Effectiveness of Dialectical Behavior Therapy on Executive Functions and Emotion Dysregulation in Adults with Bipolar Disorder
Downloads
Objective: To evaluate whether dialectical behavior therapy (DBT) improves executive functions and reduces emotion dysregulation in adults with bipolar disorder using a quasi-experimental, pretest–posttest, controlled design with four-month follow-up.
Methods and Materials: Thirty adults with DSM-5 bipolar disorder (25–45 years) were recruited via purposive sampling and randomly assigned to DBT (n=15) or wait-list control (n=15). The intervention comprised eight 90-minute group sessions over four weeks based on Linehan’s skills modules (mindfulness, emotion regulation, distress tolerance, interpersonal effectiveness). Outcomes were assessed at pretest, posttest, and four-month follow-up using Nejati’s Executive Function Questionnaire (30 items) and the Difficulties in Emotion Regulation Scale (36 items). Data were analyzed in SPSS 26 using mixed repeated-measures ANOVA with assumption checks and Greenhouse–Geisser corrections; significance was set at .05.
Findings: Groups were demographically comparable at baseline. Significant group and time effects emerged for both outcomes. Executive functions improved in the DBT group from pretest to posttest and were largely maintained at follow-up, whereas controls showed no meaningful change (group effect F large; partial η²≈.66; time effect partial η²≈.69). Emotion dysregulation decreased significantly in DBT relative to control and remained improved at follow-up (group effect partial η²≈.89; time effect partial η²≈.31). No adverse events were reported, and retention exceeded 80%.
Conclusion: Brief group-based DBT produced clinically and statistically significant improvements in executive functions and reductions in emotion dysregulation that persisted for four months. Findings support integrating DBT skills training as an adjunct to standard care for bipolar disorder; larger randomized trials with longer follow-up and treatment-fidelity monitoring are warranted.
Downloads
Alfonsi, V., Scarpelli, S., D’Atri, A., Stella, G., & De Gennaro, L. (2020). Later school start time: the impact of sleep on academic performance and health in the adolescent population. International journal of environmental research and public health, 17(7), 2574. https://doi.org/10.3390/ijerph17072574
Alidoosti, F., & Naderi, S. (2024). Parental psychological control and adolescent social problems: the mediating role of emotion regulation. Iranian Journal of Family Psychology, 11(2), 87-102. https://doi.org/10.22034/ijfp.2025.2047124.1372
Alijanzadeh, M., Makvand-Hosseini, S., & Kianersi, F. (2014). The effectiveness of group dialectical behavior therapy (based on skills training) on aggression in adolescents. Journal of Clinical Psychology, 6(3), 23-32. 10.22075/jcp.. 2017.2170
Ayık, B., Baş, A., Sağlam, N. G. U., & İzci, F. (2023). The relationship between emotional dysregulation, alexithymia, and somatization in patients with bipolar disorder. Alpha Psychiatry, 24(1), 15. https://doi.org/10.5152/alphapsychiatry.2023.22974
Bailey, B. C., Novick, D., Boyce, K., & Swartz, H. A. (2024). Dialectical behavior and social rhythm therapy for comorbid bipolar disorder and borderline personality disorder. American Journal of Psychotherapy, 77(1), 23-29. https://doi.org/10.1176/appi.psychotherapy.20230006
Bao, R., Wade, L., Leahy, A. A., Owen, K. B., Hillman, C. H., Jaakkola, T., & Lubans, D. R. (2024). Associations between motor competence and executive functions in children and adolescents: A systematic review and meta-analysis. Sports Medicine, 54(8), 2141-2156. https://doi.org/10.1007/s40279-024-02040-1
