Borderline Personality Disorder (BPD), Depression Anxiety Disorder, Dialectical Behavior Therapy, Emotional Dysregulation, Self Harm, Suicidal and Self-injurious Behavior
Conditions
Keywords
BPD, DBT, Self harm, Suicide, Borderline personality, Dialectical behavior therapy, Emotional dysregulation
Brief summary
The study aims to assess the efficacy of culturally adapted dialectical behaviour therapy (DBT) for addressing emotional dysregulation in a low- and middle-income country, as well as to evaluate the impact of DBT on secondary outcomes such as borderline personality traits, self-harm or suicide, depression, anxiety, and individuals' functioning and disability. Through a rigorous Randomised Controlled Trial (RCT), the research seeks to assess how cultural adaptations of dialectical behaviour therapy improve its applicability, engagement, and outcomes in diverse socio-cultural settings, contributing to more accessible and effective mental health interventions in resource-limited regions.
Detailed description
DBT has proven successful in high-income countries; its application in low- and middle-income countries (LMICs) is limited despite the significant mental health burden in these regions. Mental health challenges in LMICs are further compounded by socio-cultural, economic, and infrastructural barriers, highlighting the need for culturally sensitive adaptations of evidence-based therapies. Culturally adapted DBT involves modifying therapeutic components to align with local norms, values, and language, while maintaining its core strategies, including mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance. Randomised Controlled Trials (RCTs) are essential to evaluate the feasibility, acceptability, and efficacy of such culturally tailored interventions, helping bridge the mental health treatment gap in LMICs. The current study aimed to evaluate the feasibility, acceptability, and clinical effectiveness of a culturally adapted Dialectical Behaviour Therapy (DBT) intervention for addressing mental health challenges in low- and middle-income countries (LMICs) as compared to treatment as usual (TAU).
Interventions
OTHERCulturally adapted DBT
Participants will receive culturally translated and adapted dialectical behaviour therapy (DBT) materials that fit local cultural and linguistic contexts. Such material will include culturally relevant metaphors, examples, and mindfulness practices. Sessions will be conducted in the form of weekly group skills training (emotion regulation, distress tolerance, interpersonal effectiveness, mindfulness), individual therapy sessions (1 hour/week), and telephone coaching as needed.
Sponsors
Pakistan Association of Cognitive Therapists
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Intervention model description
This will be a rater-blind RCT to evaluate the feasibility and acceptability of culturally adapted DBT in addition to treatment as usual (TAU) compared with TAU only in Pakistan. This study will employ a pre-post measure and parallel design over 18 months.
Eligibility
Sex/Gender
ALL
Age
18 Years to 45 Years
Healthy volunteers
No
Inclusion criteria
* Adults aged 18-45 years * Adults who are diagnosed with or have significant traits of borderline personality disorder (BPD) * Adults who are willing to provide written informed consent
Exclusion criteria
* Severe psychiatric comorbidity (e.g., active psychosis, substance use, etc.) * Acute medical conditions interfering with participation * Lack of basic reading and writing, or any learning disability
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Emotional dysregulation | 18 Months | As measured through participants' scores on the Difficulties in Emotion Regulation Scale-16 item version (DERS-16) |
| Self-harm or suicide | 18 months | As measured through the participants' scores on the Self-Harm Inventory, as well as the presence of any suicide attempt in participants' history |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Borderline traits | 18 months | As assessed through participants' scores on the Gul Mahmood Borderline Personality Traits Scale (GMBPTS) |
| Depression and anxiety | 18 months | As measured through participants' scores on Hospital Anxiety and Depression Scale (HADS) |
| Functioning and disability | 18 months | As assessed through the WHO Disability Assessment Schedule (WHODAS 2.0) |
Countries
Pakistan
Outcome results
None listed