Clarifying conceptualization of emotional dysregulation: Differences with emotional lability during 4-month DBT skills training - A naturalistic study.

Introduction: Emotion dysregulation is common in many different psychiatric disorders and it can be effectively treated with the well-established Dialectical Behavioral Therapy (DBT). Despite its clinical relevance and increasing scientific interest, emotional dysregulation (ED) is sometimes conflated with emotional lability (EL). However, these constructs differ: ED involves top-down neurobiological processes, while EL involves bottom-up processes. As psychotherapy essentially influences top-down processes compared to pharmacotherapy, this study aimed to investigate whether ED is more sensitive to DBT than EL.

Method: Our naturalistic study involved the 39 participants (sex ratio = 9 m/30w, mean age = 33.23) who completed questionnaires assessing ED (DERS-36) and EL (ALS-18) before then after transdiagnostic DBT skills training (DBT-ST). The diagnoses of participants included BPD (64 %), BD (23 %), ADHD (23 %), addiction (17 %) or eating disorder (17 %). DBT was performed in a transdiagnostic group over 4 months.

Result: After DBT-ST, ED improved significantly with a medium effect size (d = 0.73), while EL showed no significant change (d = 0.13). The percentages of improvement on DERS were significantly higher than on ALS (p < 0.002, d = 0.50). The correlation between these both measures decreased during therapy from r = 0.37 to r = 0.32.

Discussion: Our findings indicate that ED improved more than EL after DBT and that their correlation diminished during therapy. These results suggest that ED is a different process from EL and that ED is more sensitive to treatments like DBT Skills Training. To confirm these findings, further studies are needed ideally with larger sample size, long-term follow-up and a controlled design.