Recent Innovations in Psychology

Recent Innovations in Psychology

Effectiveness of Dialectical Behavior Therapy on Emotional Regulation and Cognitive Flexibility in Men with Type 1 Bipolar Disorder

Document Type : Original Article

Authors
Ali Sadeghi 1
Maryam Jalali 2
Ali Tavakoli Benizi 3
1 MSc. in Clinical Psychology, Shahrood Branch, Islamic Azad University, Shahrood, Iran
2 Ph.D. in Psychology, Shahrood Branch, Islamic Azad University, Shahrood, Iran
3 Assistant Professor, Department of Psychology. Yadegar-e Imam Khomeini Branch, Islamic Azad University ,Shahre Rey. Iran
10.22034/rip.2024.471720.1052
Abstract
The present study was conducted with the objective of determining the efficacy of dialectical behavior therapy (DBT) in facilitating emotion regulation and cognitive flexibility in men with type 1 bipolar disorder. This research employed a semi-experimental method with a pre-test-post-test design, utilizing a control group. The statistical population comprised 75 male patients diagnosed with bipolar disorder type 1 at Imam Reza Hospital in Bojnourd (a city in Iran) in 2023. A total of 30 patients were selected using convenience sampling and randomly assigned to two groups of 15 individuals each, comprising the experimental and control groups. The questionnaires employed included the Emotion Regulation Questionnaire (ERQ) and the Cognitive Flexibility Inventory (CFI). The experimental group underwent eight sessions of dialectical behavior therapy, each lasting 90 minutes, while the control group did not receive any intervention. The results of the multivariate analysis of covariance demonstrated that dialectical group psychotherapy had a statistically significant impact on emotion regulation and cognitive flexibility in men with bipolar disorder type 1 (P < 0.01). This was evidenced by a notable increase in the emotion regulation and cognitive flexibility scores of patients in the experimental group, in comparison to the control group. Given that the results support the effectiveness of this approach on the variables mentioned, attention to this method can be very practical and effective for men with type 1 bipolar disorder.
Keywords
bipolar disorder
cognitive flexibility
dialectical behavior therapy
emotion regulation

Subjects

References

Afshari, B., Omidi, A., & Sehat, M. (2019). Effect of dialectical behavior therapy on emotion regulation and mindfulness in patients with bipolar disorder. Feyz Medical Sciences Journal, 23(3), 293-300. (In Persian). URL: http://feyz.kaums.ac.ir/article-1-3740-en.html

American Psychiatric Association, DSM-5 Task Force. (2013). Diagnostic and statistical manual of mental disorders: DSM-5™ (5th ed.). American Psychiatric Publishing, Inc.. https://doi.org/10.1176/appi.books.9780890425596

Bailey, B. C., Novick, D., Boyce, K., & Swartz, H. A. (2023). Dialectical Behavior and Social Rhythm Therapy for Comorbid Bipolar Disorder and Borderline Personality Disorder. American Journal of Psychotherapy, 77(1), 23-29. https://doi.org/10.1176/appi.psychotherapy.20230006

De Prisco, M., Oliva, V., Fico, G., Radua, J., Grande, I., Roberto, N., ... & Murru, A. (2023). Emotion dysregulation in bipolar disorder compared to other mental illnesses: a systematic review and meta-analysis. Psychological Medicine,4(5), 1-20. https://doi.org/10.1017/S003329172300243X

Dennis, J. P., & Van der wal, J. S.(2010). The cognitive flexibility inventory: Instrument development and estimates of reliability and validity. Cogn Ther Res, 34(3), 241-53. https://doi.org/10.1007/s10608-009-9276-4

DiRocco, A. (2020). Adapting Dialectical Behavior Therapy for the Treatment of Bipolar Disorder (Doctoral dissertation, Alliant International University). URL: https://www.proquest.com/openview/59ffe88e7afbed2d78e5df9e977ce87d

Eisner, L., Eddie, D., Harley, R., Jacobo, M., Nierenberg, A. A., & Deckersbach, T. (2017). Dialectical behavior therapy group skills training for bipolar disorder. Behavior therapy, 48(4), 557-566. https://doi.org/10.1016/j.beth.2016.12.006 

