Emotion regulation and impulsivity evolution during transdiagnostic DBT implementation in addictology – a 3-year naturalistic study

Addictive and eating disorders are the two deadliest psychiatric disorders. Emotional dysregulation and impulsivity are central processes in both disorders. Maladaptive emotion regulation strategies play a key role in the development and maintenance of these disorders. The standard treatment for emotion regulation is Dialectical Behavioral Therapy (DBT); its implementation is often a challenge, but transdiagnostic groups can facilitate it. Due to the lack of data available on these groups in addictology, our study aimed to determine whether emotional dysregulation and impulsivity are improved with the implementation of transdiagnostic DBT groups. Eight two-month cycles of transdiagnostic DBT groups occurred between 2021 and 2023. The 35 participants had substance use disorder (89%), addictive behavior disorder (14%), or eating disorder (20%). Other psychiatric comorbidities, especially borderline personality disorder (42.9%), were also present. The evolution of questionnaires completed by the participants and the attrition rate were analyzed. The dropout rate was 21%. During DBT, the improvement reached high effect sizes for emotional dysregulation (d = 0.9), positive cognitive emotional regulation (d = 0.978) and negative cognitive emotional regulation (d = 1.04), and medium effect sizes for impulsivity (d = 0.586) and mindfulness (d = 0.766). Depending on the cycle, improvement in emotional dysregulation ranged from 0% to 31%, and retention ranged from 12% to 100%. An association was found between attrition rate and therapists’ level of experience (effect size = 0.320, p = 0.001). While DBT is known to be effective on emotional dysregulation and impulsiveness, two particularly important functions in addictology, we found that their improvement can occur as soon as this therapy is implemented despite challenges present. These results suggest that the transdiagnostic format, which facilitates DBT implementation, preserves DBT’s effects.