ABSTRACT
A major theoretical underpinning of DBT’s conceptualization of BPD is that as a result of the combination of emotional vulnerability and invalidating environments, clients have skills deficits (Chapter 5). DBT utilizes the different modalities of treatment to achieve the three key tasks in skills training: skill acquisition, skill strengthening and skill generalization. DBT skills groups focus primarily on skills acquisition and a degree of skills strengthening. Within the individual therapy component, the therapist strengthens skills by identifying opportunities to utilize either new or weak skills, rehearsing those skills with the client and tailoring them to the client’s particular circumstances. Generalization modalities focus on ensuring that skills learnt or strengthened in therapy transfer to the client’s nontherapy environment. Research by Neacsiu et al. (2010) confirms the central importance of skills in clinical outcomes. In their study of women diagnosed with BPD who participated in three different RCTs of DBT, participants treated with DBT reported three times as much skills-use as those receiving the control treatment. Perhaps more importantly DBT skills-use fully mediated the decrease in suicide attempts and depression and the increase in anger-control over time, and partially mediated the decrease in non-suicidal self-injury over time.