Escamilla, M. A., & Zavala, J. M. (2022). Genetics of bipolar disorder. Dialogues in clinical neuroscience. 10(2), 141-152. https://doi.org/10.31887/DCNS.2008.10.2/maescamilla

Eskandari, H., & Qaderi Bagajan, K. (2017). Effect of group dialectical behavior therapy on the resiliency of people with physical disability. Middle Eastern Journal of Disability Studies, 7(0), 72..  (In Persian). URL: http://jdisabilstud.org/article-1-729-fa.html

Farvareshi, M., Alivandi Vafa, M., Fakhari, A., & Azmoudeh, M. (2019). The Effectiveness Of Dialectical Behavioral Therapy (Based On Emotion Regulation Training) On Impulsivity And Quality Of Life In Patients With Type I Bipolar Disorder: A Quasi-Experimental Study. Studies in Medical Sciences, 30(1), 29-40. (In Persian). URL: http://umj.umsu.ac.ir/article-1-4723-fa.html

Goldstein, T. R., Merranko, J., Rode, N., Sylvester, R., Hotkowski, N., Fersch-Podrat, R., ... & Birmaher, B. (2024). Dialectical behavior therapy for adolescents with bipolar disorder: A randomized clinical trial. JAMA psychiatry, 81(1), 15-24. https://doi.org/10.1001/jamapsychiatry.2023.3399

Gross, J. J., & John, O. P. (2003). Individual difference in two emotion regulation processes: Implications for affect, relationships, and wellbeing. Journal of Personality and Social Psychology, 85(2), 348-362. https://psycnet.apa.org/record/2003-05897-016

Gross, J. J., & Thompson, R. A. (2007). Emotion Regulation: Conceptual Foundations. In J. J. Gross (Ed.), Handbook of emotion regulation (pp. 3–24). The Guilford Press. URL: https://psycnet.apa.org/record/2007-01392-001

Hosseini, S., & Nasri, M. (2022). Effectiveness of a hybride dialectical behavior therapy and Lithum Carbonate compared to sole medication treatment on emotion-regulation, self-control and cognitive-flexibility of bipolar disordered patients. Journal of Clinical Psychology, 14(1), 13-24.(In Persian) https://doi.org/10.22075/jcp.2021.21997.2030 

Kazemi, R. S. V., Kakabraee, K., & Hosseini, S. S. (2019). The effectiveness of teaching emotion regulation skill based on dialectical behavioral therapy on psychological distress and cognitive flexibility cardiovascular patients. Iranian Journal of Psychiatric Nursing, 7(3), 31-40. (In Persian). URL: http://ijpn.ir/article-1-1359-en.html

Kermani, M., & Imani, S. (2025). The Mediating Role of Cognitive Flexibility in the Relationship Between Internet Addiction and Anxiety and Depression in Adolescents: A Gender Invariance Analysis. (e218093). Recent Innovations in Psychology, e218093 (In Persian). https://doi.org/10.22034/rip.2025.514124.1092

Kondo, F., Whitehead, J. C., Corbalán, F., Beaulieu, S., & Armony, J. L. (2023). Emotion regulation in bipolar disorder type-I: multivariate analysis of fMRI data. International Journal of Bipolar Disorders, 11(1), 12. https://doi.org/10.1186/s40345-023-00292-w

McCauley, E., Berk, M. S., Asarnow, J. R., Adrian, M., Cohen, J., Korslund, K., ... & Linehan, M. M. (2018). Efficacy of dialectical behavior therapy for adolescents at high risk for suicide: a randomized clinical trial. JAMA psychiatry, 75(8), 777-785. https://doi.org/10.1001/jamapsychiatry.2018.1109

Miola, A., Tondo, L., Pinna, M., Contu, M., & Baldessarini, R. J. (2023). Comparison of bipolar disorder type II and major depressive disorder. Journal of Affective Disorders, 323, 204-212. https://doi.org/10.1016/j.jad.2022.11.039

