Effectiveness of dialectical behavior therapy as a transdiagnostic treatment for improving cognitive functions: a systematic review

Submitted: September 20, 2022
Accepted: May 14, 2023
Published: July 4, 2023
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Dialectical behavior therapy (DBT) has been found to be an efficacious treatment for disorders characterized by high levels of emotional instability. In view of the multifaceted applications of DBT and the extent to which mental disorders can incapacitate cognitive functions, the current systematic review aimed to investigate the effect of DBT in strengthening cognitive functions across various mental health conditions. Original research studies employing both experimental and quasi-experimental designs were included in the review. The literature search was done using different electronic databases, from the first available literature until June 2022, that covered an approximate period of ten years. Joanna Briggs Institute checklist was used to assess the methodological rigor of the studies. Twelve studies conducted on adolescents with emotional dysregulation, and adults with borderline personality disorder, bipolar disorder, attention deficit hyperactivity disorder, and multiple sclerosis were selected. Results indicate that DBT has the potential to improve key cognitive functions such as attention, memory, fluency, response inhibition, planning, set shifting, tolerance for delayed rewards and time perception, as assessed by neuropsychological tests, self-report of cognitive functions, and neuroimaging techniques. Considering the review’s findings that showcase the effectiveness of DBT in fostering improvements in cognitive functions, DBT may possibly be chosen as a preferred treatment to ensure that patients reach optimal levels of cognitive functioning. Limitations include lack of sufficient studies encompassing all the common mental health conditions, usage of neuroimaging techniques as only an indirect measure of cognitive functioning and nuances related to the quality of individual studies.



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Abdolghaddri, M., Narimani, M., Atadokht, A., Abolghasemi, A., & Hamidrezahatamian. (2019). Comparing the effect of positive psychotherapy and dialectical behavior therapy on memory and attention in multiple sclerosis patients. Neuro Quantology, 17(12), 1-8. doi:10.14704/nq.2019.17.12.NQ19106. DOI: https://doi.org/10.14704/nq.2019.17.12.NQ19106
Afshari, B., Omidi, A., & Ahmadvand, A. (2019). Effects of dialectical behavior therapy on executive functions, emotion regulation, and mindfulness in bipolar disorder. Journal of Contemporary Psychotherapy, 123-131. doi:10.1007/s10879-019-09442-7. DOI: https://doi.org/10.1007/s10879-019-09442-7
APA (n.d.). APA Dictionary of Psychology. https://dictionary.apa.org/inferior-frontal-gyrus
Barker, T. H., Stone, J. C., Sears, K., Klugar, M., Tufanaru, C., Leonardi-Bee, J., Aromataris, E., & Munn, Z. (2023). The revised JBI critical appraisal tool for the assessment of risk of bias for randomized controlled trials. JBI Evidence Synthesis, 21(3), 494-506. doi:10.11124/jbies-22-00430. DOI: https://doi.org/10.11124/JBIES-22-00430
Benton, A. L., Hamsher, K. D., & Sivan, A. B. (1994). Multilingual Aphasia Examination: Manual of Instructions. AJA Assoc.
Blanchette, I., & Richards, A. (2010). The influence of affect on higher level cognition: A review of research on interpretation, judgement, decision making and reasoning. Cognition & Emotion, 24(4), 561-595. DOI: https://doi.org/10.1080/02699930903132496
Bohus, M., Haaf, B., Simms, T., Limberger, M. F., Schmahl, C., Unckel, C., Lieb, K., & Linehan, M. M. (2004). Effectiveness of inpatient dialectical behavioral therapy for borderline personality disorder: a controlled trial. Behaviour Research and Therapy, 42(5), 487-499. DOI: https://doi.org/10.1016/S0005-7967(03)00174-8
Brown, T. E. (1996). Attention-Deficit Disorder Scales manual. San Antonio, TX: Psychological Corporation. Chambless, D. L., & Ollendick, T. H. (2001). Empirically supported psychological interventions: controversies and evidence. Annual Review of Psychology, 52, 685-716. DOI: https://doi.org/10.1146/annurev.psych.52.1.685
Coghill, D. R., Seth, S., & Matthews, K. (2013). A comprehensive assessment of memory, delay aversion, timing, inhibition, decision making and variability in attention deficit hyperactivity disorder: Advancing beyond the three-pathway models. Psychological Medicine, 44(9), 1989-2001. doi:10.1017/s0033291713002547. DOI: https://doi.org/10.1017/S0033291713002547
Conners, C. K. (2004). Conners' continuous performance test II (Cpt II): Technical guide and software manual. Multi-Health Systems.
