Multilevel associations of daily skill use and effectiveness with anxiety, depression, and stress in a transdiagnostic sample undergoing dialectical behavior therapy skills training

Abstract

Dialectical Behavior Therapy (DBT) is effective at treating disorders of emotion dysregulation. However, it is unclear which mechanisms contribute to these effects. The aim of this study was to characterize the within-person associations of two theoretically relevant mechanisims of change, skill use and skill effectiveness, with anxiety, stress, and depression. Participants (n = 19, Mage = 31.8, 68% female) with a primary anxiety or depressive disorder completed daily reports (N = 1344) of DBT skill use, perceived effectiveness, anxiety, stress, and depression during a 16-session DBT skills training group. DBT skill use increased across treatment, p < .01, but effectiveness did not, p = .64. Within persons, participants used more skills on days with greater stress and anxiety, p < .01, which predicted next-day decreases in stress and anxiety, p = .03. On days when participants reported higher effectiveness, they used more skills than their personal average when experiencing more intense negative affect, p < .01. These results suggest using more skills, especially when used more effectively, is a mechanism by which DBT skills groups address emotional dysfunction for those with transdiagnostic emotional disorders.

The effects of the Unified Protocol and Unified Protocol skills on loneliness in the COVID‐19 pandemic

“…Patients used skills more frequently in the UP, replicating findings of other CBTs (Southward et al, 2022 ), and extending them by further demonstrating growth in the size of patients’ skill repertoires. These increases suggest that more time in treatment helps patients more regularly implement their skills when needed and grow their skill repertoires.…”

“…Although no researchers to our knowledge have assessed skill quantity in the UP, preliminary evidence of its effects have been demonstrated in other CBTs (Southward et al, 2021 ). For example, patients with mood and anxiety disorders in dialectical behavior therapy skills training used more skills on days they experienced more intense anxiety and depression, which predicted next‐day decreases in anxiety and depression (Southward et al, 2022 ). Because loneliness encompasses cognitive appraisals of relationships that can be influenced by a variety of behaviors, using a wider variety of skills may be necessary to promote decreases in loneliness.…”

“…Infrequent assessments make it difficult to (a) establish temporal relations between skill use and changes in loneliness and (b) distinguish the degree to which these relations are driven by individual differences in skill use (between‐person effects) or changes in skill use during treatment (within‐person effects). Examining loneliness more frequently and disaggregating between‐ from within‐person effects of skills allows for stronger tests of the relative efficacy of skill use on loneliness (Southward et al, 2022 ).…”

Dimensions of skill use in the unified protocol: Exploring unique effects on anxiety and depression.

“…For example, improvements in the quality of patients' cognitive skills were associated with reductions in depressive symptoms across cognitive therapy for depression (Adler et al, 2015) and predicted subsequent reductions in depressive symptoms in internet-delivered CBT for depression (Forand et al, 2018). Southward, Eberle, et al (2021) tested the effectiveness of patients' skill use among patients in Dialectical Behavior Therapy skills training. In this study, greater daily skill effectiveness was related to less intense daily anxiety and depression.…”

Intervention impact on the perceived emotion regulation repertoire of adolescents at-risk for risky sexual behaviors.

“…It is possible that adolescents participating in a health intervention targeting improved emotion regulation may not only increase the overall frequency of emotion regulation skill use, but also broaden the range of emotion regulation strategies within their repertoire. This has been demonstrated to occur in intervention studies with adults and was found to improve mental health (Grommisch et al, 2020;Southward et al, 2022). Findings have not yet been extended to an adolescent sample.…”