The Effectiveness of Dialectical Behavior Therapy on Rumination and Cognitive Avoidance in Teachers

June 12, 2026 updated by: Sepideh Navidmanesh, Islamic Azad University, Sanandaj

This randomized controlled trial evaluated the effectiveness of Dialectical Behavior Therapy (DBT) skills training in reducing rumination and cognitive avoidance among middle-school teachers in Isfahan, Iran. Teachers often experience occupational stress that may contribute to maladaptive cognitive and emotional responses. DBT is a skills-based psychological intervention that aims to improve emotional regulation, mindfulness, distress tolerance, and interpersonal effectiveness.

Thirty-four eligible teachers were randomly assigned to either a DBT intervention group or a control group. Participants in the intervention group attended ten group sessions, while the control group received no intervention during the study period. Levels of rumination and cognitive avoidance were assessed at baseline, post-intervention, and two-month follow-up using standardized questionnaires.

The study aimed to determine whether DBT skills training could reduce maladaptive cognitive processes and promote psychological well-being among teachers.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Teachers are exposed to chronic occupational stress that may contribute to maladaptive cognitive processes, including rumination and cognitive avoidance. Dialectical Behavior Therapy (DBT), originally developed for emotion dysregulation, has increasingly been applied as a transdiagnostic and skills-based intervention in non-clinical populations. DBT emphasizes mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness skills that may enhance adaptive coping and psychological resilience.

This randomized controlled trial was conducted to examine the effects of a DBT skills training program among middle-school teachers in Isfahan, Iran. Participants assigned to the intervention group attended ten structured group sessions delivered in a face-to-face format. The program was based on Linehan's DBT skills training model and focused on developing practical strategies for emotional and cognitive self-regulation. Participants in the control group did not receive the intervention during the study period.

The study was designed to evaluate whether a structured DBT-based psychoeducational program could improve cognitive and emotional functioning and contribute to the growing evidence supporting the use of DBT in educational and non-clinical settings.

Study Type

Interventional

Enrollment (Actual)

34

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Iran
    • Isfahan
      • Isfahan, Isfahan, Iran, 8481914411
        • Department of Psychology, Islamic Azad University, Mobarakeh Branch

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Female middle-school teachers from districts 4 and 5 of Isfahan, Iran.
  • Age between 35 and 52 years.
  • Willingness to participate and provide written informed consent.
  • Ability to attend the intervention sessions and complete study assessments.

Exclusion Criteria:

  • Absence from more than two intervention sessions.
  • Withdrawal of consent at any stage of the study.
  • Failure to complete post-intervention or follow-up assessments.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Other
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Dialectical Behavior Therapy Skills Training
Participants received ten face-to-face group sessions of Dialectical Behavior Therapy (DBT) skills training. The intervention included mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness skills. Assessments were conducted at baseline, post-intervention, and two-month follow-up.
Behavioral: Dialectical Behavior Therapy Skills Training
Participants assigned to the experimental group received a manualized Dialectical Behavior Therapy (DBT) skills training program delivered in a face-to-face group format. The intervention consisted of ten sessions conducted over a five-week period. The program was based on Linehan's DBT model and included training in mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness skills. Sessions involved psychoeducation, group discussion, and practical exercises designed to improve cognitive and emotional self-regulation. Participants in the control group received no intervention during the study period.
No Intervention: No-Intervention Control
Participants assigned to the control group received no intervention during the study period and completed assessments at baseline, post-intervention, and two-month follow-up.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Cognitive Avoidance
Time Frame: Baseline, post-intervention (5 weeks), and 2-month follow-up.
Change in cognitive avoidance scores measured using the Cognitive Avoidance Questionnaire. Total scores range from 25 to 125, with higher scores indicating greater cognitive avoidance and worse outcomes.
Baseline, post-intervention (5 weeks), and 2-month follow-up.
Rumination
Time Frame: Baseline, post-intervention (5 weeks), and 2-month follow-up.
Change in rumination scores measured using the Ruminative Response Scale. Total scores range from 22 to 88, with higher scores indicating greater rumination and worse outcomes.
Baseline, post-intervention (5 weeks), and 2-month follow-up.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Islamic Azad University, Sanandaj

Investigators

  • Study Chair: Maryam Kadkhodaee, PhD of Psychology, Assistant Professor of Psychology, Department of Psychology, Mo. C., Islamic Azad University, Isfahan, Iran.

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

September 15, 2024

Primary Completion (Actual)

September 15, 2024

Study Completion (Actual)

December 18, 2024

Study Registration Dates

First Submitted

June 9, 2026

First Submitted That Met QC Criteria

June 12, 2026

First Posted (Actual)

June 16, 2026

Study Record Updates

Last Update Posted (Actual)

June 16, 2026

Last Update Submitted That Met QC Criteria

June 12, 2026

Last Verified

June 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • I/05/117

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

Individual participant data that underlie the results reported in this article, after de-identification, will be made available to qualified researchers upon reasonable request. Supporting documents, including the study protocol and data dictionary, will also be available. Data will be available beginning six months after publication and ending five years after publication. Requests should be directed to the corresponding author. Access will be granted following review of the proposed use of the data and execution of a data access agreement.

IPD Sharing Time Frame

De-identified individual participant data and supporting documents will be available beginning 6 months after publication and ending 5 years after publication.

IPD Sharing Access Criteria

Qualified researchers with a methodologically sound proposal will be able to access de-identified individual participant data, the study protocol, informed consent form, and analytic code. Requests should be directed to the corresponding author. Data access will be granted following review of the proposed use and execution of an appropriate data access agreement.

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL
  • ICF
  • ANALYTIC_CODE

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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