[Research Paper] DOCUMENT 1

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Cognitive Behaviour Therapy for Emotional

Regulation in Children with Autism

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Research question: Is available evidence to support the efficacy of CBT for children aged 6-8 with Autism for emotional regulation? If the provision of CBT is appropriate for this age group, does it qualify as an intervention better provided by mainstream mental health?

Date: 17/10/2022

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1. Contents

Cognitive Behaviour Therapy for Emotional Regulation in Children with Autism ………………….. 1

• 1. Contents ……………………………………………………………………………………………………….. 1
• 2. Summary ………………………………………………………………………………………………………. 2
• 3. Cognitive Behaviour Therapy ……………………………………………………………………………. 2
• 4. Cognitive Behaviour Therapy for Emotional Regulation in Children with Autism ………. 3
• 5. NDIS and Health Mainstream Interface ……………………………………………………………… 3
• 6. References ……………………………………………………………………………………………………. 4

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2. Summary

Cognitive behaviour therapy is considered a treatment approach to address a range of mental

and emotional health issues. There is some evidence in the literature to support the use of

cognitive behaviour therapy for children with autism, however implementation techniques may

need to be modified according to the child’s functional ability to participate in the therapy. As

cognitive behaviour therapy is considered a treatment approach for symptoms, it might be

better funded by mainstream mental health services.

3. Cognitive Behaviour Therapy

Cognitive behaviour therapy (CBT) is a treatment approach for a range of mental and

emotional health issues (Better Health Channel, 2022), including:

• Anxiety
• Anxiety disorders (e.g., social phobia, obsessive compulsive disorder)
• Depression
• Low self-esteem
• Irrational fears
• Hypochondria
• Substance misuse
• Eating disorders
• Insomnia
• Certain emotional and behavioural problems in children or teenagers

CBT combines cognitive therapy (changing or challenging maladaptive thoughts) and

behaviour therapy (learning new skills or helpful behaviours) (Better Health Channel, 2022).

CBT is considered a short-term form of psychotherapy, however it can still take more time to

successfully overcome maladaptive patterns of thinking and behaving (Better Health Channel,

2022).

Although CBT treatment plans are individualised to patient need, a typical intervention would

include (Whitehouse et al., 2020):

(a) explaining the cause of anxiety,

(b) discussing the impact of anxiety on daily life,

(c) identifying situations that induce anxiety and ordering these,

(d) gradually exposing the person to the situations from least to most confronting while

managing anxiety as it arises, and

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(e) teaching the individual additional coping strategies such as relaxation.

CBT can be implemented one-to-one with a therapist, in a group setting, or online (Hillman et al., 2020). For successful treatment, CBT requires active participation in treatment, and involves a close working relationship between the individual and the therapist (Better Health Channel, 2022). CBT can be implemented by counsellors, psychologists, mental health social workers and therapists (Better Health Channel, 2022).

4. Cognitive Behaviour Therapy for Emotional Regulation in Children with Autism

Evidence has related poor emotional regulation to emotional problems in children with autism, such as anxiety, depression, and anger (Thomson et al., 2015). The use of CBT for children with autism is based on research findings that anxiety disorders and depression are common in autism, and CBT may lead to improvements in mood disturbances and better emotional regulation, reduce unhelpful routines or behaviours of concern, and increase social behaviours (Thomson et al., 2015; Whitehouse et al., 2020). One specific systematic review/meta-analysis included 45 randomised controlled trials for children and adolescents with autism, although study quality was low to moderate, found lower symptoms of socio-emotional problems after CBT as reported by informants and clinician measures (Wang et al., 2021).

It is speculated that the structured nature of CBT makes it appropriate for individuals with autism (Sharma et al., 2018), however it is also noted that some CBT techniques, such as those that rely on verbal communication or provide insight into one’s own thoughts, may be challenging for some individuals with autism and therefore would need to be modified (Hillman et al., 2020). Additionally, specific modifications for younger children with autism would involve reducing abstract language, simplifying tasks that require metacognition (thinking about thinking), and incorporating strategies to engage the child to develop real-world skills (Keefer and Vasa, 2021).

