Monitoring Change in an Adolescent DBT Skills Group: Alliance Growth, Emotion Regulation Change, and Non-Suicidal Self-Injury Outcomes

Abstract

Background: Brief DBT skills groups are widely implemented, but evidence on change processes in routine care is limited. Objective: To monitor change in working alliance, emotion regulation, and non-suicidal self-injury (NSSI) during a 4-week adolescent DBT skills group. Methods: De-identified data from 30 adolescents (mean age 15.33 years; 60% female) were analyzed. Participants completed PHQ-9, GAD-7, the Emotion Regulation Questionnaire (reappraisal, suppression), a brief NSSI frequency index, and the Working Alliance Inventory-Adolescent at session 1 and the final session. Pre-post change was tested with paired t tests and effect sizes (dz); correlations and exploratory mediation models linked alliance change to emotion regulation and NSSI change. Results: Symptoms and NSSI decreased (PHQ-9: mean change -2.50, p=.015, dz=-0.47; GAD-7: -1.87, p=.019, dz=-0.45; NSSI: -0.80, p<.001, dz=-0.90). Emotion regulation improved (reappraisal: +5.33, p<.001, dz=0.96; suppression: -2.43, p=.004, dz=-0.57). Alliance increased substantially (+12.00, p<.001, dz=3.03). Change in PHQ-9 correlated with change in NSSI (r=0.56) and GAD-7 (r=0.61). Exploratory mediation analyses did not provide evidence that emotion regulation change (ERQ) mediated the association between alliance change and NSSI change. Conclusions: A brief adolescent DBT skills group showed measurable improvements in alliance, emotion regulation, and NSSI, supporting feasible measurement-based monitoring in routine settings.