A randomized trial of brief dialectical behaviour therapy skills training in suicidal patients suffering from borderline disorder

McMain, Shelley F.; Guimond, Tim; Barnhart, Ryan; Habinski, Liat; Streiner, David L.

doi:10.1111/acps.12664

Cited by 184Personality Disorders and PsychopathologySuicide and Self-Harm StudiesBipolar Disorder and Treatment

A randomized trial of brief dialectical behaviour therapy skills training in suicidal patients suffering from borderline disorder

McMain, Shelley F., Guimond, Tim, Barnhart, Ryan, Habinski, Liat, Streiner, David L.·2017·Acta Psychiatrica Scandinavica

DOI 10.1111/acps.12664

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Abstract

Objective: Evidence‐based therapies for borderline personality disorder (BPD) are lengthy and scarce. Data on brief interventions are limited, and their role in the treatment of BPD is unclear. Our aim was therefore to evaluate the clinical effectiveness of brief dialectical behaviour therapy (DBT) skills training as an adjunctive intervention for high suicide risk in patients with BPD. Method: Eighty‐four out‐patients were randomized to 20 weeks of DBT skills (n = 42) or a waitlist (WL; n = 42). The primary outcome was frequency of suicidal or non‐suicidal self‐injurious (NSSI) episodes. Assessments were conducted at baseline 10, 20 and 32 weeks. Results: DBT participants showed greater reductions than the WL participants on suicidal and NSSI behaviours between baseline and 32 weeks (P < 0.0001). DBT participants showed greater improvements than controls on measures of anger, distress tolerance and emotion regulation at 32 weeks. Conclusions: This abbreviated intervention is a viable option that may be a useful adjunctive intervention for the treatment of high‐risk behaviour associated with the acute phase of BPD.

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A 20-week DBT skills group resulted in significant reductions in suicidal and self-harm behaviors and anger, as well as improvements in distress tolerance and emotion regulation compared to a waitlist control condition.
“In line with findings from this study, a study demonstrated that a 20-week DBT skills group resulted in significant reductions in suicidal and self-harm behaviors and anger, as well as improvements in distress tolerance and emotion regulation compared to a waitlist control condition [21].”
From Implementation of brief dialectical behavior therapy skills training among borderline personality disorder patients in Malaysia: feasibility, acceptability, and preliminary outcomes (2021) · cites this paper as [21]

