Does DBT affect emotional regulation and impulsivity from the beginning of implementation? A 3-year naturalistic study on transdiagnostic groups in addictology

Introduction . Addictions and eating disorders are the 2 deadliest psychiatric disorders. Central processes in both disorders are emotional dysregulation and impulsivity, maladaptive emotion regulation strategies have an important role in the development and maintenance of eating disorders and addictions. The standard treatment for emotion regulation is Dialectical Behavioral Therapy (DBT), its implementation is often a challenge but can be facilitated by transdiagnostic groups. As few data are available on these groups in addictology, the aim of our study was to check that emotional dysregulation and impulsivity are improved as soon as transdiagnostic DBT groups are implemented. Method . Eight two-month cycles of transdiagnostic DBT groups were led between 2021 and 2023. The 35 participants had substance addiction (89%), behavioral addiction (14%), or eating disorder (20%). Other psychiatric comorbidities, especially borderline personality disorder (42.9%), were also present. The evolution of questionnaires completed by the participants and the attrition rate were analyzed. Results . The average dropout rate was 21%. During DBT, the improvement reached high effect sizes for emotional dysregulation (d=0.9), positive cognitive emotional regulation (d=0.978) and negative cognitive emotional regulation (d=1.04), and medium effect sizes for impulsivity (d=0.586) and mindfulness (d=0.766). Depending on the cycle, clinical outcomes ranged from 0% to 31% improvement in emotional dysregulation and from 12% to 100% retention. An association was found between attrition rate and therapists' level of experience (effect size = 0.320, p=.001). Discussion . While we know the effectiveness of DBT on emotional dysregulation and impulsivity, two particularly important functions in addictology, we found that their improvement can occur as soon as this therapy is implemented despite challenges present. These results suggest that transdiagnostic format, which is a solution to facilitate DBT implementation, preserves the effects of DBT. In addictology, few therapies address emotional regulation and impulsivity: CBT is less suitable for severe cases because change and acceptance skills are not dialectically balanced, and pharmacotherapy does not act on limbic system by top-down mechanisms because it does not teach skills. Therefore, to improve emotion regulation of patients with addictions, it is necessary to study solutions more often to facilitate implementation of DBT such as transdiagnostic groups.