Öngen DE.(2010). Cognitive emotion regulation in the prediction of depression and submissive behavior: Gender and grade level differences in Turkish adolescents. Procedia-Social and Behavioral Sciences, 9(3):1516-23. https://doi.org/10.1016/j.sbspro.2010.12.358

Pisk, S. V., Ivezic, E., Mance, L. S., Matic, K., Svetinovic, D., Grosic, V., & Filipcic, I. (2023). Bipolar disorder type II-will the new classification help in setting an adequate diagnosis. European Psychiatry, 66(S1), S709-S710. https://doi.org/10.1192/j.eurpsy.2023.1485

Qasimpour, A., Ilbeigi, R., & Hassanzadeh. S. (2011). Psychometric characteristics of Gross and John emotional regulation questionnaire in an Iranian sample. The 6th Student Mental Health Conference, Gilan University. (In Persian). URL: https://elmnet.ir/doc/470108998-71994

Radoeva, P. D., Jenkins, G. A., Schettini, E., Gilbert, A. C., Barthelemy, C. M., DeYoung, L. L., ... & Dickstein, D. P. (2020). White matter correlates of cognitive flexibility in youth with bipolar disorder and typically developing children and adolescents. Psychiatry Research: Neuroimaging, 305, 111169. https://doi.org/10.1016/j.pscychresns.2020.111169

Soltani, E., Shareh, H., Bahrainian, S. A., & Farmani, A. (2013). The mediating role of cognitive flexibility in correlation of coping styles and resilience with depression. Pajoohandeh Journal, 18(2), 88-96. (In Persian). URL: http://pajoohande.sbmu.ac.ir/article-1-1518-en.html

Tondo, L., Miola, A., Pinna, M., Contu, M., & Baldessarini, R. J. (2022). Differences between bipolar disorder types 1 and 2 support the DSM two-syndrome concept. International Journal of Bipolar Disorders, 10(1), 1-11. https://doi.org/10.1186/s40345-022-00268-2

Varo, C., Amoretti, S., Sparacino, G., Jiménez, E., Solé, B., del Mar Bonnin, C., ... & Verdolini, N. (2023). Emotional intelligence: a comparison between patients after first episode mania and those suffering from chronic bipolar disorder type I. Psychological Medicine, 53(7), 3065-3076. https://doi.org/10.1017/S0033291721005122

Vijayapriya, C. V., & Tamarana, R. (2023). Effectiveness of dialectical behavior therapy as a transdiagnostic treatment for improving cognitive functions: a systematic review. Research in Psychotherapy: Psychopathology, Process, and Outcome, 26(2), 14-22. https://doi.org/10.4081/ripppo.2023.662

Wright, K., Dodd, A. L., Warren, F. C., Medina-Lara, A., Dunn, B., Harvey, J., ... & Lynch, T. R. (2021). Psychological therapy for mood instability within bipolar spectrum disorder: a randomised, controlled feasibility trial of a dialectical behaviour therapy-informed approach (the ThrIVe-B programme). International Journal of Bipolar Disorders, 9,(4), 1-13. https://doi.org/10.1186/s40345-021-00226-4