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Effect of Psychotherapy for Borderline Personality Disorder on Quality of Life: A Systematic Review and Meta-Analysis
Chakhssi, F., Zoet, J. M., Oostendorp, J. M., Noordzij, M. L., & Sommers‐Spijkerman, M. (2019) · Journal of Personality Disorders · doi:10.1521/pedi_2019_33_439 · Cited by 23 · see citing works
Changes in suicide and non‐suicidal self‐injury ideation and the moderating role of specific emotions over the course of dialectical behavior therapy
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DUDE - a universal prevention program for non-suicidal self-injurious behavior in adolescence based on effective emotion regulation: study protocol of a cluster-randomized controlled trial
Buerger, A., Emser, T. S., Seidel, A., Scheiner, C., von Schoenfeld, C., Ruecker, V., Heuschmann, P. U., & Romanos, M. (2022) · Trials · doi:10.1186/s13063-021-05973-4 · Cited by 23 · see citing works
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Current state of the evidence on community treatments for people with complex emotional needs: a scoping review
Ledden, S., Rains, L. S., Schlief, M., Barnett, P., Ching, B. C. F., Hallam, B., Günak, M. M., Steare, T., Parker, J., Labovitch, S., et al. (2021) · BMC Psychiatry · doi:10.1186/s12888-022-04171-z · Cited by 17 · see citing works
“DBT vs inactive/nonspecialist RCT [46-57] 12 20-100 (n=12) 1990-1999 (n=2); 20002009 (n=4); 2010-2019 (n=6) Asia (n=1); Europe (n=4); North America (n=4); Oceania (n=1); UK (n=2) Diagnoses: “BPD” diagnosis (n=10); “personality disorder” diagnosis and self-harm (n=1); “BPD” criteria and self-harm (n=1).”
Dialectical behaviour therapy: Implementation of an evidence-based intervention for borderline personality disorder in public health systems
Flynn, D., Kells, M., & Joyce, M. (2021) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2021.01.002 · Cited by 22 · see citing works
Perspectives on Dialectical Behavior Therapy and Mentalization-Based Therapy for Borderline Personality Disorder: Same, Different, Complementary?
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Implementation of brief dialectical behavior therapy skills training among borderline personality disorder patients in Malaysia: feasibility, acceptability, and preliminary outcomes
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A systematic review and meta-analysis of mindfulness-and acceptance-based interventions for affect intolerance/sensitivity
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A systematic review of interventions aimed at improving emotional regulation in children, adolescents, and adults
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Evaluation of a skills-based peer-led art therapy online-group for people with emotion dysregulation
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Coping with Suicidal Urges: An Important Factor for Suicide Risk Assessment and Intervention
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Third-wave interventions for eating disorders in adolescence – systematic review with meta-analysis
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“required to be effective [64], and predictors of nonresponse [65].”
Background
An Emergency Department‐Initiated Intervention to Lower Relapse Risk after Attempted Suicide
Martínez‐Alés, G., Jiménez‐Sola, E., Román‐Mazuecos, E., Sánchez-Castro, P., de Dios, C., Vega, B. R., & Bravo‐Ortiz, M. F. (2019) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12542 · Cited by 13 · see citing works
Dialectical Behavior Therapy in the Treatment of Comorbid Borderline Personality Disorder and Eating Disorder in a Naturalistic Setting: A Six-Year Follow-up Study
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Subgroups of borderline personality disorder: A latent class analysis
Antoine, S. M., Fredborg, B. K., Streiner, D. L., Guimond, T. H., Dixon–Gordon, K. L., Chapman, A. L., Kuo, J. R., Links, P. S., & McMain, S. (2023) · Psychiatry Research · doi:10.1016/j.psychres.2023.115131 · Cited by 13 · see citing works
Self-citation
Mechanisms of change in dialectical behavior therapy
Chapman, A. L., & Owens, L. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-816384-9.00003-8 · Cited by 13 · see citing works
Outcomes of brief versions of Dialectical Behaviour Therapy for diagnostically heterogeneous groups in a routine care setting
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Just try it: Preliminary results of a six‐month therapy for borderline personality disorder
Martin, S. S., & Del-Monte, J. (2022) · Personality and Mental Health · doi:10.1002/pmh.1555 · Cited by 12 · see citing works
“Dialectical behavioral therapy, in its brief format, has begun proving its effectiveness via randomized controlled trials (RCT) settings (McMain et al., 2009; McMain et al., 2017), but to our knowledge, no French DBT adaptation of the short version has been evaluated as of yet.”
BackgroundMethod
Exploring the Effectiveness of Dialectical Behavior Therapy Versus Systems Training for Emotional Predictability and Problem Solving in a Sample of Patients With Borderline Personality Disorder
Guillén, V., García‐Palacios, A., Miñana, S. B., Baños, R., Botella, C., & Marco, J. H. (2020) · Journal of Personality Disorders · doi:10.1521/pedi_2020_34_477 · Cited by 12 · see citing works
The effectiveness of a short-term DBT skills group in a ‘real-world’ clinical setting
Wieczorek, M., Kacen, T., King, B., & Wilhelm, K. A. (2021) · Australasian Psychiatry · doi:10.1177/10398562211038907 · Cited by 11 · see citing works
Daily Self-Monitoring of Symptoms and Skills Learning in Patients With Borderline Personality Disorder Through a Mobile Phone App: Protocol for a Pragmatic Randomized Controlled Trial
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Randomized effectiveness‐implementation trial of dialectical behavior therapy interventions for young people with borderline personality disorder symptoms
de Andrade, D., Davidson, L., Robertson, C., Williams, P. L., Leung, J., Walter, Z. C., Allan, J., & Hides, L. M. (2024) · Journal of Clinical Psychology · doi:10.1002/jclp.23725 · Cited by 12 · see citing works
Dialectical Behavior Therapy in Autism
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“Yet findings from two randomized controlled trials (RCT) suggest that brief formats of standalone DBT skills training groups (DBT-S) are effective to reduce ED, NSSI and suicidal behaviors in people with BPD even though dropout rates are higher using this mode alone [50–52].”
Dialectical Behavior Therapy for Adolescents: Treatment Outcomes in an Outpatient Community Setting
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“…was based on the DBT component analysis study (Linehan et al., 2015), showing the importance of DBT skills in treatment, and is consistent with other published studies on shorter cycles of DBT (McMain et al., 2017) and anecdotal reports from other programs on an international DBT list-serv.”
