Dialectical behaviour therapy skills reconsidered: applying skills training to emotionally dysregulated individuals who do not engage in suicidal and self-harming behaviours
Open accessAbstract
Background: Dialectical behaviour therapy (DBT) is an evidence-based intervention for borderline personality disorder (BPD) but is an intensive treatment with significant health service costs. Access to DBT can sometimes be restricted due to limited resources. Positive results have been reported for the use of DBT skills training (DBT-ST), one of the four modes of standard DBT, in the treatment of individuals with BPD who self-harm. This study evaluates DBT-ST for a subgroup of individuals attending community mental health services who may have a diagnosis of BPD (or emerging BPD traits) but who are not actively self-harming. Methods: Participants in this study were 100 adults attending community mental health services with a diagnosis of BPD, emerging BPD traits or emotion dysregulation who were not actively self-harming. The majority of participants were female (71%), aged 25–34 years (32%), single (48%) and unemployed (34%). Participants partook in a 24-week DBT-ST intervention delivered by DBT therapists. Outcome measures included the Difficulties in Emotion Regulation Scale (DERS), the DBT Ways of Coping Checklist (DBT-WCCL) and the Five Facet Mindfulness Questionnaire (FFMQ). Measures were administered at pre-intervention, at the end of each skills module, and at post-intervention. Results: Significant reductions in emotion dysregulation (DERS) and dysfunctional coping (DBT-WCCL) scores were reported from pre- to post-intervention (p < .001). A significant increase in mindfulness scores (FFMQ) and DBT skill use (DBT-WCCL) was also observed (p < .001). However, the drop-out rate was high (49% at post-intervention). Discussion: The results of this uncontrolled study suggest that a standalone 24-week DBT-ST intervention may have a beneficial impact in terms of a reduction in emotion dysregulation and dysfunctional coping, and an increase in mindfulness and DBT skills use in patients with BPD/ emerging BPD traits who are not currently engaging in self-harm. Adequately powered randomised controlled trials are required to determine treatment efficacy in comparison to standard DBT for this population.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
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?
This attrition rate is lower than those in other studies of DBT skills training groups.
“this attrition rate is lower than those in other studies of DBT skills training groups, 34,38”
From Dialectical behaviour therapy skills training: A feasibility study with active duty military. (2022) · cites this paper as [38]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Diagnostic and Statistical Manual of Mental Disorders
American Psychiatric Association (2013) · doi:10.1176/appi.books.9780890425596 · Cited by 116,369 · see citing works
Gratz, K. L., & Roemer, L. (2004) · Journal of Psychopathology and Behavioral Assessment · doi:10.1023/b:joba.0000007455.08539.94 · Cited by 8,942 · see citing works
(1993) · Medical Entomology and Zoology · Cited by 2,491 · see citing works
Bohlmeijer, E., ten Klooster, P. M., Fledderus, M., Veehof, M., & Baer, R. (2011) · Assessment · doi:10.1177/1073191111408231 · Cited by 990 · cited 1× · see citing works
“– The Five Facet Mindfulness Questionnaire (FFMQ) is a 24-item self-report measure of mindfulness comprising five subscales [19].”
BackgroundPrevalence and correlates of personality disorder in Great Britain
Coid, J., Yang, M., Tyrer, P., Roberts, A., & Ullrich, S. (2006) · British Journal of Psychiatry · doi:10.1192/bjp.188.5.423 · Cited by 901 · see citing works
The prevalence of DSM-IV personality disorders in psychiatric outpatients
Zimmerman, M., Rothschild, L., & Chelminski, I. (2005) · American Journal of Psychiatry · doi:10.1176/appi.ajp.162.10.1911 · Cited by 825 · see citing works
Linehan, M. M., Korslund, K. E., Harned, M. S., Gallop, R. J., Lungu, A., Neacsiu, A. D., McDavid, J., Comtois, K. A., & Murray-Gregory, A. M. (2015) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2014.3039 · Cited by 714 · see citing works
Trull, T. J., Jahng, S., Tomko, R. L., Wood, P. K., & Sher, K. J. (2010) · Journal of Personality Disorders · doi:10.1521/pedi.2010.24.4.412 · Cited by 651 · see citing works
Black, D. W., Blum, N., Pfohl, B., & Hale, N. (2004) · Journal of Personality Disorders · doi:10.1521/pedi.18.3.226.35445 · Cited by 522 · see citing works
Soler, J., Pascual, J. C., Tiana, T., Cebrià, A., Barrachina, J., Campins, M. J., Gich, I., Alvarez, E., & Pérez, V. (2009) · Behaviour Research and Therapy · doi:10.1016/j.brat.2009.01.013 · Cited by 267 · see citing works
Valentine, S. E., Bankoff, S. M., Poulin, R. M., Reidler, E. B., & Pantalone, D. W. (2015) · Journal of Clinical Psychology · doi:10.1002/jclp.22114 · Cited by 219 · see citing works
The dialectical behavior therapy ways of coping checklist: development and psychometric properties
Neacsiu, A. D., Rizvi, S. L., Vitaliano, P. P., Lynch, T. R., & Linehan, M. M. (2010) · Journal of Clinical Psychology · doi:10.1002/jclp.20685 · Cited by 200 · cited 1× · see citing works
“– The Dialectical Behaviour Therapy Ways of Coping Checklist (DBT-WCCL) is a 59-item self-report measure of skills used in response to difficult situations over the past month and has two subscales; DBT skills use and dysfunctional coping [20].”