References
Afshari, B., Omidi, A., & Sehat, M. (2019). Effect of dialectical behavior therapy on emotion regulation and mindfulness in patients with bipolar disorder. Feyz Medical Sciences Journal, 23(3), 293-300. (In Persian). URL: http://feyz.kaums.ac.ir/article-1-3740-en.html
American Psychiatric Association, DSM-5 Task Force. (2013). Diagnostic and statistical manual of mental disorders: DSM-5™ (5th ed.). American Psychiatric Publishing, Inc.. https://doi.org/10.1176/appi.books.9780890425596
Bailey, B. C., Novick, D., Boyce, K., & Swartz, H. A. (2023). Dialectical Behavior and Social Rhythm Therapy for Comorbid Bipolar Disorder and Borderline Personality Disorder. American Journal of Psychotherapy, 77(1), 23-29. https://doi.org/10.1176/appi.psychotherapy.20230006
De Prisco, M., Oliva, V., Fico, G., Radua, J., Grande, I., Roberto, N., ... & Murru, A. (2023). Emotion dysregulation in bipolar disorder compared to other mental illnesses: a systematic review and meta-analysis. Psychological Medicine,4(5), 1-20. https://doi.org/10.1017/S003329172300243X
Dennis, J. P., & Van der wal, J. S.(2010). The cognitive flexibility inventory: Instrument development and estimates of reliability and validity. Cogn Ther Res, 34(3), 241-53. https://doi.org/10.1007/s10608-009-9276-4
DiRocco, A. (2020). Adapting Dialectical Behavior Therapy for the Treatment of Bipolar Disorder (Doctoral dissertation, Alliant International University). URL: https://www.proquest.com/openview/59ffe88e7afbed2d78e5df9e977ce87d
Eisner, L., Eddie, D., Harley, R., Jacobo, M., Nierenberg, A. A., & Deckersbach, T. (2017). Dialectical behavior therapy group skills training for bipolar disorder. Behavior therapy, 48(4), 557-566. https://doi.org/10.1016/j.beth.2016.12.006 
Escamilla, M. A., & Zavala, J. M. (2022). Genetics of bipolar disorder. Dialogues in clinical neuroscience. 10(2), 141-152. https://doi.org/10.31887/DCNS.2008.10.2/maescamilla
Eskandari, H., & Qaderi Bagajan, K. (2017). Effect of group dialectical behavior therapy on the resiliency of people with physical disability. Middle Eastern Journal of Disability Studies, 7(0), 72..  (In Persian). URL: http://jdisabilstud.org/article-1-729-fa.html
Farvareshi, M., Alivandi Vafa, M., Fakhari, A., & Azmoudeh, M. (2019). The Effectiveness Of Dialectical Behavioral Therapy (Based On Emotion Regulation Training) On Impulsivity And Quality Of Life In Patients With Type I Bipolar Disorder: A Quasi-Experimental Study. Studies in Medical Sciences, 30(1), 29-40. (In Persian). URL: http://umj.umsu.ac.ir/article-1-4723-fa.html
Goldstein, T. R., Merranko, J., Rode, N., Sylvester, R., Hotkowski, N., Fersch-Podrat, R., ... & Birmaher, B. (2024). Dialectical behavior therapy for adolescents with bipolar disorder: A randomized clinical trial. JAMA psychiatry, 81(1), 15-24. https://doi.org/10.1001/jamapsychiatry.2023.3399
Gross, J. J., & John, O. P. (2003). Individual difference in two emotion regulation processes: Implications for affect, relationships, and wellbeing. Journal of Personality and Social Psychology, 85(2), 348-362. https://psycnet.apa.org/record/2003-05897-016
Gross, J. J., & Thompson, R. A. (2007). Emotion Regulation: Conceptual Foundations. In J. J. Gross (Ed.), Handbook of emotion regulation (pp. 3–24). The Guilford Press. URL: https://psycnet.apa.org/record/2007-01392-001
Hosseini, S., & Nasri, M. (2022). Effectiveness of a hybride dialectical behavior therapy and Lithum Carbonate compared to sole medication treatment on emotion-regulation, self-control and cognitive-flexibility of bipolar disordered patients. Journal of Clinical Psychology, 14(1), 13-24.(In Persian) https://doi.org/10.22075/jcp.2021.21997.2030 
Kazemi, R. S. V., Kakabraee, K., & Hosseini, S. S. (2019). The effectiveness of teaching emotion regulation skill based on dialectical behavioral therapy on psychological distress and cognitive flexibility cardiovascular patients. Iranian Journal of Psychiatric Nursing, 7(3), 31-40. (In Persian). URL: http://ijpn.ir/article-1-1359-en.html