Cañada, Y., Torres, S. C., Andreu-Martinez, J., Cristancho, D. B., Giglioli, I. A. C., Garcia-Blanco, A., Adriasola, A., Navalón, P., Sierra, P., & Alcañiz, M. (2024). Characterization and assessment of executive functions through a virtual cooking task in euthymic patients with bipolar disorder. Journal of Psychiatric Research, 178, 349-358. https://doi.org/10.1016/j.jpsychires.2024.08.007
Cao, C., Chen, D., & Zhou, Y. (2025). Perceived stress and academic procrastination among higher vocational nursing students: the mediating roles of positive and negative emotions. BMC nursing, 24(1), 36. https://doi.org/10.1186/s12912-024-02672-8
De Prisco, M., Oliva, V., Fico, G., Radua, J., Grande, I., Roberto, N., Anmella, G., Hidalgo-Mazzei, D., Fornaro, M., & de Bartolomeis, A. (2023). Does bipolar disorder differ from other mental illnesses in terms of emotion dysregulation? A systematic review and meta-analysis. European Psychiatry, 66(S1), S571-S572. https://doi.org/10.1192/j.eurpsy.2023.1199
Durpoix, A., Lachaux, E., Weiner, L., & Weibel, S. (2023). Transdiagnostic skills training group of dialectical behavior therapy: a long-term naturalistic study. Borderline personality disorder and emotion dysregulation, 10(1), 37. https://doi.org/10.1186/s40479-023-00243-y
Ghaderi, S., Fatehi, F., Kalra, S., Mohammadi, S., & Batouli, S. A. H. (2024). Involvement of the left uncinate fasciculus in the amyotrophic lateral sclerosis: an exploratory longitudinal multi-modal neuroimaging and neuropsychological study. Brain Structure and Function, 230(1), 8. https://doi.org/10.1007/s00429-024-02884-3
Goldstein, T. R., Merranko, J., Rode, N., Sylvester, R., Hotkowski, N., Fersch-Podrat, R., Hafeman, D. M., Diler, R., Sakolsky, D., & Franzen, P. (2024). Dialectical behavior therapy for adolescents with bipolar disorder: A randomized clinical trial. JAMA psychiatry, 81(1), 15-24. https://doi.org/10.1001/jamapsychiatry.2023.3399
Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of psychopathology and behavioral assessment, 26(1), 41-54. https://doi.org/10.1023/B:JOBA.0000007455.08539.94
Guo, X., Ouyang, N., Sun, G., Zhang, N., Li, Z., Zhang, X., Li, G., Wang, C., Qiao, L., & Zhou, Y. (2024). Multifaceted intensive blood pressure control model in older and younger individuals with hypertension: a randomized clinical trial. JAMA cardiology, 9(9), 781-790. https://doi.org/10.1001/jamacardio.2024.1449
Hsu, J.-W., Chen, L.-C., Lin, W.-C., Bai, Y.-M., Tsai, S.-J., & Chen, M.-H. (2025). Reduced levels of vascular endothelial growth factor were associated with psychopathology in youth with first-episode schizophrenia. Schizophrenia Research, 284, 269-274. https://doi.org/10.1016/j.schres.2025.08.020
Jones, B. D., Umer, M., Kittur, M. E., Finkelstein, O., Xue, S., Dimick, M. K., Ortiz, A., Goldstein, B. I., Mulsant, B. H., & Husain, M. I. (2023). A systematic review on the effectiveness of dialectical behavior therapy for improving mood symptoms in bipolar disorders. International Journal of Bipolar Disorders, 11(1), 6. https://doi.org/10.1186/s40345-023-00288-6
Kessing, L. V. (2024). Why is lithium [not] the drug of choice for bipolar disorder? A controversy between science and clinical practice. International Journal of Bipolar Disorders, 12(1), 3. https://doi.org/10.1186/s40345-023-00322-7
Khaledian, Y., Brevik, E. C., Pereira, P., Cerdà, A., Fattah, M. A., & Tazikeh, H. (2017). Modeling soil cation exchange capacity in multiple countries. Catena, 158, 194-200. https://doi.org/10.1016/j.catena.2017.07.002
Linehan, M. M., & Wilks, C. R. (2015). The course and evolution of dialectical behavior therapy. American Journal of Psychotherapy, 69(2), 97-110. https://doi.org/10.1176/appi.psychotherapy.2015.69.2.97
Manion, A. J. (2022). Exploring The Lived Experiences Of Public High School Teachers And Instructional Coaches Participating In Virtual Instructional Coaching During The COVID-19 Pandemic.
