Survival curves analysis showed no significant differences in the time to relapse or recurrence of depressive mode between the ER+M and PE groups (Long Rank Test, X² = 2.83, p = .09).

Patients treated with ER+M showed greater improvement in depression and general psychiatric symptoms than those in the PE group as indicated by the following group differences in symptom scores—

• HDRS (-2.32; 95% CI: -4.51 to -.16; p= 0 .048),
• BDI-II (-2.22; 95% CI:-5.23 to 1.61; p = 0.36); and
• SCL-90-GSI (- 0.37; 95% CI: -.53 to -.013; p = 0.040

Thus, ER + M demonstrated significantly higher improvements in depressive than PE using the HDRS measure, whereas the difference the two groups did not reach the level of significance on the BDI-II scale. The group difference in the SCL-90-GSI scores indicates a significantly greater impact of ER+M than PE on the general psychiatric symptoms.

Patients treated with ER+M showed a greater gain in mindfulness and awareness than those treated with PE. However the difference was not statistically significant (group difference in MAAS = 0.25 95% CI:-.26 to .42; p = 0.31)

“More s tudies are needed to confirm the efficacy of ER+M to decrease depressive symptoms and overall ps ychopathology.”¹ Page 1

“Future res earch s hould be conducted to continue exploring the efficacy of specific DBT skills such as emotion regulation and/or mindfulness to prevent depression relapses. In this line of research, dismantling studies of DBT skills are mandatory to better determine which combination of skills is most efficacious in preventing MDD relapse.”¹ Page 8

Three patients (6.5%) in the DBT group compared with five patients (11.11%) in the TAU group attempted suicide during the 6-month trial and 6-month follow-up. The hospitalization rate was 35% in both groups over the period. A survival analysis of suicide attempts and hospitalization did not show a significant difference between the two groups.

Patients in both DBT and TAU groups showed improvements in suicidal ideation, depression, and anxiety during the six months therapy phase. There were no statistically significant differences between the two groups, with respect to any of these outcome measures. However, during the follow-up period, DBT patients demonstrated significantly greater improvement than TAU patients in anxiety symptoms as assessed by BAI scores (p = 0.04).

On BAARS-IV inattentive scores, more DBT patients showed positive response SH patients (11 [65%] DBT versus 6 [38%]; p = 0 .12). Among those responding to treatment, 10 (59%) showed recovery with DBT compared with 5 (31%) with SH (p = 0.11). the difference was not statistically significant in either comparison.

At the follow-up assessment, patients with DBT showed significantly greater positive response than those with SH (65% versus 2%; p = 0.02). Of the responders, 53% with DBT showed recovery compared with 4 with SH. The difference was not statistically significant (p = 0.10).

On BADDS total scores, significantly more DBT patients showed positive response with executive functioning than SH patients (65% versus 19%6; p = 0 .008). Among the responders, a significantly higher proportion of patients with DBT showed recovery than with SH (53% versus 6%: p = 0.004).

At the follow-up assessment, 10 (59%) a significantly higher proportion of DBT patients showed positive response than SH patients (59% versus 25.0%; p = 0.049). The recovery rates followed a similar trend DBT versus SH (47% versus 13% p = 0.03).

Participants who received DBT reported greater improvement in QoL than those with SH at the posttreatment (p = 0.015) but not at the follow-up assessment (p = 0.52).

Patients who received DBT did not show a significant change in anxiety symptoms (p = 0.21), and depressive symptoms (p = 0.26) compared with those who received SH.

Patients who received DBT showed a significantly more significant improvement in overall mindfulness than those who received SH both at the posttreatment, (p = 0.047) and at the follow-up evaluation (p = 0.023).

The DBT patients attended 88% of scheduled sessions, and the dropout rate was 6%. The patients gave a significantly higher total acceptability scores to DBT than to SH (p < 0.001).

“DBT group skills training may be efficacious, acceptable, and feasible for treating ADHD among college students. A larger randomized trial is needed for further evaluation.”⁴ Page 260

“Overall, results suggest that DBT group skills training may be a useful intervention for college students with ADHD, improving participants’ ADHD symptoms, EF, and quality of life to a greater degree than skills training via self-guided handouts. Mean change effect sizes ranged from moderate to large immediately after treatment (d = 0.47-0.94) and 3 months after treatment (d = 0.71-0.84). The intervention may also improve mindfulness and sustained attention. Participant acceptability of the treatment is high, and the group-based approach requires fewer resources and thus may offer greater feasibility than interventions delivered individually.”⁴ Page 269

During the therapy phase, patients with both DBT-ST and ASG reported significantly less emotion dysregulation over time but that those in DBT-ST improved significantly more and faster (d = 1.86)

At follow-up participants in DBT-ST trended toward losing some of their gains, while participants in ASG trended toward continuing to improve. However, there was no significant difference between the two groups.

