Feasibility of dialectical behavior therapy skills training as an outpatient program in treating alcohol use disorder: The role of difficulties with emotion regulation and experiential avoidance

Abstract

Background: This study aimed to investigate the feasibility of a 3-month Dialectical Behavior Therapy Skills Training stand-alone outpatient program (DBT-ST-OP) for alcohol use disorder (AUD) by comparing primary and secondary outcomes with the same intervention provided in a mixed format (inpatient + outpatient). The study also assessed experiential avoidance (EA) changes during treatment and its early predictive role in treatment retention. Ultimately, the mediating role of difficulties with emotion regulation (DER), EA changes, and the functional relationships between them were explored in relation to abstinence maintenance (AM).Methods: A voluntary sample of 171 treatment-seeking individuals with AUD was consecutively admitted. AM was indicated by random weekly urine toxicological screening. DER and EA were assessed at the beginning, after 1 month, and at the end of treatment. Two serial multiple mediational models were estimated.Results: DBT-ST-OP showed more beneficial primary (i.e., AM, attrition rate, treatment attendance) and secondary (i.e., DER levels) outcomes compared with the same treatment provided in a mixed format. EA significantly decreased during the treatment, independently of baseline levels. Further, it did not represent an early predictive factor for drop-out. DER changes were a full mediator of AM and explained EA changes during the treatment.Conclusion: DBT-ST is a feasible stand-alone outpatient program for AUD. DER represents a relevant therapeutic process in explaining AM and EA changes. Future controlled and follow-up studies should focus on the efficacy of DBT-ST in treating AUD and evaluate the role of DER and EA in long-term relapse prevention.

Keywords:

• Dialectical behavior therapy skills training
• alcohol use disorder
• feasibility
• difficulties with emotion regulation
• experiential avoidance

Disclosure statement

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors alone are responsible for the content and writing of this paper. All authors equally participated in designing study and writing protocol as well as in manuscript preparation. The authors report no relevant financial conflicts.