The effect of dialectical behaviour therapy skills training on suicidality in borderline personality disorder

Scope: Individuals with Borderline Personality Disorder (BPD) are known to be at high risk of suicide. Although Dialectical Behaviour Therapy (DBT) has been found to reduce suicidality in this population, more research is required to understand which specific components of the therapy are responsible for this reduction. Purpose: This study was aimed at identifying which specific skills taught during DBT skills training can be effective in reducing suicidality in individuals with BPD. A secondary aim was to investigate DBT’s effectiveness in increasing participants’ use of DBT skills and decreasing use of dysfunctional ways of coping (DWC). Method: Participants were 72 adults, 86.1% women, aged 18 – 55 years (M = 26.96, SD = 8.89), diagnosed with BPD, who received treatment in one of three DBT treatment programs in the Hunter New England Local Health District in New South Wales, Australia. Participants were assessed one to six times over 12 months of DBT. DBT skills and DWC were assessed using the Dialectical Behaviour Therapy Ways of Coping Checklist (DBT-WCCL). Suicidality was assessed primarily using the Suicidal Affect-Behaviour-Cognition Scale (SABCS-4). Results: Multilevel modelling (MLM) showed increased use of the DBT skills “increased pleasant things,” “took care of my body,” “talked to someone,” and “told myself what I had accomplished” was associated with lower levels of suicidality. MLM indicated that time in treatment did not predict a reduction in suicidality, however, pairwise comparisons indicated the change between the first and last assessment points was statistically significant. MLM showed that participants demonstrated increased use of DBT skills and decreased use of DWC over treatment (ps < .001). DBT skills use increased significantly over the initial, but not the final, six months of therapy. Use of DWC decreased significantly over both the initial and final six months of therapy. Conclusions: This study demonstrated that increased use of a number of DBT skills was associated with lower levels of suicidality. Results indicated that DBT skills training was effective in teaching individuals with BPD the use of adaptive skills and reducing the use of maladaptive ways of coping. Practical Implications: These findings can assist in the refinement of DBT skills training or contribute to the development of interventions specifically designed to reduce suicide risk in people with BPD, and possibly other populations.