اثربخشی رفتاردرمانی دیالکتیکی بر کاهش رفتارهای خودآسیب‌رسان در بیماران مبتلا به افسردگی مزمن

امیرهوشنگ  کیانپور; فرشید کمالی نژاد

Authors

Amirhooshang Kianpour M.A. Student, Department of Clinical Psychology, Islamshahr Branch, Islamic Azad University, Tehran, Iran. Author https://orcid.org/0000-0002-3063-8561
Farshid Kamalinejad Department of Clinical Psychology, Isl.C., Islamic Azad University, Tehran, Iran. Corresponding author https://orcid.org/0009-0008-4314-9020

Keywords:

Dialectical behavior therapy, self-injurious behaviors, chronic depression, persistent depressive disorder, emotion regulation

Abstract

This study aimed to investigate the effectiveness of dialectical behavior therapy in reducing self-injurious behaviors among patients with chronic depression. This clinical trial employed a pretest-posttest-follow-up design with a control group. The statistical population consisted of patients with chronic depression who referred to counseling and psychotherapy centers in 2025. Forty patients aged 18–60 years with a diagnosis of persistent depressive disorder based on DSM-5 criteria and a history of at least one self-injurious behavior during the previous six months were selected through purposive sampling. After matching, participants were randomly assigned to an experimental group (n=20) and a control group (n=20). The experimental group received 12 weekly 90-minute sessions of dialectical behavior therapy based on Linehan’s standard protocol, whereas the control group received no psychological intervention. Data were collected using the Inventory of Statements About Self-Injury at pretest, posttest, and two-month follow-up. Repeated-measures analysis of variance and Bonferroni post hoc comparisons were performed using SPSS version 26. Repeated-measures analysis of variance indicated a significant main effect of time on self-injurious behaviors (F=15.537, p<0.001, ηp²=0.290). The main effect of group was also statistically significant (F=111.801, p<0.001, ηp²=0.746). More importantly, the time × group interaction was significant (F=31.793, p<0.001, ηp²=0.456), indicating that changes in self-injurious behavior scores over time differed significantly between the experimental and control groups. Bonferroni pairwise comparisons showed significant differences between pretest and posttest and between pretest and follow-up (p<0.001), whereas the difference between posttest and follow-up was not significant (p>0.05). Moreover, the estimated mean self-injury score in the experimental group was significantly lower than that in the control group (mean difference=-8.533, p<0.001). Dialectical behavior therapy produced a significant and sustained reduction in self-injurious behaviors among patients with chronic depression. Accordingly, DBT can be considered an effective therapeutic intervention, either independently or as an adjunct to conventional treatment programs for patients with persistent depressive disorder who exhibit self-injurious behaviors.

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References

Abolghasemi, A., Sabet Dizkouhi, K., & Kafi, M. (2021). Comparison of Resilience, Self-Compassion, and Early Victimization Experiences in Students with and without Self-Injurious Behaviors. Clinical Psychology and Personality, 19(2), 45-56.

Ahmadi Marvili, N., Mirzahosseini, H., & Monirpour, N. (2019). A Predictive Model of Self-Harming Behaviors and Suicidal Tendency Based on Attachment Styles and Personality Organization in Adolescent Students: The Mediating Role of Cognitive Emotion Regulation Strategies. Applied Psychological Research, 10(3), 101-117.

Amini, A., & Shariatmadar, A. (2018). The Effectiveness of Group Dialectical Behavior Therapy on Catastrophizing and Rumination in Mothers of Children with Intellectual Disabilities. Counseling Culture and Psychotherapy Quarterly, 9(34), 171-190.

DeCou, C. R., Comtois, K. A., & Landes, S. J. (2019). Dialectical Behavior Therapy Is Effective for the Treatment of Suicidal Behavior: A Meta-Analysis. Behavior therapy, 50(1), 60-72. https://doi.org/10.1016/j.beth.2018.03.009

Favieri, R., Favieri, F., Google, S., & Casagrande, M. (2024). New Addictions in Late Adolescence and Emerging Adulthood: How Attachment Style May Predict Problematic Use of Social Networks and Binge-Watching. Healthcare, 12(5), 556. https://doi.org/10.3390/healthcare12050556

Frost, R. O., Ong, C., Steketee, G., & Tolin, D. F. (2016). Behavioral and Emotional Consequences of Thought Listing versus Cognitive Restructuring during Discarding Decisions in Hoarding Disorder. Behaviour Research and Therapy, 85, 13. https://doi.org/10.1016/j.brat.2016.08.003

Gajari, M. (2025). Examining the Effect of Trauma-Focused Cognitive Behavioral Therapy on Children's Self-Harming Behaviors. Bandar Abbas.

Grundmanis, L. (2023). Examining the Relationship Between Non-Suicidal Self Injury and.

Haddadi Kouhsar, A. A., Moradi, A., Ghobari Bonab, B., & Imani, F. (2018). Comparison of the Effectiveness of Spiritual Therapy Based on Iranian Culture with a Cognitive-Behavioral Approach and Mindfulness-Based Stress Reduction in Reducing Depression, Anxiety, and Stress in Patients with Chronic Pain. Clinical Psychology Studies, 8(31), 1-30.

Khanar, R. (2025). Cognitive-Existential Reconstruction of Identity and Explanation of the Meaning-Making Process of Authentic Happiness in Adolescents with Specific Learning Disorders: An Integrated Cognitive-Behavioral and Positive Psychology Approach. Bandar Abbas.

Klonsky, E. D., & Olino, T. M. (2008). Identifying Clinically Subgroups of Self-Injurers among Young Adults: A Latent Class Analysis. Journal of consulting and clinical psychology, 76(1), 22-27. https://doi.org/10.1037/0022-006X.76.1.22

Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J., & Heard, H. H. (2006). Two-Year Randomized Controlled Trial and Follow-Up of Dialectical Behavior Therapy vs Therapy by Experts for Suicidal Behaviors and Borderline Personality Disorder. Archives of General Psychiatry, 63, 757-766. https://doi.org/10.1001/archpsyc.63.7.757

Ludvik, D., & Boschen, M. J. (2015). Cognitive Restructuring and Detached Mindfulness: Comparative Impact on a Compulsive Checking Task. Journal of Obsessive-Compulsive and Related Disorders, 5, 8-15. https://doi.org/10.1016/j.jocrd.2015.01.004

Mahmoudi, A., & Amini, N. (2025). The Effectiveness of Dialectical Behavior Therapy on Depressive Symptoms and Self-Harming Behaviors in Adolescent Girls with Suicidal Tendency. Eslamshahr.

Sharifi, S. (2024). Comparing the Effectiveness of Dialectical Behavior Therapy, Schema Therapy, and Psychodynamic Psychotherapy in Reducing Symptoms and Signs of Borderline Personality Disorder: A Systematic Review. Mashhad.