Kermani, M., & Imani, S. (2025). The Mediating Role of Cognitive Flexibility in the Relationship Between Internet Addiction and Anxiety and Depression in Adolescents: A Gender Invariance Analysis. (e218093). Recent Innovations in Psychology, e218093 (In Persian). https://doi.org/10.22034/rip.2025.514124.1092
Kondo, F., Whitehead, J. C., Corbalán, F., Beaulieu, S., & Armony, J. L. (2023). Emotion regulation in bipolar disorder type-I: multivariate analysis of fMRI data. International Journal of Bipolar Disorders, 11(1), 12. https://doi.org/10.1186/s40345-023-00292-w
McCauley, E., Berk, M. S., Asarnow, J. R., Adrian, M., Cohen, J., Korslund, K., ... & Linehan, M. M. (2018). Efficacy of dialectical behavior therapy for adolescents at high risk for suicide: a randomized clinical trial. JAMA psychiatry, 75(8), 777-785. https://doi.org/10.1001/jamapsychiatry.2018.1109
Miola, A., Tondo, L., Pinna, M., Contu, M., & Baldessarini, R. J. (2023). Comparison of bipolar disorder type II and major depressive disorder. Journal of Affective Disorders, 323, 204-212. https://doi.org/10.1016/j.jad.2022.11.039
Öngen DE.(2010). Cognitive emotion regulation in the prediction of depression and submissive behavior: Gender and grade level differences in Turkish adolescents. Procedia-Social and Behavioral Sciences, 9(3):1516-23. https://doi.org/10.1016/j.sbspro.2010.12.358
Pisk, S. V., Ivezic, E., Mance, L. S., Matic, K., Svetinovic, D., Grosic, V., & Filipcic, I. (2023). Bipolar disorder type II-will the new classification help in setting an adequate diagnosis. European Psychiatry, 66(S1), S709-S710. https://doi.org/10.1192/j.eurpsy.2023.1485
Qasimpour, A., Ilbeigi, R., & Hassanzadeh. S. (2011). Psychometric characteristics of Gross and John emotional regulation questionnaire in an Iranian sample. The 6th Student Mental Health Conference, Gilan University. (In Persian). URL: https://elmnet.ir/doc/470108998-71994
Radoeva, P. D., Jenkins, G. A., Schettini, E., Gilbert, A. C., Barthelemy, C. M., DeYoung, L. L., ... & Dickstein, D. P. (2020). White matter correlates of cognitive flexibility in youth with bipolar disorder and typically developing children and adolescents. Psychiatry Research: Neuroimaging, 305, 111169. https://doi.org/10.1016/j.pscychresns.2020.111169
Soltani, E., Shareh, H., Bahrainian, S. A., & Farmani, A. (2013). The mediating role of cognitive flexibility in correlation of coping styles and resilience with depression. Pajoohandeh Journal, 18(2), 88-96. (In Persian). URL: http://pajoohande.sbmu.ac.ir/article-1-1518-en.html
Tondo, L., Miola, A., Pinna, M., Contu, M., & Baldessarini, R. J. (2022). Differences between bipolar disorder types 1 and 2 support the DSM two-syndrome concept. International Journal of Bipolar Disorders, 10(1), 1-11. https://doi.org/10.1186/s40345-022-00268-2
Varo, C., Amoretti, S., Sparacino, G., Jiménez, E., Solé, B., del Mar Bonnin, C., ... & Verdolini, N. (2023). Emotional intelligence: a comparison between patients after first episode mania and those suffering from chronic bipolar disorder type I. Psychological Medicine, 53(7), 3065-3076. https://doi.org/10.1017/S0033291721005122
Vijayapriya, C. V., & Tamarana, R. (2023). Effectiveness of dialectical behavior therapy as a transdiagnostic treatment for improving cognitive functions: a systematic review. Research in Psychotherapy: Psychopathology, Process, and Outcome, 26(2), 14-22. https://doi.org/10.4081/ripppo.2023.662
Wright, K., Dodd, A. L., Warren, F. C., Medina-Lara, A., Dunn, B., Harvey, J., ... & Lynch, T. R. (2021). Psychological therapy for mood instability within bipolar spectrum disorder: a randomised, controlled feasibility trial of a dialectical behaviour therapy-informed approach (the ThrIVe-B programme). International Journal of Bipolar Disorders, 9,(4), 1-13. https://doi.org/10.1186/s40345-021-00226-4

  • Receive Date 05 August 2024
  • Revise Date 19 September 2024
  • Accept Date 22 September 2024
  • First Publish Date 07 December 2024