Sexual (SM) and gender (GM) minoritised (SGM) people experience elevated rates of mental health difficulties and self-injury. Dialectical behaviour therapy (DBT) is effective for these difficulties, yet sexual orientation and gender identity are infrequently reported in psychological intervention research, limiting understanding of inclusion and outcome equity. This systematic review examined the proportion of DBT studies reporting sexual orientation and gender identity; the proportion of SGM participants in DBT samples; and the effectiveness, acceptability, and feasibility of DBT for SGM groups. Databases were systematically searched, and findings were synthesised using narrative and meta-analytic methods. Across 170 studies including comprehensive DBT, 10–11% reported sexual orientation and 12–17% reported gender identity beyond binary categories. Only 1–2% of all studies explicitly classified participants’ gender as cisgender and transgender, and up to 5% used broad gender categories such as ‘other’. Where data were available, SM participants comprised approximately 36% and GM participants 3–17% of samples. Pooled analyses indicated significant pre–post improvements for SM participants, with effects mostly comparable to heterosexual groups; GM outcomes were similar in fewer studies. Meta-analytic estimates showed negligible differences in treatment completion, with disparities largely confined to the pre-treatment phase and between subgroups. The limited reporting of sexual orientation and gender identity in DBT research constrains understanding of representation and equity in outcomes. Routine, collaboratively designed, data collection is essential to evaluate equity in DBT effectiveness and to prevent inadvertent invalidation through omission.

Key learning aims

1. (1) To identify the proportion of psychological intervention studies – focusing on dialectical behaviour therapy (DBT) – that report participants’ sexual orientation and gender identity.

2. (2) To determine the representation of SGM participants within DBT research samples.

3. (3) To evaluate the effectiveness, acceptability, and feasibility of DBT for SGM participants.

4. (4) To provide recommendations for improving the recording and reporting of sexual orientation and gender identity in psychological intervention research and clinical practice.

Sustainability of DBT programmes and the factors which potentially influence this has received little attention from researchers. In this article, we review the literature reporting on sustainability of DBT programmes in outpatient settings. We also seek to advance the limited knowledge on this topic by reporting on the sustainability of DBT programmes delivered by teams that trained via a coordinated implementation approach in Ireland. As part of this perspective piece we conducted a systematic literature search which identified four studies reporting on DBT programme sustainability. All four reported on programmes delivered by teams that had received training as per the DBT Intensive Training Model. The findings of these studies are summarised and we consider the effect on DBT programme sustainability of introducing a coordinated implementation approach in Ireland.

Personality disorders are a group of psychological disorders characterised by a developmental nature, long-lasting impairment and emotional suffering. Personality disorders have an estimated prevalence rate of approximately 8% in community settings, but in in-patient settings the rate might be as high as 76%. Cognitive–behavioural therapies (CBTs) include psychotherapies that emphasise the identification and modification of maladaptive thought patterns and behaviours that contribute to the maintenance of psychological disorders. CBTs have demonstrated their effectiveness in treating various types of personality disorder. This article focuses on the nature of personality disorders and their categorial and dimensional assessment and neurobiology. We present three influential CBT models used in personality disorders: schema therapy, cognitive interpersonal therapy and dialectical behaviour therapy. For each one, we outline the rationale, intervention strategies and therapeutic techniques, with practical examples and summary tables to illustrate their application.

Few studies have investigated the feasibility of researching brief forms of dialectical behaviour therapy (DBT) for borderline personality disorder (BPD) in public mental health settings. This study aimed to provide preliminary evidence for the feasibility of implementing DBT over a 6-month period for BPD symptoms within Australian public mental health services. Of the 79 participants with BPD recruited, 62 commenced and 24 participants completed the therapy. The participants attended one of three outpatient DBT programmes and completed measures of BPD symptoms, DBT skills-use, and difficulties with emotion regulation at baseline and after 6 months of treatment. A major challenge with feasibility identified was the high attrition rate (61%). However, for completers there were significant improvements in BPD symptoms, DBT skills-use, and difficulties with emotion regulation. These effect sizes were used to estimate the sample sizes needed by future larger trials of brief DBT for BPD in public health settings. The implementation of brief DBT for BPD patients within a public mental health outpatient setting, appears to result in significant reductions in BPD symptoms. However, further exploration of strategies to reduce drop-out rates are required.

