Executive Functioning Outcomes Among Adolescents Receiving Dialectical Behavior Therapy

Changes in the adolescent brain underlie the development of executive functions (EFs) after the onset of puberty; however, adolescents that engage in deliberate self-harm (DSH) have impaired EFs in the areas of inhibition, emotion regulation, shifting, and interpersonal functioning. On the other hand, dialectical behavior therapy (DBT) has been shown to be effective in treating adolescents with DSH. Moreover, the DBT skills of mindfulness, emotion regulation, distress tolerance, interpersonal effectiveness, and “walking the middle path” are suited to treat these adolescents with impaired EFs. This single group pre-post study examined changes in adolescents’ EFs who were enrolled in DBT. Ninety-three adolescents from a 16-week DBT program for DSH were administered the Behavior Rating Inventory of Executive Function-Self Report (BRIEF-SR) at pre-treatment and post-treatment. Adolescents improved from the elevated to non-clinical range on the Emotional Control, Shifting, and Monitor scales in addition to the Global Executive Composite of the BRIEF-SR. Significant effects for funding type on shifting, interpersonal functioning, and overall EF were observed while a significant effect for previous history of psychiatric hospitalizations was observed for emotion regulation. DBT appears to be effective for improving the EFs of adolescents with DSH and for specific subgroups of this population. Knowledge of these adolescents’ profile of EFs will assist clinicians in determining the type and level of intervention with DBT in order to shape positive behaviors during this important period of brain development.