5. NDIS and Health Mainstream Interface

The NDIS is responsible for ongoing functional support for day-to-day living. The National Disability Insurance Scheme (NDIS) does not fund clinical treatment from a mental health profession to address symptoms (National Disability Insurance Agency, 2018). As CBT is considered a treatment therapy to address mental health symptoms, it is likely to be more appropriately funded by the health system (National Disability Insurance Agency, 2022):

“cognitive behavioural therapy is a form of clinical treatment and the health system, not the NDIS, is the most appropriate agency to fund this support”

Further information can be found at Mental Health Access Snapshot 5 – NDIS and Other Services.docx (2018) and Mental health supports | NDIS (2022).

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6. References

Better Health Channel. (2022). Cognitive behaviour therapy. State Government Victoria. Accessed from https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/cognitive- behaviour-therapy

Hillman, K., Dix, K., Ahmed, K., Lietz, P., Trevitt, J., O’Grady, E., Uljarevic, M., Vivanti, G., & Hedley, D. (2020). Interventions for Anxiety in Mainstream School-Aged Children with Autism Spectrum Disorder: A Systematic Review. Campbell Systematic Reviews, 16(2).

Keefer, A., & Vasa, R. A. (2021). DINOSAUR: an integrated cognitive-behavioral treatment for anxiety in young children with ASD. Journal of neurodevelopmental disorders, 13(1), 46. https://doi.org/10.1186/s11689-021-09396-9

National Disability Insurance Agency. (2018). Mental health access snapshot series: snapshot 5 – NDIS and other services supporting your mental health. Accessed from https://intranet.ndiastaff.ndia.gov.au/service- delivery/_layouts/15/WopiFrame.aspx?sourcedoc=/service- delivery/Documents/Mental%20Health%20Access%20Snapshot%205%20%E2%80%9 3%20NDIS%20and%20Other%20Services.docx&action=default&DefaultItemOpen=1

National Disability Insurance Agency. (2022). Mental health supports. Accessed from https://ourguidelines.ndis.gov.au/would-we-fund-it/improved-health-and- wellbeing/mental-health-supports

Sharma, S. R., Gonda, X., & Tarazi, F. I. (2018). Autism Spectrum Disorder: Classification, diagnosis and therapy. Pharmacology & therapeutics, 190, 91–104. https://doi.org/10.1016/j.pharmthera.2018.05.007

Thomson, K., Burnham Riosa, P., & Weiss, J. A. (2015). Brief Report of Preliminary Outcomes of an Emotion Regulation Intervention for Children with Autism Spectrum Disorder. Journal of autism and developmental disorders, 45(11), 3487–3495. https://doi.org/10.1007/s10803-015-2446-1

Wang, X., Zhao, J., Huang, S., Chen, S., Zhou, T., Li, Q., Luo, X., & Hao, Y. (2021). Cognitive Behavioral Therapy for Autism Spectrum Disorders: A Systematic Review. Pediatrics, 147(5), e2020049880. https://doi.org/10.1542/peds.2020-049880

Whitehouse, A., Varcin, K., Waddington, H., Sulek, R., Bent, C., Ashburner, J., Eapen, V., Goodall, E., Hudry, K., Roberts, J., Silove, N., Trembath, D. Interventions for children on the autism spectrum: A synthesis of research evidence. Autism CRC, Brisbane, 2020.

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[Research Paper] DOCUMENT 2

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Dialectical Behaviour Therapy

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This document is intended to assist Technical Advice and Practice Improvement Branch (TAPIB) staff with provision of technical advice or practice improvement activities. Branch Manager clearance is required before research documents are shared outside the branch.