Result
Benchmarks for dialectical behavioural therapy intervention in adults and adolescents with borderline personality symptoms
Azevedo, J., Carreiras, D., Hibbs, C., Guiomar, R. N. R. M., Osborne, J., Hibbs, R., & Swales, M. A. (2024) · International Journal of Clinical and Health Psychology · doi:10.1016/j.ijchp.2024.100446 · Cited by 8 · see citing works
Getting Specific about Emotion and Self-Inflicted Injury: An Examination Across Emotion Processes in Borderline Personality Disorder
Fitzpatrick, S., Zeifman, R. J., Krantz, L. H., McMain, S., & Kuo, J. R. (2019) · Archives of Suicide Research · doi:10.1080/13811118.2019.1586605 · Cited by 8 · see citing works
Self-citation
The contribution of skills to the effectiveness of dialectical behavioral therapy
Lee, R. K., Harms, C. A., & Jeffery, S. (2022) · Journal of Clinical Psychology · doi:10.1002/jclp.23349 · Cited by 7 · see citing works
Dialectical behavior therapy for individuals with substance use problems: theoretical adaptations and empirical evidence
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Psychotherapy for Borderline Personality Disorder: Does the Type of Treatment Make a Difference?
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Motivational Enhancement as a Pretreatment to a Transdiagnostic Intervention for Emerging Adults with Emotion Dysregulation: A Pilot Randomized Controlled Trial.
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The self-efficacy in distress tolerance scale (SE-DT): a psychometric evaluation
Alfonsson, S., Mardula, K., Toll, C., Isaksson, M., & Wolf‐Arehult, M. (2022) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-022-00195-9 · Cited by 7 · see citing works
“This result is in accordance with several treatment studies, reporting that skills training can improve BPD patients’ ability to perform skillful behaviors [37], and that higher levels of SE are associated with less frequent self-harm [6].”
BackgroundResult
Distal predictors of trait driving anger. The influence of attachment styles through the mediation effect of general anger and self-esteem
Herrero‐Fernández, D., Redondo, I., Parada‐Fernández, P., Oliva-Macías, M., & Rohwer, H. (2020) · Transportation Research Part F Traffic Psychology and Behaviour · doi:10.1016/j.trf.2020.07.005 · Cited by 6 · see citing works
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Borderline Personality Disorder
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Effectiveness of Eight-Session Dialectical Behavior Therapy Skills Classes for Reducing Symptoms of Anxiety, Depression, and Emotional Dysregulation in a Transdiagnostic Population
Riddell, J. K., Neufeld, D. C., Kinley, J., Davidson, D., Mota, N. P., Unger, J. A., Henriksen, C., Conway, T., Jetté, J., & Jiang, D. (2025) · International Journal of Group Psychotherapy · doi:10.1080/00207284.2025.2454677 · Cited by 4 · see citing works
“More broadly, DBT has been documented to be effective in reducing anger and increasing individuals’ ability to tolerate distress and regulate their emotions (McMain et al., 2017).”
Feasibility and initial impact of single-session internet-delivered acceptancevschange skills for emotions for stress- and trauma-related problems: a randomized controlled trial
McLean, C. L., Ruork, A. K., Ramaiya, M., & Fruzzetti, A. E. (2023) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465823000206 · Cited by 6 · see citing works
Chapter 10. Early Identification and Prevention of Personality Pathology: An AMPD-Informed Model of Clinical Staging
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Effectiveness of iconic therapy for the reduction of borderline personality disorder symptoms among suicidal youth: study protocol for a randomised controlled trial
Hurtado-Santiago, S., Parra, J. G., Bersabé, R. M., & Mayoral, F. (2018) · BMC Psychiatry · doi:10.1186/s12888-018-1857-x · Cited by 5 · see citing works
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Hall, A., Gregg, L., O’Ceallaigh, B., & Wittkowski, A. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1640341 · Cited by 4 · see citing works
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“In this line, DBT in the context of suicidality is used for risk management and reduction [25,26].”
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Clinical Factor 2016
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Current state of the evidence on community treatments for people with complex emotional needs: a scoping reviewPreprint
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Treatment Moderators of Symptom Severity in Psychotherapy for People with Borderline Personality Disorder: Systematic Review with Meta-Analyses of Individual Participant Data
Ribeiro, J. P., Stoffers-Winterling, J. M., Jørgensen, M. S., Juul, S., Matbouriahi, M., Fisher, D. J., van Ballegooijen, W., Kongerslev, M., Simonsen, E. H., Karyotaki, E., et al. (2025) · Psychotherapy and Psychosomatics · doi:10.1159/000548417 · Cited by 3 · see citing works
Self-citation
A randomized 3-month, parallel-group, controlled trial of CALMA m-health app as an adjunct to therapy to reduce suicidal and non-suicidal self-injurious behaviors in adolescents: study protocol
Rodante, D., Chiapella, L., Fedi, R. O., Papávero, E., Lavoie, K., & Daray, F. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1087097 · Cited by 2 · see citing works
“In the management of an emotional crisis, the CALMA app follows the steps of crisis management and telephone coaching, initially going through the problem-solving strategy until reaching discomfort tolerance or emotional regulation skills as selfmanagement strategies (11, 57, 58).”
Method
The Longitudinal Mediating Effect of Distress Tolerance in a Mindfulness-Based Intervention: A Randomized Controlled Trial
Bingqian, L. I. U., Xie, Q., Ye, G., Zhou, A. Y., Zhang, A. J., & Liu, X. (2023) · Journal of Evidence-Based Psychotherapies · doi:10.24193/jebp.2023.2.10 · Cited by 4 · see citing works
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Chapman, A. L., Hood, P., & Turner, C. J. (2023) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780197611272.013.55 · Cited by 3 · see citing works
A Dialectical Behavior Therapy Skills Group in a Psychoanalytic Community Service: A Pilot Study
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“In this way, ECS programmes have become a common treatment pathway in NHS services in order to meet the high demand, despite lacking adequate empirical support (Crossland et al., 2017; James et al., 2008; McMain et al., 2017; Sambrook et al., 2006).”
Background
A feasibility randomised controlled trial with an embedded qualitative evaluation of perinatal emotional skills groups for women with borderline personality disorder: protocol for the EASE study
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Self-citation

