypal controls.

    “when compared to non-clinical controls and matched schizotypal personality disorder controls, adults diagnosed with BPD showed greater activation in the amygdala (an area related to emotional reactivity) when being shown emotional but not neutral pictures”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Hazlett et al., 2012 source

      The Results (‘Amygdala activation during picture processing’) report greater amygdala activation in BPD than in healthy and schizotypal controls for emotional, but not neutral, pictures when the pictures were repeated. The claim omits that repetition condition; the same passage reports greater activation in healthy controls than in BPD patients for novel pleasant pictures. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • Interpretationcitation

    The enhanced ability to accept and express emotions may account for DBT's superiority in reducing other primary outcomes such as suicide attempts and crisis service use.

    “it may be the enhanced ability to accept and express these emotions that accounts for DBT’s superiority in reducing other primary outcomes, such as suicide attempts and crisis service use (Linehan et al., 2006).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Linehan et al., 2006 source

      The COMMENT and USE OF CRISIS SERVICES sections report that DBT outperformed therapy by experts on suicide attempts and crisis-service use. They do not establish that an enhanced ability to accept and express emotions explains those outcomes; the COMMENT instead says the treatment comparison provides little information about mechanisms. Page numbers are unavailable in our copy. (LLM, conf=0.90)

      Experimental — accuracy not yet measured
  • Classified as probably not a substantial claim. 39
  • May combine two claims. 25
  • The quote only partly states this claim. 1

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Intense anger and difficulty controlling anger expression are diagnostic criteria for BPD.

    “Experiencing intense anger and difficulty controlling anger expression are part of the diagnostic criteria for BPD (American Psychiatric Association, 2013)”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites American Psychiatric Association, 2013 source

      The supplied passages under “Symptoms and patterns” (11 September 2026; no page given) discuss depression, not borderline personality disorder. Searches for BPD diagnostic criteria and for intense anger or difficulty controlling anger found no relevant passage in our copy, so it cannot verify the claim. (LLM, conf=0.78)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Individuals with BPD report higher baseline negative emotion than controls, but no heightened reactivity to emotional stimuli was found.

    “Newer evidence suggests that people with a BPD diagnosis indeed report experiencing high levels of baseline negative emotion relative to controls although heightened reactivity in the presence of emotional stimuli was not found”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Kuo & Linehan, 2009 source

      The Results (Baseline Negative Emotional Intensity) report significantly higher self-reported baseline negative emotion in the BPD group than in nonclinical controls, but no significant difference from the social-anxiety-disorder control group. The Discussion (Emotional Reactivity) reports no greater self-reported or physiological reactivity in BPD. Thus, the baseline comparison is supported for one control group, not controls generally. (LLM, conf=0.83)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Participants were randomly assigned to DBT or CTBE using adaptive minimization randomization matched on five prognostic variables.

    “Participants were randomly assigned to DBT (n = 52) or to CTBE (n = 49) using an adaptive minimization randomization procedure that matched participants on five prognostic variables (see Linehan et al., 2006).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Linehan et al., 2006 source

  • May combine two claims.

    Premisecitation

    DBT is effective in reducing anger, with some studies finding it superior to treatment as usual.

    “Research has consistently shown that DBT is effective in reducing anger, with some studies finding that it is superior to treatment as usual (TAU; Linehan, Heard, & Armstrong, 1993; Evershed et al., 2003; Shelton, Kesten, Zhang, & Trestman, 2011; Koons et al., 2001; Koons et al., 2006; Soler et al., 2009), with a few exceptions (Linehan et al., 1999; Bohus et al., 2004)”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites Linehan, Heard, & Armstrong, 1993

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Evershed et al., 2003 source
    • cites Shelton, Kesten, Zhang, & Trestman, 2011 source

      The Results report reduced physical aggression after DBT-CM among incarcerated male adolescents, which supports a related but narrower finding. The paper does not report a reduction in anger specifically, and its Methods and Conclusion state that the study had no control group, so it cannot establish superiority to treatment as usual. Page numbers are unavailable in our copy. (LLM, conf=0.82)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Comorbid anxiety disorders and heightened aggression increase the odds of suicidal behavior in various clinical presentations, including BPD.

