(PS11-C67) The Effect of Dialectical Behavior Therapy on Dysregulated Anger in Borderline Personality Disorder: A Meta-analysis

Dysregulated anger, a core symptom of borderline personality disorder (BPD), is of considerable public health importance, with substantial societal costs and implications. Though anger is a useful emotion that can serve constructive purposes such as motivation to change stressful or difficult situations, chronic high levels of anger are associated with coronary heart disease (Smith et al., 2004), hypertension (Harburg et al., 2003), cancer (Thomas et al., 2000), and early mortality (Trudel-Fitzgerald et al., 2021). Additionally, anger is the most common emotional antecedent to aggressive behavior (Bettencourt et al., 2006; Novaco, 2016), which results in approximately 19,000 homicides and over 1.5 million hospitalizations per year in the US alone (Center for Disease Control [CDC], 2014; CDC 2021) and costs billions of dollars annually worldwide in medical expenses and lost productivity (Corso et al., 2007). Several psychosocial treatment approaches have been applied with individuals with BPD who exhibit difficulties regulating anger. Dialectical behavior therapy (DBT), a treatment designed to target emotional (e.g., affect lability, excessive anger) and behavioral (self-harm, aggression) dysregulation among high-risk individuals, such as those diagnosed with BPD (Harned et al., 2006; Linehan, 1993; Linehan et al., 1991), has begun to garner an evidence base in the reduction of anger dysregulation. However, the overall effects of DBT on anger outcomes among individuals diagnosed with BPD are unknown. To address this limitation, a systematic review with meta-analysis was conducted on 18 studies (N = 1,136), published in PsycINFO and PubMed between January 1994 and February 2022, assessing the effect of DBT on anger among those diagnosed with BPD. Included studies were empirical research articles published in a peer-reviewed journal that assessed the delivery of standard or adapted DBT among participants with BPD, using at least one quantitative outcome measure of anger. All studies included the core skills of DBT (i.e., mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness). The meta-analytic results were assessed for moderating effects of demographic (percentage female in the sample, age), treatment-related (administration of the standard outpatient DBT program, treatment duration, number of treatment sessions), and study-related (within- vs. between-subjects design, study publication year) variables. Risk of publication bias was also assessed. Results demonstrated that DBT significantly reduced anger among those diagnosed with BPD (Hedge’s G = -0.28, 95% CI [-0.38, -0.16]), independent of demographic and treatment-related variables. Only study-related variables, namely, between-subjects study designs and studies published earlier, were associated with greater reductions in anger. Findings from the present meta-analysis suggest that DBT is efficacious in reducing dysregulated anger in patients diagnosed with BPD across a variety of clinical settings and treatment features/adaptations, suggesting that the core elements of DBT may be responsible for the observed effect.