Dougherty, D. M., Bjork, J. M., Harper, R. A., Marsh, D. M., Moeller, F. G., Mathias, C. W., & Swann, A. C. (2003). Behavioral impulsivity paradigms: a comparison in hospitalized adolescents with disruptive behavior disorders. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 44(8), 1145-1157. DOI: https://doi.org/10.1111/1469-7610.00197
Dougherty, D. M., Mathias, C. W., Marsh, D. M., & Jagar, A. A. (2005). Laboratory behavioral measures of impulsivity. Behavior Research Methods, 37, 82-90. doi:10.3758/BF03206401. DOI: https://doi.org/10.3758/BF03206401
Fabre, L., & Lemaire, P. (2019). How emotions modulate arithmetic performance: A study in arithmetic problem verification tasks. Experimental Psychology, 66(5), 368-376. DOI: https://doi.org/10.1027/1618-3169/a000460
Field, M., Eastwood, B., Bradley, B. & Mogg, K. 2006. Selective processing of cannabis cues in regular cannabis users. Drug and Alcohol Dependence, 85, 75-82. DOI: https://doi.org/10.1016/j.drugalcdep.2006.03.018
Fleming, A. P., McMahon, R. J., Moran, L. R., Peterson, A. P., & Dreessen, A. (2015). Pilot randomized controlled trial of dialectical behavior therapy group skills training for ADHD among college students. Journal of Attention Disorders, 19(3), 260-271. DOI: https://doi.org/10.1177/1087054714535951
Flynn, D., Joyce, M., Weihrauch, M., & Corcoran, P. (2018). Innovations in Practice: Dialectical behaviour therapy - skills training for emotional problem solving for adolescents (DBT STEPS-A): evaluation of a pilot implementation in Irish postprimary schools. Child and Adolescent Mental Health, 23(4), 376-380. DOI: https://doi.org/10.1111/camh.12284
Fruzzetti, A. E. (2022). Dialectical Thinking. Cognitive and Behavioral Practice, 29(3), 567-570. DOI: https://doi.org/10.1016/j.cbpra.2022.02.011
Guy, S. C., Isquith, P. K., & Gioia, G. A. (2004). Behavior rating inventory of executive function-self-report version. Lutz, FL: Psychological Assessment Resources.
Harvey, P. D. (2012). Clinical applications of neuropsychological assessment. Dialogues in Clinical Neuroscience, 14(1), 91-99. doi:10.31887/dcns.2012.14.1/pharvey. DOI: https://doi.org/10.31887/DCNS.2012.14.1/pharvey
Iskric, A., & Barkley-Levenson, E. (2021). Neural Changes in Borderline Personality Disorder After Dialectical Behavior Therapy-A Review. Frontiers in psychiatry, 12, 772081. doi:10.3389/fpsyt.2021.772081 DOI: https://doi.org/10.3389/fpsyt.2021.772081
Joanna Briggs Institute. (2020). Checklist for quasi-experimental studies (non-randomized experimental studies. Available from: https://jbi.global/critical-appraisal-tools
Jongen, P. J., Ter Horst, A. T., & Brands, A. M. (2012). Cognitive impairment in multiple sclerosis. Minerva medica, 103(2), 73-96.
Linehan, M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.
Linehan, M. M. (2003). Dialectical behavior therapy. Association for Behavioral and Cognitive Therapies.
Linehan, M. M., Dimeff, L. A. & Sayrs, J. H. R. (2004). Dialectical behavior therapy for substance abusers with borderline personality disorder: An extension of standard DBT. Unpublished manuscript.
Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard, H. L., Korslund, K. E., Tutek, D. A., Reynolds, S. K., & Lindenboim, N. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63(7), 757-766. DOI: https://doi.org/10.1001/archpsyc.63.7.757
Linehan, M. (2014). DBT Skills training manual (2nd ed.). Guilford Publications.