The Frequency of Personality Disorders in Psychiatric Patients
Zimmerman, M. A., Chelminski, I., & Young, D. (2008) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2008.03.015 · Cited by 186 · see citing works
McMain, S. F., Guimond, T., Barnhart, R., Habinski, L., & Streiner, D. L. (2017) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12664 · Cited by 184 · see citing works
The Lifetime Course of Borderline Personality Disorder
Biskin, R. S. (2015) · The Canadian Journal of Psychiatry · doi:10.1177/070674371506000702 · Cited by 145 · see citing works
The Oxford Handbook of Dialectical Behaviour Therapy
(2017) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780198758723.001.0001 · Cited by 140 · see citing works
Brazier, J. E., Tumur, I., Holmes, M. C., Ferriter, M., Parry, G. D., Dent-Brown, K., & Paisley, S. (2006) · Health Technology Assessment · doi:10.3310/hta10350 · Cited by 131 · cited 1× · see citing works
“Given the multiple modes of treatment, the time required for each on a weekly basis, and the overall duration of the programme, DBT is sometimes considered a time and resource intensive treatment [13].”
Background
Flagged first, then by citations
Research works printed but not linked: 1
- [11]NICE Borderline personality disorder: Treatment and Management. NICE Clinical Guidelines, No. 78 2009 London National Institute for Health and Clinical Excellence 39480982
Cited by
Sorted by citations
Berger, E., Reupert, A., Campbell, T. C. H., Morris, Z., Hammer, M., Diamond, Z. M., Hine, R. H., Patrick, P., & Fathers, C. (2022) · Educational Psychology Review · doi:10.1007/s10648-022-09690-5 · Cited by 84 · see citing works
Salgó, E., Szeghalmi, L., Bajzát, B., Berán, E., & Unoka, Z. (2021) · PLoS ONE · doi:10.1371/journal.pone.0248409 · Cited by 26 · see citing works
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
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
Self-citationMindfulness in Borderline Personality Disorder: Decentering Mediates the Effectiveness
Schmidt, C., Soler, J., Carmona, C., Elices, M., Domínguez‐Clavé, E., Vega, D., & Pascual, J. C. (2021) · Psicothema · doi:10.7334/psicothema2020.437 · Cited by 22 · see citing works
Moore, K. E., Johnson, J. E., Luoma, J. B., Taxman, F. S., Pack, R. P., Corrigan, P. W., Hart, J., & Slone, J. D. (2023) · Health & Justice · doi:10.1186/s40352-023-00224-x · Cited by 21 · see citing works
“This measure has been used to assess improvement across treatment among people with various degrees/severity of mental illness (Brown et al., 2019; Kells et al., 2020; Stein et al., 2016).”
MethodVijayapriya, C., & Tamarana, R. (2023) · Research in Psychotherapy Psychopathology Process and Outcome · doi:10.4081/ripppo.2023.694 · 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
Abraham, J. G., Thomas, N., Shenoy, D. S., & Padickaparambil, D. S. (2024) · Psychiatry Research · doi:10.1016/j.psychres.2024.116016 · Cited by 8 · see citing works
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
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) · medRxiv · doi:10.1101/2021.12.07.21267399 · Cited by 4 · see citing works
Dialectical behaviour therapy skills training: A feasibility study with active duty military.
Jewer, C., & Forsyth, A. (2022) · Journal of Military Veteran and Family Health · doi:10.3138/jmvfh-2022-0010 · Cited by 2 · see citing works
The Relationship Between Borderline Personality Disorder Symptoms and Mindfulness: A Meta-Analysis
Bogos, G., Măirean, C., Tiperciuc, A., Muntele‐Hendreș, D., & Mariș, A.-M. (2025) · Mindfulness · doi:10.1007/s12671-025-02674-w · Cited by 2 · see citing works
“More recent clinical work (Kells et al., 2020) reinforces this perspective and suggests that these moderating factors should be taken into account when developing interventions.”
Strang, M., & Sakdalan, J. A. (2025) · Neurodiversity · doi:10.1177/27546330251400335 · Cited by 3 · see citing works
“For instance, Kells et al. (2020) found that DBT skills training signi fi cantly reduced emotion dysregulation and improved mindfulness skills in adults with BPD, emerging BPD traits, or broader dif fi culties with emotional regulation.”