DBT-ST patients significantly increased their skills use over time during the therapy phase(16.0% in DBT-ST versus 3.5% in ASG; d = 1.02). The gains were maintained during the follow-up.

During the therapy phase, patients in both DBT-ST and ASG reported a significant decrease in their anxiety severity, but DBT-ST participants improved significantly faster (d = 1.37). The trend was similar during the follow-up period.

Improvements in depression severity were similar in both the DBT-ST and ASG groups during the treatment phase and follow-up, although trended towards greater gains than ASG.

The average attendance was higher (66%) with DBT-ST than with ASG (50%), but the dropout rate was higher with ASG (59%) than with DBT-ST (32%). The difference between the groups in these respects was not statistically significant in either comparison.

At the end of treatment, patients treated with DBT-ST attributed the significantly greater improvement in depression or anxiety to their treatment than patients in ASG (p < 0.01). Patients treated with DBT-ST reported a significantly higher confidence in recommending their therapy to a friend than patients treated with ASG (p <0 .01)

Overall, a significantly higher percentage of patients in the DBT-PTSD arm than the TAU-WL arm showed a response to treatment (38.9% vs. 2.6%; p < 0.001).

Within the subgroups of patients with co-occurring BPD, the respective response rates were 29.4% (n = 5) for DBT-PTSD versus 0.0% for TAU-WL. The difference was statistically significant (p = 0.039).

At the time of discharge (week 12) the mean (SD) CAPS score in the DBT-PTSD group had reduced from 87.92 (14.20) at baseline to 60.31 (26.79) compared with no significant change in the TAU-WL group. The difference was statistically significant (p < 0.001).

The mean (SD) CAPS scores at the week-18 (57.47 [25.66]) and week-24 (58.50 [24.20]) follow-up evaluation show that the patients in the DBT-PTSD group retained their gains from the treatment phase.

The mean (SD) PDS score declined from 2.22 (0.44) at baseline to 1.61 (0.64) at week-12 for patients in the DBT-PTSD group. At the follow-up evaluations, the respective PDS scores were 1.53 (0.55) at week-18 and 1.53 (0.65) and at week-24. Patients in the TAU-WL group did not have a significant change from baseline over the course of the study.

None of the patients in the DBT-PTSD group showed worsening of PTSD symptoms during the study period compared with six patients in the TAU-WL group whose symptoms worsened.

Concerning measures of psychopathology and social functioning, the BDI and the GAF scores showed that patients in the DBT-PTSD group had significantly more improvement than did those in the TAU-WL group. However, the SCL-90-R, the DES, and the BSL did not show statistically better improvements.

“DBT-PTSD is an efficacious treatment of CSA-related PTSD, even in the presence of severe co-occurring psychopathology such as BPD.”⁶ page 221}

“Considering these limitations, we state that this newly developed modular treatment approach is the first to be shown to be both effective and safe for patients with CSA-related PTSD and co-occurring BPD including current self-harming behaviour. Utilisation of the treatment under outpatient conditions will be the next step.”⁶ page 231

In a multilevel model, shame, guilt, disgust, distress, and fear decreased significantly from the start to the end of the therapy whereas radical acceptance increased. Therapy response measured with the CAPS was associated with change in trauma-related emotions.

The therapy response was related to decreases in all other trauma-related emotions and increases in acceptance, but this relationship did not reach statistical significance in most of the measures due to the small sample size and high standard errors.

“Trauma-related emotions and radical acceptance showed significant changes from the start to the end of DBT-PTSD. Future studies with larger sample sizes and control group designs are needed to test whether these changes are due to the treatment.”⁷ page 1

After 12 weeks therapy, a significantly higher proportion of patients treated with DBT the majority of patients had minimal or mild depression compared with those in the control group (92% versus 42%; p = 0.0009). Thus 58% of patients in the control group still had moderate to severe depression.

The average MSES scores improved over time for both study groups indicating a significant enhancement in the perception of self-efficacy (p < 0.0001). Although mean scores of MSES total were not different in the two study groups, the scores improved for all patients in the DBT group whereas the pattern of scores was inconsistent for the control group.

The average ACS scores improve over time for both the DBT group and the Wait-list control, but the changes were not statistically significant. However, DBT showed a trend of higher improvements in ACS depressed mood and anxiety subscale scores than the control.

The majority (75%) of patients who received DBT rated their overall impression of the group as “excellent” and 24% rated their experience as “good”; while one patient rated the group as “fair”.