MacPherson, H. A., Cheavens, J. S., & Fristad, M. A. (2012). Dialectical behavior therapy for adolescents: Theory, treatment adaptations, and empirical outcomes. Clinical Child and Family Psychology Review, 16(1), 59-80. doi:10.1007/s10567-012-0126-7. DOI: https://doi.org/10.1007/s10567-012-0126-7
Maffei, C., Cavicchioli, M., Movalli, M., Cavallaro, R., & Fossati, A. (2018). Dialectical behavior therapy skills training in alcohol dependence treatment: Findings based on an open trial. Substance Use & Misuse, 53(14), 2368-2385. doi:10.1080/10826084.2018.1480035. DOI: https://doi.org/10.1080/10826084.2018.1480035
Mancke, F., Schmitt, R., Winter, D., Niedtfeld, I., Herpertz, S. C., & Schmahl, C. (2018). Assessing the marks of change: how psychotherapy alters the brain structure in women with borderline personality disorder. Journal of Psychiatry & Neuroscience: JPN, 43(3), 171-181. DOI: https://doi.org/10.1503/jpn.170132
Mattanah, J. J., Becker, D. F., Levy, K. N., Edell, W. S., & Mc-Glashan, T. H. (1995). Diagnostic stability in adolescents followed up 2 years after hospitalization. American Journal of Psychiatry, 152(6), 889-894. DOI: https://doi.org/10.1176/ajp.152.6.889
Mazza, J. J., Dexter-Mazza, E. T., Miller, A. L., Rathus, J. H., Murphy, H. E., & Linehan, M. M. (2016). DBT® skills in schools: Skills training for emotional problem solving for adolescents (DBT STEPS-A). Guilford Press. DOI: https://doi.org/10.1093/oxfordhb/9780198758723.013.21
McKay, M., Wood, J. C., & Brantley, J. (2019). The dialectical behavior therapy skills workbook: Practical DBT exercises for learning mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. New Harbinger Publications.
McMain, S., Korman, L. M., & Dimeff, L. (2001). Dialectical behavior therapy and the treatment of emotion dysregulation. Journal of Clinical Psychology, 57(2), 183-196. DOI: https://doi.org/10.1002/1097-4679(200102)57:2<183::AID-JCLP5>3.0.CO;2-Y
Mehlum, L. (2021). Mechanisms of change in dialectical behaviour therapy for people with borderline personality disorder. Current Opinion in Psychology, 37, 89-93. DOI: https://doi.org/10.1016/j.copsyc.2020.08.017
Millan, M. J., Agid, Y., Brüne, M., Bullmore, E. T., Carter, C. S., Clayton, N. S., Connor, R., Davis, S., Deakin, B., DeRubeis, R. J., Dubois, B., Geyer, M. A., Goodwin, G. M., Gorwood, P., Jay, T. M., Joëls, M., Mansuy, I. M., Meyer-Lindenberg, A., Murphy, D., … Young, L. J. (2012). Cognitive dysfunction in psychiatric disorders: characteristics, causes and the quest for improved therapy. Nature Reviews. Drug Discovery, 11(2),141-168. DOI: https://doi.org/10.1038/nrd3628
Miller, A. L., Muehlenkamp, J. J., & Jacobson, C. M. (2008). Fact or fiction: Diagnosing borderline personality disorder in adolescents. Clinical psychology review, 28(6), 969-981. DOI: https://doi.org/10.1016/j.cpr.2008.02.004
Miller, A. L., Rathus, L. H., Linehan, M. M., Wetzler, S., & Leigh, E. (1997). Dialectical behavior therapy adapted for suicidal adolescents. Journal of Psychiatric Practice, 3(2), 78. DOI: https://doi.org/10.1097/00131746-199703000-00002
Miotto, E. C., Savage, C. R., Evans, J. J., Wilson, B. A., Martins, M., Iaki, S., & Amaro, E. (2006). Bilateral activation of the prefrontal cortex after strategic semantic cognitive training. Human Brain Mapping, 27(4), 288-295. doi:10.1002/hbm.20184. DOI: https://doi.org/10.1002/hbm.20184
Neacsiu, A. D., Eberle, J. W., Kramer, R., Wiesmann, T., & Linehan, M. M. (2014). Dialectical behavior therapy skills for transdiagnostic emotion dysregulation: a pilot randomized controlled trial. Behaviour Research and Therapy, 59, 40-51. DOI: https://doi.org/10.1016/j.brat.2014.05.005
Hendler, T., Pessoa, L., & Shackman, A. J. (2015). The neurobiology of emotion-cognition interactions: fundamental questions and strategies for future research. Frontiers in Human Neuroscience. doi:10.3389/fnhum.2015.00058. DOI: https://doi.org/10.3389/fnhum.2015.00058
Page, M. J., McKenzie, J., Bossuyt, P., Boutron, I., Hoffmann, T., mulrow, c., Shamseer, L., Tetzlaff, J., Akl, E., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E., Mayo-Wilson, E., McDonald, S., Moher, D. (2020). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021. doi:10.31222/osf.io/v7gm2. DOI: https://doi.org/10.31222/osf.io/v7gm2
Poissant, H., Mendrek, A., Talbot, N., Khoury, B., & Nolan, J. (2019). Behavioral and Cognitive Impacts of Mindfulness- Based Interventions on Adults with Attention-Deficit Hyperactivity Disorder: A Systematic Review. Behavioural neurology, 5682050. doi:10.1155/2019/5682050. DOI: https://doi.org/10.1155/2019/5682050
Ritschel, L. A., Lim, N. E., & Stewart, L. M. (2015). Transdiagnostic Applications of DBT for Adolescents and Adults. American Journal of Psychotherapy, 69(2), 111-128. DOI: https://doi.org/10.1176/appi.psychotherapy.2015.69.2.111
Robins, C. J. (2002). Zen principles and mindfulness practice in dialectical behavior therapy. Cognitive and Behavioral Practice, 9(1), 50-57. DOI: https://doi.org/10.1016/S1077-7229(02)80040-2
Rodrigo, A. H. (2015). Changes in Neural Systems Underlying Response Inhibition in Patients with BPD After Six Months of Dialectical Behaviour Therapy. University of Toronto.