    “Comorbid anxiety disorders (Pagura et al., 2010; Sareen, 2011) and heightened aggression (Evren, Cınar, Evren, & Celik, 2011) increase the odds for suicidal behavior in a variety of clinical presentations, including BPD.”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites Pagura et al., 2010 source

      The Results (Suicidality; page not supplied) and Discussion report higher odds of lifetime suicide attempts among people with comorbid PTSD and BPD than among those with either disorder alone. Pagura et al. examine PTSD specifically, not anxiety disorders generally or a variety of clinical presentations. The heightened-aggression claim is attached to a different citation and is not assessed here. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites Sareen, 2011 source

      The Conclusions report increased suicidal-behavior risk among people with anxiety disorders, and the section on borderline personality disorder (BPD) says the association persists after adjusting for BPD. It does not establish that comorbid anxiety increases suicidal behavior specifically among people with BPD. Heightened aggression is attributed to a different citation in the citing sentence. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites Evren, Cınar, Evren, & Celik, 2011 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    Effect sizes were calculated with Feingold's formula and interpreted using Cohen's criteria.

    “Effect sizes for each longitudinal analysis were computed using the formula provided by Feingold (2009) and interpreted using Cohen (1988)’s specifications.”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Feingold, 2009 source
    • cites Cohen, 1988

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingown data

    For the Anger, Shame, and Guilt variables, there were no significant main effects of cohort and no significant cohort by time or cohort by condition by time interactions.

    “There were no significant main effects of cohort, and no significant cohort by time or cohort by condition by time interaction effects for any of the Anger, Shame, or Guilt variables (p > .05).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    For Experiential Avoidance, there was a significant cohort by time interaction, which was included in the main analyses.

    “For Experiential Avoidance, there was a significant cohort by time interaction, which was included in the main analyses, F(1,78.79) = 11.83, p < .001.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    DBT produced significantly greater improvements than CTBE in the expression of anger and experiential avoidance.

    “Third, DBT resulted in significantly greater improvements than CTBE in the expression of anger and experiential avoidance.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    For Anger Trait, there was no significant main effect of dropout and no significant time by condition by dropout interaction.

    “there was no significant main effect of drop out, or significant time by condition by drop out interaction effect, F(1, 98.65) = 0.16, p = .69; F(1, 90.28) = 0.51, p = .48, respectively.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    For Anger Trait, there was a significant dropout by time interaction, which was included in the main analyses.

    “For Anger Trait, there was a significant drop out (yes/no) by time interaction, which was included in the main Anger Trait analyses, F(1, 98.89) = 4.40, p < .05”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Modeling quadratic or log time effects produced no additional findings, so only linear model results are reported.

    “There were no additional findings when the quadratic or log effect for time for each outcome was modeled; therefore, only the results of the linear models are presented.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Across both treatment conditions, there was a significant effect of time on Anger In, Anger Out, Anger Control, and Anger Trait.

    “Analyses with the STAXI subscales (Anger In, Anger Out, Anger Control, Anger Trait) indicated that, across both treatment conditions, a significant effect of time in treatment was found, F (1, 81.50) = 59.70, p < .001; F (1, 92.80) = 12.46, p < .001; F (1, 89.48) = 9.44, p < .005; F (1, 101.33) = 35.91, p < .001, respectively.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    For Experiential Avoidance, the main effect of cohort and the cohort by time by condition interaction were not significant.

    “The main effect of cohort and the cohort by time by condition interaction effect were not significant predictors of Experiential Avoidance, F(1,77.20) = 0.24, p = .63; F(1,77.79) = 1.58, p = .21, respectively.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    Participants in DBT improved significantly in anger control.