Dialectical Behavior Therapy for High Suicide Risk in Individuals With Borderline Personality Disorder: A Randomized Clinical Trial and Component Analysis
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Authors: McMain, S. F., Guimond, T., Barnhart, R., Habinski, L., & Streiner, D. L.
Affiliations: Centre for Addiction and Mental Health (CA)
Royal Alexandra Hospital (CA)
University of Toronto (CA)
Corresponding author: McMain, Shelley F.
ORCID: McMain, Shelley F.
Guimond, Tim
Barnhart, Ryan
Streiner, David L.
Venue: Acta Psychiatrica Scandinavica
Publisher: Wiley
Published: 2016-11-13
Volume: 135
Issue: 2
Pages: 138-148
ISSN: 0001-690X (ISSN-L)
1600-0447
DOI: 10.1111/acps.12664
OpenAlex: W2551164964
Cited by: 184
References: 35
Citations by year: 2026: 18 · 2025: 10 · 2024: 12 · 2023: 17 · 2022: 21 · 2021: 52 · 2020: 22 · 2019: 21 · 2018: 8 · 2017: 2 · 2016: 1
FWCI: 14.28
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Acta Psychiatrica Scandinavica (publishedVersion)
PubMed (publishedVersion)
Funders: Ontario Mental Health Foundation
Topics: Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
Keywords: dialectical behavior therapy, skills training, borderline personality disorder, suicide risk, suicidal behavior, non-suicidal self-injury, brief intervention, adjunctive therapy, anger, distress tolerance, emotion regulation
MeSH terms: Adult, Behavior Therapy, Borderline Personality Disorder, Female, Humans, Male, Middle Aged, Prospective Studies, Suicide, Self-Injurious Behavior, Treatment Outcome, Evidence-Based Medicine, Young Adult, Suicidal Ideation

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A randomized trial of brief dialectical behaviour therapy skills training in suicidal patients suffering from borderline disorder

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