Emotion regulation and substance use frequency in women with substance dependence and borderline personality disorder receiving dialectical behavior therapy

Abstract

Background: Dialectical behavior therapy (DBT) identifies emotion dysregulation as central to the dangerous impulsivity of borderline personality disorder (BPD) including substance use disorders, and DBT targets improved emotion regulation as a primary mechanism of change. However, improved emotion regulation with DBT and associations between such improvement and behavioral outcomes such as substance use has not been previously reported. Objective: Thus, the goal of this study was to assess for improvement in emotion regulation and to examine the relationship between improvements in the emotion regulation and substance use problems following DBT treatment. Method: Emotion regulation as assessed by the Difficulties in Emotion Regulation Scale, depressed mood as assessed by the Beck Depression Inventory, and their associations with substance use frequency were investigated in 27 women with substance dependence and BPD receiving 20 weeks of DBT in an academic community outpatient substance abuse treatment program. Results: Results indicated improved emotion regulation, improved mood, and decreased substance use frequency. Further, emotion regulation improvement, but not improved mood, explained the variance of decreased substance use frequency. Conclusion and Scientific Significance: This is the first study to demonstrate improved emotion regulation in BPD patients treated with DBT and to show that improved emotion regulation can account for increased behavioral control in BPD patients. Significance and future research: Emotion regulation assessment is recommended for future studies to further clarify the etiology and maintenance of disorders associated with emotional dysregulation such as BPD and substance dependence and to further explore emotion regulation as a potential mechanism of change for clinical interventions.

• emotion regulation
• substance dependence
• borderline personality disorder
• dialectical behavior therapy

ACKNOWLEDGMENTS

This research was supported in part by the following NIH grants: P50-DA0941 (Bruce J. Rounsaville, M.D.), P50-DA16556 (RS), and T-32-MH062994 (Morris Bell, Ph.D.), and by the Department of Mental Health and Addiction Services (DMHAS) of the State of Connecticut. We thank the clinical and research staff of the Substance Abuse Treatment Unit at the Connecticut Mental Health Center for their contribution to this research. We are also grateful to Drs. Steve Southwick and Bruce Rounsaville for their helpful comments on an earlier version of this manuscript.

Declaration of Interest

The authors report no conflict of interest. The authors alone are responsible for the content and writing of this paper.