    “participants in DBT improved significantly”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The ability to control anger improved in DBT but not in CTBE.

    “In addition, the ability to control anger improved in DBT but not in CTBE”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    For Experiential Avoidance, Anger In, Anger Out, Anger Control, Shame, and Guilt, there were no significant main effects of dropout status and no significant dropout by time or dropout by condition by time interactions.

    “There were no significant main effects of treatment drop out status, and there were no significant drop out by time, drop out by condition by time interaction effects for Experiential Avoidance, Anger In, Anger Out, Anger Control, Shame, or Guilt (p > .05)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Relative to controls, individuals with BPD describe stronger emotions, stronger reactions to emotional cues, and more unstable affect.

    “A review of the literature on BPD and emotional distress found that people diagnosed with BPD consistently report having more intense emotions, having greater reactivity to emotionally evocative stimuli, and experiencing greater affective instability than controls.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Rosenthal et al., 2008 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The TMAS-28 has a one-month test-retest reliability of r = .84.

    “Test-retest scores for the TMAS-28 (r = .84) have shown the instrument to be stable over a one-month period (Taylor, 1953).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Taylor, 1953 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Shame predicts recurrence of self-injurious behavior in women with BPD.

    “Shame has been found to predict recurrence of self-injurious behavior in women diagnosed with BPD (Brown, Comtois, & Linehan, 2002).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Brown, Comtois, & Linehan, 2002 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Shame is a common and persistent emotion in BPD.

    “Furthermore, shame is a common and persistent emotion in BPD (Rizvi, Brown, Bohus, & Linehan, 2011; Gratz, Rosenthal, Tull, Lejuez, & Gunderson, 2010)”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Rizvi, Brown, Bohus, & Linehan, 2011 source
    • cites Gratz, Rosenthal, Tull, Lejuez, & Gunderson, 2010 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Baseline assessments occurred before participants learned their treatment assignment.

    “Baseline assessments occurred before participants were informed of their treatment assignment”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The PFQ2 has a confirmed two-factor structure and adequate internal consistency, test-retest reliability, and construct validity.

    “The PFQ2 has a confirmed two factor structure, and adequate internal consistency, test-retest reliability, and construct validity.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Harder & Zalma, 1990 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Appropriate covariance structures for random and repeated effects were selected analytically using chi-square tests of model fit.

    “For each HLM model appropriate covariance structures for random and repeated effects were analytically determined based on chi-square tests comparing indices of model fit (Verbeke, 1997)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Verbeke, 1997

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The AAQ had acceptable internal consistency at baseline.

    “The measure had acceptable internal consistency (Cronbach’s α = .83) at baseline.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In general samples, guilt is linked to reduced self-control.

    “in general samples guilt has been linked to reduced self-control (Hofmann & Fisher, 2012).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Hofmann & Fisher, 2012 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Up to 95% of BPD outpatients have comorbid emotional disorders.

    “In addition, up to 95% of BPD outpatients report comorbid emotional disorders (i.e., mood and anxiety disorders; Harned et al., 2008).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Harned et al., 2008 source

  • May combine two claims.

    Study design and conductnone given

    Participants in the two conditions did not differ on demographic variables or diagnostic characteristics.

    “Participants in the two conditions did not differ on demographic variables or diagnostic characteristics.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    DBT is an emotion-focused treatment designed to improve emotional experience and expression and reduce experiential avoidance in people with BPD.

    “DBT is an emotion-focused treatment that is designed to improve emotional experience and expression and reduce experiential avoidance in people diagnosed with BPD.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Linehan, 1993a

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In Cohort 1, the PFQ2 had a baseline Cronbach's alpha of .79.

    “Cronbach’s α at baseline was .79.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Heightened guilt is associated with BPD.

    “heightened levels of guilt have also been associated with BPD (Rüsch et al., 2007)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Rüsch et al., 2007 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The STAXI has good internal consistency and construct validity.

