Emotion regulation group therapy for deliberate self-harm: a multi-site evaluation in routine care using an uncontrolled open trial design

Hanna Sahlin, Johan Bjureberg, Kim L Gratz, Matthew T Tull, Erik Hedman, Jonas Bjärehed, Jussi Jokinen, Lars-Gunnar Lundh, Brjánn Ljótsson, Clara Hellner, Hanna Sahlin, Johan Bjureberg, Kim L Gratz, Matthew T Tull, Erik Hedman, Jonas Bjärehed, Jussi Jokinen, Lars-Gunnar Lundh, Brjánn Ljótsson, Clara Hellner

Abstract

Objective: Emotion regulation group therapy (ERGT) has shown promising results in several efficacy trials. However, it has not been evaluated outside a research setting. In order to increase the availability of empirically supported treatments for individuals with borderline personality disorder and deliberate self-harm, an evaluation of ERGT in routine clinical care was conducted with therapists of different professional backgrounds who had received brief intensive training in ERGT prior to trial onset.

Design: Multi-site evaluation, using an uncontrolled open trial design with assessments at pretreatment, post-treatment and 6-month follow-up.

Setting: 14 adult outpatient psychiatric clinics across Sweden.

Participants: Ninety-five women (mean age=25.1 years) with borderline personality disorder (both threshold and subthreshold) and repeated self-harm were enrolled in the study. Ninety-three per cent of participants completed the post-treatment assessment and 88% completed the follow-up assessment.

Primary and secondary outcome measures: Primary outcome was self-harm frequency as measured with the Deliberate Self-Harm Inventory. Secondary outcomes included self-harm versatility, emotion dysregulation, other self-destructive behaviours, depression, anxiety, stress symptoms and interpersonal and vocational difficulties.

Intervention: ERGT is an adjunctive, 14-week, acceptance-based behavioural group treatment that directly targets both self-harm and its proposed underlying mechanism of emotion dysregulation.

Results: At post-treatment, intent-to-treat analyses revealed a significant improvement associated with a moderate effect size on the primary outcome of self-harm frequency (51%, reduction; Cohen's d=0.52, p<0.001) as well as significant improvements in the secondary outcomes of self-harm versatility, emotion dysregulation, other self-destructive behaviours and general psychiatric symptomatology. These results were either maintained or further improved on at 6-month follow-up.

Conclusions: ERGT appears to be a feasible, transportable and useful treatment for deliberate self-harm and other self-destructive behaviours, emotion dysregulation and psychiatric symptoms when delivered by clinicians in the community.

Trial registration number: NCT01986257; results.

Keywords: borderline personality disorder; emotion regulation; group therapy; implementation.

Conflict of interest statement

Competing interests: HS, JBju, KLG, MTT, JBjä, L-GL, JJ and CH report no competing interests. EH and BL are shareholders of a company, Dahlia, specialised in psychiatric symptom assessment.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
Participant flow through the study. BPD, borderline personality disorder; DSH, deliberate self-harm; ERGT, emotion regulation group therapy.

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