Mossini, M. (2024). Efficacy of Dialectical Behavioral Therapy Skills in Addressing Emotional Dysregulation among Adolescents: A Systematic Literature Review. International Journal on Social and Education Sciences, 6(3), 439-451. https://doi.org/10.46328/ijonses.684
Nejati, V., Bahrami, H., Abravan, M., & Motiei, H. (2013). Executive function and working memory in attention deficit/hyperactivity disorder and healthy children. Journal of Gorgan university of medical sciences, 15(3), 69-76. http://goums.ac.ir/journal/article-1-1802-en.html
O’Connell, K. S., Koromina, M., van der Veen, T., Boltz, T., David, F. S., Yang, J. M. K., Lin, K.-H., Wang, X., Coleman, J. R., & Mitchell, B. L. (2025). Genomics yields biological and phenotypic insights into bipolar disorder. Nature, 639(8056), 968-975.
Oliva, V., Fico, G., De Prisco, M., Gonda, X., Rosa, A. R., & Vieta, E. (2025). Bipolar disorders: an update on critical aspects. The Lancet Regional Health–Europe, 48. https://doi.org/10.1016/j.lanepe.2024.101135
Paulet, T., & Weiner, L. (2025). Imagery-based cognitive therapy to reduce emotional dysregulation and mood instability in bipolar disorder: a case-series study. Behavioural and Cognitive Psychotherapy, 53(1), 1-16. https://doi.org/10.1017/S1352465824000420
Paulette, D. (2024). Welcome to the club: The life and lessons of a Black woman DJ. Manchester University Press. https://doi.org/10.7765/9781526166913
Poletti, S., Mazza, M. G., & Benedetti, F. (2024). Inflammatory mediators in major depression and bipolar disorder. Translational Psychiatry, 14(1), 247. https://doi.org/10.1038/s41398-024-02921-z
Ribeiro, M., Yordanova, Y. N., Noblet, V., Herbet, G., & Ricard, D. (2024). White matter tracts and executive functions: a review of causal and correlation evidence. Brain, 147(2), 352-371. https://doi.org/10.1093/brain/awad308
Singh, B., Bennett, H., Miatke, A., Dumuid, D., Curtis, R., Ferguson, T., Brinsley, J., Szeto, K., Petersen, J. M., & Gough, C. (2025). Effectiveness of exercise for improving cognition, memory, and executive function: a systematic umbrella review and meta-meta-analysis. British journal of sports medicine, 59(12), 866-876. https://doi.org/10.1136/bjsports-2024-108589
Song, J., Jonsson, L., Lu, Y., Bergen, S. E., Karlsson, R., Smedler, E., Gordon-Smith, K., Jones, I., Jones, L., & Craddock, N. (2024). Key subphenotypes of bipolar disorder are differentially associated with polygenic liabilities for bipolar disorder, schizophrenia, and major depressive disorder. Molecular psychiatry, 29(7), 1941-1950. https://doi.org/10.1038/s41380-024-02448-1
Vijayapriya, C., & Tamarana, R. (2023). Effectiveness of dialectical behavior therapy as a transdiagnostic treatment for improving cognitive functions: a systematic review. Research in Psychotherapy: Psychopathology, Process, and Outcome, 26(2), 662. https://doi.org/10.4081/ripppo.2023.662
Zhong, Y., Chen, Y., Su, X., Wang, M., Li, Q., Shao, Z., & Sun, L. (2024). Global, regional, and national burdens of bipolar disorders in adolescents and young adults: a trend analysis from 1990 to 2019. General Psychiatry, 37(1), e101255. https://doi.org/10.1136/gpsych-2023-101255
Copyright (c) 2025 International Journal of Body, Mind and Culture
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