    “The STAXI has been shown to have good internal consistency and construct validity (Spielberger, 1988).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Spielberger, 1988

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Blinded, independent clinical assessors conducted all assessments.

    “Blinded, independent clinical assessors conducted all assessments.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    A restricted estimated maximum likelihood model was used to handle missing data.

    “A restricted estimated maximum likelihood (REML) model was used to account for the missing data.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Chronic suppression of negative thoughts mediates the link between borderline personality features and negative affect.

    “chronic suppression of negative thoughts was shown to mediate the relationship between borderline personality features and negative affect (Rosenthal, Cheavens, Lejuez, & Lynch, 2005)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Rosenthal, Cheavens, Lejuez, & Lynch, 2005 source

  • May combine two claims.

    Premisecitation

    Some physiological indicators supported greater emotional reactivity and negative affect, while skin conductance did not.

    “Some indices of emotional distress (e.g., heart rate) did offer support for greater emotional reactivity and a propensity towards experiencing more negative affect, while other indices (i.e., skin conductance response) refuted this hypothesis”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Rosenthal et al., 2008 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In Cohort 1, the TMAS had a baseline Cronbach's alpha of .73.

    “Cronbach’s α at baseline was .73.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Changing experiential avoidance and reducing maladaptive experience and expression of anger, anxiety, shame, and potentially guilt could improve the internal experience of BPD clients and reduce behavioral dyscontrol.

    “Therefore, changing experiential avoidance and attempting to reduce maladaptive experience and expression of anger, anxiety, shame, and potentially guilt should be key targets in treating people diagnosed with BPD as they could improve the internal experience of BPD clients thus contributing to reduced behavioral dyscontrol.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The AAQ is a widely used self-report measure of experiential avoidance with good psychometric properties.

    “The AAQ (Hayes et al., 2004) is a widely used self-report measure of experiential avoidance with good psychometric properties (e.g., Roemer, Salters, Raffa, & Orsillo, 2005).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Hayes et al., 2004 source
    • cites Roemer, Salters, Raffa, & Orsillo, 2005 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In medical settings, BPD patients show more disruptive behaviors indicating dysregulated anger than non-BPD controls.

    “In medical settings, when compared to non-BPD controls, BPD patients display more disruptive behaviors that are indicative of dysregulated anger (yelling, screaming, threatening, etc; Sansone, Farukhi, & Wiederman, 2011).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Sansone, Farukhi, & Wiederman, 2011 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Exaggerated anger responses are commonly reported among adults with BPD.

    “exaggerated anger responses are commonly reported among adults with a BPD diagnosis”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Clarkin, Widiger, Frances, Hurt, & Gilmore, 1983 source
    • cites Gardner, Libenluft, O’Leary, & Cowdry, 1991 source
    • cites Koenigsberg et al., 2002 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The STAXI subscales had acceptable internal consistency at baseline.

    “Cronbach’s α for the STAXI subscales at baseline were: Anger Trait (.88), Anger Out (.85), Anger In (.72), Anger Control (.87).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    DBT is a cognitive behavioral treatment for BPD with substantial empirical support.

    “Dialectical Behavior Therapy (DBT; Linehan, 1993a, 1993b), is a cognitive behavioral treatment for BPD with substantial empirical support (Kliem, Kroger, & Kosfelder, 2010; Leichsenring, Leibing, Kruse, New, & Leweke, 2011).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Kliem, Kroger, & Kosfelder, 2010 source
    • cites Leichsenring, Leibing, Kruse, New, & Leweke, 2011 source

  • May combine two claims.

    Premisecitation

    DBT is generally effective in reducing anxiety, although evidence that it outperforms other treatments is mixed.

    “Likewise, evidence suggests that DBT is generally effective in reducing anxiety, although findings supporting that DBT outperforms other treatments are mixed.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Bohus et al., 2004 source
    • cites Turner, 2000 source
    • cites Koons et al., 2006 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Pattern-mixture models were used to test whether key slope estimates depended on missing data patterns or cohort effects.