Rodrigo, A., Domenico, S. I. D., Ayaz, H., Gulrajani, S., Lam, J., & Ruocco, A. C. (2014). Differentiating functions of the lateral and medial prefrontal cortex in motor response inhibition. NeuroImage, 85 Pt 1, 423-431. DOI: https://doi.org/10.1016/j.neuroimage.2013.01.059
Rosenthal, M. Z., Lynch, T. R. & Linehan, M. M. 2005. Dialectical Behavior Therapy for individuals with Borderline Personality Disorder and Substance Use Disorders. In: Frances, R. J., Miller, S. I. & Mack, A. H. (eds.) Clinical Textbook of Addictive Disorders. 3rd ed. New York: Guilford Press.
Ruff, R. M. (1987). The Ruff Figural Fluency Test: A Normative Study with Adults. DOI: https://doi.org/10.1080/87565648709540362
Sadock, B. J., & Sadock, V. A. (2011). Kaplan and Sadock's synopsis of psychiatry: Behavioral sciences/Clinical psychiatry. Lippincott Williams & Wilkins.
Sauer-Zavala, S., Gutner, C. A., Farchione, T. J., Boettcher, H. T., Bullis, J. R., & Barlow, D. H. (2017). Current definitions of “Transdiagnostic” in treatment development: A search for consensus. Behavior Therapy, 48(1), 128-138. doi:10.1016/j.beth.2016.09.004 DOI: https://doi.org/10.1016/j.beth.2016.09.004
Schmitt, R., Winter, D., Niedtfeld, I., Herpertz, S. C., & Schmahl, C. (2016). Effects of Psychotherapy on Neuronal Correlates of Reappraisal in Female Patients With Borderline Personality Disorder. Biological Psychiatry. Cognitive Neuroscience and Neuroimaging, 1(6), 548-557. DOI: https://doi.org/10.1016/j.bpsc.2016.07.003
Secrist, C. D. (2014). The Role of Executive Functioning in the Treatment of Borderline Personality Disorder. University of Washington Libraries.
Shahgholian, M., Azadfallah, P., Fathi-Ashtiani, A., & Khodadadi, M. (2012). Design of the Wisconsin Card Sorting Test (WCST) computerized version: Theoretical fundamental, developing and psychometrics characteristics. J Clinical Psychology Studies, 1(4), 110-134.
