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Abstract
A central component of Dialectical Behavior Therapy (DBT) is the teaching of specific
behavioral skills with the aim of helping individuals with Borderline Personality
Disorder (BPD) replace maladaptive behaviors with skillful behavior. Although existing
evidence indirectly supports this proposed mechanism of action, no study to date has
directly tested it. Therefore, we examined the skills use of 108 women with BPD participating
in one of three randomized control trials throughout one year of treatment and four
months of follow-up. Using a hierarchical linear modeling approach we found that although
all participants reported using some DBT skills before treatment started, participants
treated with DBT reported using three times more skills at the end of treatment than
participants treated with a control treatment. Significant mediation effects also
indicated that DBT skills use fully mediated the decrease in suicide attempts and
depression and the increase in control of anger over time. DBT skills use also partially
mediated the decrease of nonsuicidal self-injury over time. Anger suppression and
expression were not mediated. This study is the first to clearly support the skills
deficit model for BPD by indicating that increasing skills use is a mechanism of change
for suicidal behavior, depression, and anger control.