    “We also implemented pattern-mixture models (Hedeker & Gibbons, 1997) to assess whether important slope estimates were dependent on missing data patterns (Hamer & Simpson, 2009) or cohort effects.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Hedeker & Gibbons, 1997 source
    • cites Hamer & Simpson, 2009 source

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The present results were secondary outcomes from a treatment trial for suicidal and self-injuring women diagnosed with BPD.

    “It is important to also highlight that the present results were secondary outcomes from a treatment trial for suicidal and self-injuring women diagnosed with BPD.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Treatment dropout and cohort effects were examined as potential confounders in each model.

    “Two potential confounding factors were examined for each model: treatment drop out and cohort effects.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Non-linear change over time was assessed by adding quadratic time and ln(time) models for each outcome.

    “To assess whether non-linear changes over time better explained the results we also conducted two additional statistical analyses for each outcome, one adding a quadratic time effect, and one modeling time using a ln(time) function.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    For each outcome, two random-effects models and several covariance structures were compared for fit, and the best fitting model is reported in Table 2.

    “Two models (random intercept, random intercept and random slope) and several covariance structures were tested for fit for each outcome variable and the best fitting model is reported in Table 2.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Use of skills is a mechanism of change for primary outcomes across multiple BPD treatments.

    “Neacsiu Rizvi and Linehan (2010) found that use of skills is a mechanism of change for primary outcomes (e.g., suicide attempts, self injurious behavior) across multiple treatments for BPD.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Neacsiu Rizvi and Linehan, 2010

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Observed power for the effect sizes was computed using Optimal Design.

    “Observed power for these effect sizes was computed using Optimal Design (see Raudenbush & Liu, 2001).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Raudenbush & Liu, 2001 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    No corrections for multiple testing were made because of the study's low power and preliminary nature.

    “Finally, given the low power and preliminary nature of this study, we did not make corrections for multiple testing.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Prior research found no differences between DBT and CTBE in improving anxiety disorder diagnoses.

    “it is consistent with prior research indicating no differences between DBT and CTBE in improving anxiety disorder diagnoses (Harned et al., 2008)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Harned et al., 2008 source
53 of 53

  • The paper relies on this without support.

    Little prior research has examined how treatment affects the experience and expression of specific negative emotions.

    “Nevertheless, there is little research examining treatment effects on the experience and expression of specific negative emotions.”

  • The paper relies on this without support.

    No prior DBT study has included shame or guilt as an outcome or examined DBT's differential effect on experiential avoidance.

    “To our knowledge, no study of DBT has included shame or guilt as an outcome, nor has any study examined the differential effect of DBT on experiential avoidance.”

  • The paper relies on this without support.

    No studies have assessed the relationship between guilt and behavioral dyscontrol in BPD.

    “We found no studies assessing the relationship between guilt and behavioral dyscontrol in BPD”

  • The paper relies on this without support.

    DBT is already established as an effective treatment for high-risk behaviors in BPD, including suicide attempts, non-suicidal self-injury, and substance dependence.

    “research on DBT has established it as an effective treatment for high-risk behaviors related to BPD, such as suicide attempts, non-suicidal self-injury, and substance dependence.”

  • The paper relies on this without support.

    Changes over time in the outcomes reflect effects of the expert treatments rather than passage of time or other factors.

    “First, as hypothesized, both expert treatments for BPD led to significant improvements in all outcomes.”
5 of 5

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • There are many additional evidence-based treatment models that reduce trauma symptoms associated with CSA and/or operate on one or more of the transdiagnostic mechanisms linking CSA with psychopathology.