Keng, S., Pang, N. T. P., Tanin, C., Cheng, Y. H., Wong, A., & Hadi, N. M. B. N. (2024) · Psychology in the Schools · doi:10.1002/pits.23246 · Cited by 2 · see citing works
Lee, H., & Lee, G. K. (2024) · Autism in Adulthood · doi:10.1089/aut.2023.0144 · Cited by 3 · see citing works
Elsayad, S. M., & Alghtani, I. (2022) · Port Said Scientific Journal of Nursing · doi:10.21608/pssjn.2022.102220.1155 · Cited by 2 · see citing works
Díaz, M. E. G., Heredia, M. E. R., López-Peñaloza, J., de la Torre, A. E. H., Loyo, L. M. S., & Reyes-Ortega, M. A. (2025) · Revista de Psicología y Educación - Journal of Psychology and Education · doi:10.70478/rpye.2025.20.04 · Cited by 1 · see citing works
Affirmative Dialectical Behavior Therapy Graduate Group With LGBTQ+ Veterans
Boot-Haury, J. W., McCoy, R. T., Brennan, J. M., Sinha, S., Dolsen, E. A., Sears, M. S., & Joseph, K. M. (2025) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2025.07.002 · Cited by 1 · see citing works
Clarke, J. B., Barton, A., Bojor, N., Green, L. T., & Tse, J. C. L. (2026) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x26100531 · Cited by 1 · see citing works
“DBT skills groups have previously been found to be effective in reducing symptoms of CEN (Kells et al ., 2020).”
Influentialسمیر, أ. (2021) · مجلة جامعة الفيوم للعلوم التربوية والنفسية · doi:10.21608/jfust.2021.65651.1311
An Overview of Group Cognitive Behavioral Therapy: Science and Practice
Nowakowski, M. E., & Bieling, P. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-818697-8.00205-3
الله, م. خ. م. ع. (2021) · مجلة کلیة علوم ذوی الاحتیاجات الخاصة · doi:10.21608/jshm.2021.71374.1101
Sanza, M., Campa, J., & Barone, L. (2023) · PSICOBIETTIVO · doi:10.3280/psob2023-002004
Taliercio, J. R., Wigod, T., Shen, J., Garcia, J., Davino, S., Servidio, E., Sparapani, E., McGinn, L. K., & Miller, A. L. (2024) · Emerging Adulthood · doi:10.1177/21676968241242829
“…found to have strong psychometric properties, such as both good internal consistency reliability and construct validity, resulting in its utilization in a variety of treatment settings (Burmeister et al., 2016; Stein et al., 2015), and remains a commonly-used measurement today (Kells et al., 2020).”
BackgroundAbbaslou, F., Dehghani, Y., Rajabi, S., & Hosseini, F. (2025) · International Journal of Mental Health · doi:10.1080/00207411.2025.2570516
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. (2022) · Figshare · doi:10.6084/m9.figshare.20962345
Habilidades en atención plena o mindfulness (DBT-M) en adultos con TLP: Revisión sistemática
Condoy, T. N. N., Armijos, X. F. M., & Sánchez, G. L. T. (2025) · Revista Científica y Arbitrada de Psicología NUNA YACHAY · doi:10.56124/nuna-yachay.v7i14.025
Habilidades en atención plena o mindfulness (DBT-M) en adultos con TLP: Revisión sistemática
Condoy, T. N. N., Armijos, X. F. M., & Sánchez, G. L. T. (2025) · Revista Científica y Arbitrada de Psicología NUNA YACHAY · doi:10.56124/nuna-yachay.v7i14.022
Chakmak, Y., Jicol, C., & Petrini, K. (2026) · Computers in Human Behavior · doi:10.1016/j.chb.2026.109106
Talebi, G., Nikyar, H., & Shirzadi, H. (2025) · International Journal of Psychology (IPA) · doi:10.66224/ijpb.19.1.61
Clarke, J. B., & Bojor, N. (2026) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x26100786
“Kells et al .”
Does group size matter? An evaluation of the impact of group size on DBT skills training outcomes
Barton, A., Green, L. T., & Rudd, C. (2026) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x26100889
“Further evidence from Kells et al .”
- Authors
- Kells, M., Joyce, M., Flynn, D., Spillane, A., & Hayes, A.
- Affiliations
- Health Service Executive (IE)
- University College Cork (IE)
- Corresponding author
- Joyce, Mary
- Venue
- Borderline Personality Disorder and Emotion Dysregulation
- Published
- 2020-01-30
- Volume
- 7
- Issue
- 1
- Pages
- 3-3
- ISSN
- 2051-6673 (ISSN-L)
- PMC
- PMC6993331
- OpenAlex
- W3013383054
- Cited by
- 33
- References
- 18
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 5 · 2023: 3 · 2022: 5 · 2021: 8
- FWCI
- 1.60
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Borderline Personality Disorder and Emotion Dysregulation (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Lenus, The Irish Health Repository (Dr Steevens Hospital Library) (submittedVersion)
- Funders
- National Office for Suicide Prevention (N/A)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- dialectical behavior therapy, DBT skills training, borderline personality disorder, emotional dysregulation, self-harm, suicidal behavior, community mental health services, mindfulness, dysfunctional coping, treatment discontinuation
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.
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 ›
Are you an author, or do you see a problem with this page? Request a review