The UK government implemented national social-distancing measures in response to the global COVID19 pandemic. As a result, many appointments in the National Health Service (NHS) took place virtually, including psychological interventions in out-patient settings. This study explored the experiences of adolescents participating in a dialectical behaviour therapy (DBT-A) programme via teletherapy (i.e. via video or telephone call) in a Children and Adolescent Mental Health Service (CAMHS). Thirteen adolescents with emotion dysregulation and related problems completed an online qualitative survey about their experience and acceptance of DBT-A delivered virtually. Thematic analysis was conducted on the survey data and generated three over-arching themes: (1) sense of loss; (2) feeling uncontained; and (3) benefits of virtual DBT. These over-arching themes were composed of eight subthemes (‘loss of connection with group and therapist’; ‘loss of skills-building opportunities’; ‘limited privacy’; ‘lack of safe therapy space’; ‘difficult endings’; ‘home comforts’; ‘convenience and accessibility’; and ‘easier to participate with others’). This study suggests that adolescents doing virtual DBT-A need approaches that acknowledge and address the additional relational, emotional and practical challenges of online therapy while maintaining fidelity to the evidence-based treatment model. Suggestions for further research and preliminary practice guidelines are discussed.

Borderline personality disorder (BPD) is a mental health condition characterized by emotion dysregulation, interpersonal impairment, and high suicidality. Dialectical behaviour therapy (DBT) is the most widely studied psychotherapeutic treatment for BPD. To date, the vast majority of DBT research has focused on cisgender women, with a notable lack of systematic investigation of sex and/or gender differences in treatment response. In order to encourage effective, equitable treatment of BPD, further investigation into treatment targets in this population is critical. Here, we employed a systematic strategy to delineate gaps in the DBT literature pertaining to sex and gender differences and propose directions for future research. Findings demonstrate a significant discrepancy in measurement of sex and gender, particularly among gender-diverse individuals. Exploring DBT treatment response across the full spectrum of genders will facilitate the provision of more tailored, impactful care to all individuals who suffer from BPD.

As a principle-driven treatment, dialectical behaviour therapy (DBT) offers concepts and strategies that can be flexibly applied to address unique types of invalidation, such as stigma experienced by marginalized groups. A pilot DBT skills training group that included material on using skills to dialectically manage the effects of stigma was conducted with four sexual and gender minority (SGM) veterans. The group included standard DBT skills along with explicitly teaching about stigma commonly faced by SGM individuals and ways to apply DBT skills to the experiences of stigma. This pilot group was conducted to determine the acceptability of such a group as well as its effects on symptoms (depression, emotion regulation), use of DBT skills in daily living, and the psychological burden of stigma-related experiences. The group was well-received by participants; outcomes suggest promising trends in reducing psychological distress and increasing use of DBT skills to cope. Implications for clinical practice using a dialectical approach to stigma management and future directions are provided.

While dialectical behaviour therapy (DBT) appears efficacious in reducing suicidal and self-harming behaviour, it is unclear whether DBT reduces emotion regulation (ER) difficulties, a purported mechanism of change of treatment. This review aims to investigate and evaluate the current evidence to understand the effectiveness of DBT in improving ER difficulties. A qualitative synthesis of studies investigating the effectiveness of DBT on self-reported ER difficulties as measured by the Difficulties in Emotion Regulation Scale (DERS) was performed, identifying eligible studies using PsycINFO, PubMed, MEDLINE and EMBASE databases. Fourteen studies were identified. Current evidence indicates that DBT does not show consistent benefits relative to existing psychological treatments in improving ER difficulties. The literature is compromised by significant methodological limitations increasing risk of bias across study outcomes. Furthermore, high variability across DBT programs and a lack of investigation regarding adherence and participant engagement within interventions was observed. Further research is needed in order to conclude regarding the effectiveness of DBT in improving ER difficulties. Consistent use of active treatment conditions, greater standardisation of DBT-based interventions, in addition to further examination of participant engagement level in DBT-based interventions in the long term may assist understanding as to whether DBT improves ER difficulties.