    “There are many additional evidence-based treatment models that reduce trauma symptoms associated with CSA and/or operate on one or more of the transdiagnostic mechanisms linking CSA with psychopathology”

    From Child Sexual Abuse as a Unique Risk Factor for the Development of Psychopathology: The Compounded Convergence of Mechanisms (2021) · cites this paper as Neacsiu et al. 2014

    The Results (Primary Analyses) show that DBT reduced experiential avoidance in women with borderline personality disorder, supporting it as an example of a treatment acting on a psychological process. The paper does not establish that this process links childhood sexual abuse (CSA) to psychopathology or assess reductions in CSA-related trauma symptoms. Its findings also cannot substantiate the claim about many treatment models. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • Experiential avoidance is a maladaptive coping strategy associated with the development and severity of PTSD and BPD.

    “Experiential avoidance—or efforts to suppress and avoid painful or aversive stimuli such as thoughts, emotions, memories, and physiological arousal associated with trauma (Hayes et al. 1996)—is a maladaptive coping strategy associated with the development and severity of PTSD (Cameron et al. 2010) and BPD (Neacsiu et al. 2014).”

    From Child Sexual Abuse as a Unique Risk Factor for the Development of Psychopathology: The Compounded Convergence of Mechanisms (2021) · cites this paper as Neacsiu et al. 2014

    The introductory passage (labeled Abstract in our copy; page unavailable) describes experiential avoidance as particularly problematic in BPD and reports higher avoidance among people with BPD than comparison groups. The Discussion (page unavailable) discusses avoidance as a possible contributor to maladaptive behavior, but the paper does not establish an association with the development or severity of BPD. The PTSD portion of the citing sentence is attributed to a different source. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • A detailed analysis of outcomes of a randomized clinical effectiveness study showed that DBT resulted in greater reductions in experiential avoidance and expressed anger than community-based expert treatment, but not for guilt, shame, anxiety or anger suppression and dyscontrol.

    “A detailed analysis of outcomes of a randomized clinical effectiveness study showed that DBT resulted in greater reductions in experiential avoidance and expressed anger than community-based expert treatment, but not for guilt, shame, anxiety or anger suppression and dyscontrol [125].”

    From Complex PTSD and borderline personality disorder (2021) · cites this paper as [125]

  • Experiential avoidance was decreased better in DBT compared to Community Treatment by Experts in a randomized controlled trial.

    “Experiential avoidance was decreased better in DBT compared to Community Treatment by Experts in a randomized controlled trial (Neacsiu et al., 2014a).”

    From Emotion regulation in schema therapy and dialectical behavior therapy. (2016) · cites this paper as Neacsiu et al., 2014a

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • ConsistentF(1, 98.89) = 4.4reported p < .05 · recomputed p = .038

    “F(1, 98.89) = 4.40, p < .05”

  • ConsistentF(1, 98.65) = 0.16reported p = .69 · recomputed p = .690

    “F(1, 98.65) = 0.16, p = .69”

  • ConsistentF(1, 90.28) = 0.51reported p = .48 · recomputed p = .477

    “F(1, 90.28) = 0.51, p = .48”

  • ConsistentF(1, 78.79) = 11.83reported p < .001 · recomputed p < .001

    “F(1,78.79) = 11.83, p < .001”

  • ConsistentF(1, 77.2) = 0.24reported p = .63 · recomputed p = .626

    “F(1,77.20) = 0.24, p = .63”

  • ConsistentF(1, 77.79) = 1.58reported p = .21 · recomputed p = .213

    “F(1,77.79) = 1.58, p = .21”

  • ConsistentF(1, 81.5) = 59.7reported p < .001 · recomputed p < .001

    “F (1, 81.50) = 59.70, p < .001”

  • ConsistentF(1, 92.8) = 12.46reported p < .001 · recomputed p < .001

    “F (1, 92.80) = 12.46, p < .001”

  • ConsistentF(1, 89.48) = 9.44reported p < .005 · recomputed p = .003

    “F (1, 89.48) = 9.44, p < .005”

  • ConsistentF(1, 101.33) = 35.91reported p < .001 · recomputed p < .001

    “F (1, 101.33) = 35.91, p < .001”