Shallice, T. (1982). Specific impairments of planning. Philosophical Transactions of the Royal Society of London. B, Biological Sciences, 298(1089), 199-209. DOI: https://doi.org/10.1098/rstb.1982.0082
Silveira, C., Guedes, R., Maia, D., Curral, R., & Coelho, R. (2019). Neuropsychiatric symptoms of multiple sclerosis: State of the art. Psychiatry Investigation, 16(12), 877-888. doi:10.30773/pi.2019.0106 DOI: https://doi.org/10.30773/pi.2019.0106
Smith, A., Freeman, K., Montgomery, S., Vermeersch, D., & James, S. (2018). Executive functioning outcomes among adolescents receiving dialectical behavior therapy. Child and Adolescent Social Work Journal. DOI: https://doi.org/10.1007/s10560-018-0578-9
Soler, J., Elices, M., Pascual, J. C., Martín-Blanco, A., Feliu-Soler, A., Carmona, C., & Portella, M. J. (2016). Effects of mindfulness training on different components of impulsivity in borderline personality disorder: results from a pilot randomized study. Borderline personality disorder and emotion dysregulation, 3, 1. doi:10.1186/s40479-015-0035-8. DOI: https://doi.org/10.1186/s40479-015-0035-8
Soler, J., Valdepérez, A., Feliu-Soler, A., Pascual, J. C., Portella, M. J., Martín-Blanco, A., Alvarez, E., & Pérez, V. (2012). Effects of the dialectical behavioral therapy-mindfulness module on attention in patients with borderline personality disorder. Behaviour Research and Therapy, 50(2), 150-157. DOI: https://doi.org/10.1016/j.brat.2011.12.002
Sterne, J. A. C., Savović, J., Page, M. J., Elbers, R. G., Blencowe, N. S., Boutron, I., Cates, C. J., Cheng, H.-Y., Corbett, M. S., Eldridge, S. M., Emberson, J. R., Hernán, M. A., Hopewell, S., Hróbjartsson, A., Junqueira, D. R., Jüni, P., Kirkham, J. J., Lasserson, T., Li, T., … Higgins, J. P. T. (2019). RoB 2: a revised tool for assessing risk of bias in randomised trials [Review of RoB 2: a revised tool for assessing risk of bias in randomised trials]. BMJ , 366, l4898. DOI: https://doi.org/10.1136/bmj.l4898
Strauss, E., Sherman, E. S., & Spreen, O. (2006). A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary (3rd. Ed). New York, NY: Oxford University Press.
Stroop. (1935). Studies of interference in serial verbal reactions. Journal of Experimental Psychology. https://psycnet.apa.org/journals/xge/18/6/643/. DOI: https://doi.org/10.1037/h0054651
Tavakoli, M., Barekatain, M., & Emsaki, G. (2015). An Iranian normative sample of the Color Trails Test. Psychology & Neuroscience, 8(1), 75-81. DOI: https://doi.org/10.1037/h0100351
Thomsen, M. S., Ruocco, A. C., Carcone, D., Mathiesen, B. B., & Simonsen, E. (2017). Neurocognitive deficits in borderline personality disorder: Associations with childhood trauma and dimensions of personality psychopathology. Journal of Personality Disorders, 31(4), 503-521. doi:10.1521/pedi_2016_30_265. DOI: https://doi.org/10.1521/pedi_2016_30_265
Torrent, C., Martinez-Aran, A., Daban, C., Sanchez-Moreno, J., Comes, M., Goikolea, J. M., Salamero, M., & Vieta, E. (2006). Cognitive impairment in bipolar II disorder Cognitive impairment in bipolar II disorder. British Journal of Psychiatry, 189, 254-259. doi:10.1192/bjp.bp.105.017269. DOI: https://doi.org/10.1192/bjp.bp.105.017269
Tuckman, A. (2007). Integrative treatment for adult ADHD. Oakland, CA: New Harbinger.
Van Dijk, S., Jeffrey, J., & Katz, M. R. (2013). A randomized, controlled, pilot study of dialectical behavior therapy skills in a psychoeducational group for individuals with bipolar disorder. Journal of Affective Disorders, 145(3), 386-393. DOI: https://doi.org/10.1016/j.jad.2012.05.054
Verbruggen, F., Logan, G. D. & Stevens, M. 2008. STOP-IT: Windows executable software for the stop-signal paradigm. Behavior Research Methods, 40, 479-483. DOI: https://doi.org/10.3758/BRM.40.2.479
Wayne, K. R. (2018). Using Dialectical Behavior Therapy to Improve School Performance of High School Students. Philadelphia College of Osteopathic Medicine.
Wechsler, D. (1945). A Standardized Memory Scale for Clinical Use. Psychological Corporation. DOI: https://doi.org/10.1080/00223980.1945.9917223
Wechsler, D. (1981). Wechsler adult intelligence scale: revised WAIS-R. Psychological Corporation.
Xiao, J., Chow, K. M., Liu, Y., & Chan, C. W. (2019). Effects of dignity therapy on dignity, psychological well-being, and quality of life among palliative care cancer patients: A systematic review and meta-analysis. Psycho-Oncology, 28(9), 1791-1802. doi:10.1002/pon.5162. DOI: https://doi.org/10.1002/pon.5162
Zargar, F., Haghshenas, N., Rajabi, F., & Tarrahi, M. J. (2019). Effectiveness of Dialectical Behavioral Therapy on Executive Function, Emotional Control and Severity of Symptoms in Patients with Bipolar I Disorder. Advanced biomedical research, 8, 59. doi:10.4103/abr.abr_42_19. DOI: https://doi.org/10.4103/abr.abr_42_19

How to Cite

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). https://doi.org/10.4081/ripppo.2023.662

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