Background: Adapted DBT programmes have been well documented but little has been published on such programmes in the perinatal period. Aim: To assess the effectiveness of a stand-alone DBT skills group for perinatal women with emotion dysregulation. Method: A stand-alone DBT-informed skills training group was offered to 21 women with emotional dysregulation under the care of a perinatal community mental health team; 14 completed the programme. Staff received support via a consultation group. Modules included mindfulness, emotional regulation, distress tolerance and interpersonal effectiveness adapted to the specific demands of parenting infants. Outcome measures were collected at three time points: assessment, start of the group and at the end. Results: Statistical analysis showed significant reduction in CORE scores over the intervention period (t (13) = 5.32, p < .001; Cohen's d = 0.83), with similar effects on the Mental Health Confidence Scale (t (13) = ‒8.03, p < .001, Cohen's d = 0.83) and Living with Emotions Scale (t (13) = ‒9.42, p < .001, Cohen's d = 0.93). There were no significant changes on these three measures from assessment to start of the group. Conclusions: In this uncontrolled study, the intervention period was associated with reduced distress, increased confidence and ability to regulate emotion. Recommendations for continuing this model of service delivery are made. Further research is needed.

Background: Previous studies about the effectiveness of Dialectical Behaviour Therapy for the treatment of Borderline Personality Disorder have had promising results. However, no previous studies have examined its effectiveness when delivered in low secure inpatient services for women. Aims: To evaluate clinical outcomes during and after a 1-year period of admission within a low secure unit for women offering a Dialectical Behaviour Therapy programme. Method: A naturalistic, within subjects study of clinical data collected as part of routine practice was conducted. Participants were18 consecutively admitted women who met the diagnostic criteria for Borderline Personality Disorder and had completed at least 1 year of treatment. Measures covered: risk behaviours; self-reported symptoms of Borderline Personality Disorder, and current mood and symptom experience; staff reports of clinical problems, needs and social functioning. Scores were compared between admission and at 6 months and 1 year. Results: There was a statistically significant improvement on all 13 measures over the year's treatment. Most improvement was demonstrated between admission and 6 months. Conclusions: Engagement in1-year's treatment was associated with significant reduction in risk behaviours and both staff-rated and self-rated outcome measures. Some significant questions remain about which elements of the programme are most effective but the results are encouraging.

In a pilot evaluation study, effectiveness of a 20-week dialectical behavioural therapy (DBT) skills training group program was explored for adult clients with borderline personality disorder (BPD; N = 140). Subjective ratings of depression, anxiety and BPD symptomatology were obtained pre and post group therapy. Objective measures of service utilisation levels were obtained for the 6 months prior to group therapy, the duration of therapy, and the 6 months following therapy. Group completers (n = 68) showed reductions in depression, anxiety and BPD symptomatology, as well as in the number of emergency department attendances. Completers with previous high service utilisation had decreases in telephone counselling calls and inpatient days during therapy, and fewer emergency department attendances post therapy. Completers had larger decreases in service utilisation than noncompleters (n = 72). Simultaneous engagement in individual DBT was related to higher group completion than was individual therapy as usual, but it did not impact on level of service utilisation or psychological functioning. This quasi-experimental pilot study suggests that DBT groups may improve psychological functioning and decrease service utilisation for BPD clients, particularly those with high service utilisation. The treatment warrants systematic evaluation.