Effectiveness of Dialectical‐Behavioral Intervention on Emotional Regulation Difficulties, Distress Tolerance, and Social Functioning Among Patients With Bipolar Disorder: Randomized Controlled Trial

Abstract

Aim To determine the effect of implementing dialectical behavior therapy (DBT) skills training groups on emotional regulation difficulties, distress tolerance, and social functioning among patients with bipolar disorder (BD). Methods A randomized controlled trial was conducted with 120 patients diagnosed with BD who were attending follow‐up at the outpatient clinic. Participants were randomly assigned to either the experimental group, which received 16 group psychoeducation sessions held twice weekly, or the control group, which received standard outpatient care. Analysis of variance (ANOVA) with repeated measures was applied to compare normally distributed quantitative variables across more than two time points or stages, with post hoc tests used for pairwise comparisons. Results The experimental group of DBT skills training demonstrated significant improvement over the control group in the overall emotional regulation difficulties scale ( F = 60.0, p ≤ 0.001, F = 1.0, p = 1.000, respectively), distress tolerance (104.40 ± 2.39 to 60.0 ± 3.55 and 57.70 ± 2.94, p < 0.001), and social functioning ( F = 295.503, p ≤ 0.001, F = 11.107, p = 0.918, respectively). Conclusion The DBT skills training has demonstrated improvements in all the measured outcomes across the one‐ and 3‐month intervals of follow‐ups. The existing findings suggest replication on a larger scale with diverse populations. Additionally, nurse‐led DBT skills training groups are indicated in tertiary mental health settings. Implication The structured approach of DBT skills training is well‐suited for addressing the complex needs of patients with BD, enhancing the overall efficacy of the treatment. Further research is needed to identify which skills are best suited for specific issues about emotional regulation. Trial Registration ClinicalTrials.gov identifier: NCT05741268