Efficacy of dialectical behavior therapy-based interventions for individuals with autism spectrum disorder: a systematic review and meta-analysis

BACKGROUND: Autism spectrum disorder (ASD) is characterized by social communication deficits and emotional dysregulation. Dialectical behavior therapy (DBT) has shown potential benefits in various psychiatric conditions; however, evidence regarding its effectiveness in individuals with ASD remains limited. This study aimed to evaluate the effects of DBT-based interventions on emotional regulation, suicidal ideation, and depressive symptoms in ASD. METHODS: Six English and Chinese databases were searched from inception to April 1, 2025. Randomized controlled trials (RCTs) comparing DBT-based interventions with control conditions in individuals with ASD were included. Data were pooled using standardized mean difference (SMD) with 95% confidence intervals (CI). Heterogeneity was assessed using the I² statistic, and subgroup analyses were conducted. RESULTS: Four RCTs involving 375 participants were included. Compared with controls, DBT-based interventions were associated with significant improvements in emotional regulation (SMD = - 0.89, 95% CI: -1.67 to - 0.10) and reductions in suicidal ideation (SMD = - 1.97, 95% CI: -3.02 to - 0.91) and depressive symptoms (SMD = - 2.23, 95% CI: -4.35 to - 0.11). Subgroup analysis indicated that shorter session duration (≤ 60 min) was associated with greater improvements in emotional regulation, whereas no significant effect was observed for longer sessions (> 60 min). No significant effects were found for anxiety. CONCLUSION: DBT-based interventions show potential benefits in improving emotional regulation, reducing suicidal ideation, and alleviating depressive symptoms in individuals with ASD. However, the findings should be interpreted with caution due to the limited number of trials and substantial heterogeneity. Further large-scale, high-quality RCTs are warranted.