An exploratory study of dialectical behaviour therapy for emotional dysregulation and challenging behaviours after acquired brain injury.
Marie Kuppelin, Antoine Goetsch, Régine Choisel and 3 others
PMID 39031392WHAT IT FOUND
Dialectical behaviour therapy added to a brain-injury rehabilitation programme was feasible: three of seventeen dropped out, median attendance was 89%, and satisfaction was good.
Group-only therapy was not enough; individual sessions and videos helped. This study does not show the therapy works.
Key findings
01Adding DBT to the EMOI-TC multidisciplinary programme was feasible: three of seventeen participants dropped out, median group attendance was 89%, and satisfaction was good.
02Group-only DBT was not enough: the first group recalled a median of 7 of 22 skills, and later adaptations added individual sessions and YouTube videos.
03Emotion regulation scores improved more in the ABI-DBT group than controls (reported difference of -7.6 points on the 16 to 80 DERS-16 scale), but the study was not randomised and ABI-DBT was added to EMOI-TC, so ABI-DBT's separate effect cannot be known.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study was exploratory and not randomised, and the ABI-DBT group had higher emotion dysregulation at baseline, so the groups were not comparable. All participants also received the EMOI-TC multidisciplinary programme, so the contribution of DBT alone cannot be separated. The sample was small, and the number analysed differed by outcome: 27 participants for DERS-16 and 23 participants for QOLIBRI. The intervention changed between groups: the first group had group sessions only, and the second group added individual sessions and YouTube videos. Fidelity to DBT was not formally assessed, and the authors call this a major flaw. Focus group feedback was not audio-recorded or transcribed, and no formal qualitative analysis was done. Participants were selected by the team's perception of need, and not all had clear emotion dysregulation on the DERS-16. The DERS-16 psychometric properties in ABI are unknown, and stability showed high variability for some patients. Follow-up data were available for only 14 participants, assessed 5 to 10 months later. Controls had fewer women than the ABI-DBT group, another sign that the groups were not matched.
The easy way to misread this
Do not read the better scores in the ABI-DBT group as proof that DBT works. The study was not randomised, the ABI-DBT group started with worse emotion regulation, and DBT was added to a multidisciplinary programme, so the separate effect of DBT cannot be known.