  • ConsistentF(1, 92.8) = 4.87reported p < .05 · recomputed p = .030

    “F(1, 92.80) = 4.87, p < .05”

  • ConsistentF(1, 89.48) = 1.58reported p = .21 · recomputed p = .212

    “F(1, 89.48) = 1.58, p = .21”

  • ConsistentF(1, 79.98) = 78.9reported p < .001 · recomputed p < .001

    “F (1, 79.98) = 78.90, p < .001”

  • ConsistentF(1, 79.98) = 4.78reported p < .05 · recomputed p = .032

    “F (1, 79.98) = 4.78, p < .05”

  • ConsistentF(1, 55.63) = 22.95reported p < .001 · recomputed p < .001

    “F (1, 55.63) = 22.95, p < .001”

  • ConsistentF(1, 55.63) = 0.23reported p = .64 · recomputed p = .633

    “F (1, 55.63) = 0.23, p = .64”

  • ConsistentF(1, 52.08) = 15.17reported p < .001 · recomputed p < .001

    “F (1, 52.08) = 15.17, p < .001”

  • ConsistentF(1, 52.08) = 0.001reported p = .98 · recomputed p = .975

    “F (1, 52.08) = 0.001, p = .98”

  • ConsistentF(1, 47.8) = 21.89reported p < .001 · recomputed p < .001

    “F (1, 47.80) = 21.89, p < .001”

  • ConsistentF(1, 47.8) = 0.27reported p = .6 · recomputed p = .606

    “F (1, 47.80) = 0.27, p = .60”

20 of 20

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • CTBE did not improve significantly on every outcome

    Minor

    The discussion says both treatments produced significant improvements on all outcomes, but the results say CTBE did not change significantly on Anger Out. The results also report no significant improvement in anger control for CTBE.

  • PFQ2 response scale has conflicting point counts

    Minor

    The measure is described as having a four-point scale, yet its stated endpoints run from 0 to 4, which would conventionally comprise five integer response points.

  • Cohort effects reported for measures given to only one cohort

    Minor

    The results report cohort-effect tests for shame and guilt, but their measure, the PFQ2, was administered only to Cohort 1. Those outcomes therefore cannot support a comparison between cohorts.

3 of 3

Cites

Flagged first, then by citations

3 of the 86 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Related

Authors
Neacsiu, A. D., Lungu, A., Harned, M. S., Rizvi, S. L., & Linehan, M. M.
Affiliations
  • University of Washington (US)
  • Rutgers, The State University of New Jersey (US)
Corresponding author
Neacsiu, Andrada D.
ORCID
Venue
Behaviour Research and Therapy
Publisher
Elsevier BV
Published
2014-02
Volume
53
Pages
47-54
ISSN
0005-7967 (ISSN-L)
DOI
10.1016/j.brat.2013.12.004
PMC
PMC3955205
OpenAlex
W2058882203
Cited by
80
References
86
Citations by year
2026: 5 · 2025: 1 · 2024: 7 · 2023: 8 · 2022: 5 · 2021: 9 · 2020: 8 · 2019: 4 · 2018: 4 · 2017: 5 · 2016: 6 · 2015: 14 · 2014: 4
FWCI
8.89
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Behaviour Research and Therapy (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Department of Biotechnology, Ministry of Science and Technology, India
  • National Institutes of Health
  • National Institute of Mental Health (MH01593, MH-34486, R01MH034486, K05MH001593)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
dialectical behavior therapy, borderline personality disorder, negative affectivity, emotional experience, emotional expression, experiential avoidance, anger, guilt, shame, anxiety, anger suppression, suicidal behavior, self-harm, women
MeSH terms
Adolescent, Adult, Borderline Personality Disorder, Community Mental Health Services, Emotions, Female, Follow-Up Studies, Humans, Middle Aged, Surveys and Questionnaires, Suicide, Cognitive Behavioral Therapy, Self-Injurious Behavior, Treatment Outcome, Young Adult

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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