The TAPIB Research and Capability team take care to ensure the research presented is accurate at the time of writing. Due to the nature of our work, we are not able to ensure that all relevant research has been considered in the development of this document or that information remains accurate after publishing.

1. Contents

Dialectical Behaviour Therapy ……………………………………………………………………………………… 1

1. Contents ………………………………………………………………………………………………………….. 1

2. Summary …………………………………………………………………………………………………………. 2

3. Dialectical Behaviour Therapy …………………………………………………………………………….. 3

4. The Efficacy of Dialectical Behaviour Therapy ………………………………………………………. 4

4.1 Autism Spectrum Disorder and Dialectical Behaviour Therapy ................................ 4

4.2 Dissociative Personality Disorder and Dialectical Behaviour Therapy ..................... 7

4.3 Borderline Personality Disorder and Dialectical Behaviour Therapy ........................ 7

4.4 Other Conditions and Dialectical Behaviour Therapy ............................................... 8

5. Funding Options for Dialectical Behaviour Therapy in Australia ……………………………….. 9

6. Dialectical Behaviour Therapy Experts in Australia ………………………………………………. 10

7. References …………………………………………………………………………………………………….. 12

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2. Summary

Dialectical behaviour therapy is a type of ‘talk therapy’ which involves developing mindfulness skills, distress tolerance skills, emotional regulation skills and interpersonal effectiveness. It is used to treat symptoms such as strong emotions, self-harm, suicidal thoughts or suicide attempts, impulsive behaviour, and unstable relationships.

Recent research shows that dialectical behaviour therapy is an acceptable and feasible form of treatment for adults with autism spectrum disorder and without intellectual disability. There is preliminary evidence that dialectical behaviour therapy delivered in a way appropriate for individuals with autism spectrum disorder and without intellectual disability may improve emotion dysregulation and ability to identify emotions, depression, quality of life, mindfulness, and social functioning. It may also lead to a decrease in suicide attempts, suicide ideation and/or self-harming behaviour. However, the generalisability and quality of results is affected by the relatively small experimental groups, the lack of consistent use of control groups and randomisation, the almost exclusive use of self-reporting to measure symptom improvement, and the use of different measurement tools across studies. Studies also tended to opt for shorter intervention durations with the longest being 6.5 months.

Recent studies and systematic reviews on the efficacy of dialectical behaviour therapy in treating borderline personality disorder present inconclusive results. There is evidence of positive effects of dialectical behaviour therapy including decreases in suicidal behaviour, self- harm, depressive symptoms, general psychopathology, emotional dysregulation, hospital visits and persistent somatic symptoms, and an increase in interpersonal and psychosocial functioning and quality of life. However, there is also evidence that dialectical behaviour therapy may not have a superior effect to other forms of therapy on symptoms such as suicide attempts, self-harm, borderline personality disorder symptom severity, depression, and anxiety.

We did not find studies investigating the use of dialectical behaviour therapy in treating dissociative identity disorder that were published after 2016. However, it has been suggested that dialectical behaviour therapy may be appropriate for dissociative identity disorder as dissociative identity disorder is highly comorbid with borderline personality disorder and shared symptoms of the two disorders such as self-harm, suicidal behaviour, and emotion dysregulation, all of which can show improvement during dialectical behaviour therapy.

In most Australian states, DBT programs can be accessed through both the public and private mental health system (SANE, 2017). The Australian BPD Borderline Personality Disorder Foundation has a variety of resources including information on DBT programs in Australian states and territories.

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3. Dialectical Behaviour Therapy

Dialectical behaviour therapy (DBT) is a type of cognitive behaviour therapy. It is useful for people with borderline personality disorder (BPD) or other conditions associated with difficulty regulating strong emotions (HealthDirect, 2024).

DBT involves acceptance-oriented and change-oriented skills which are seemingly ‘dialectical’ or opposite skills. It can help patients to accept themselves as they are, build skills to regulate their emotions and improve interpersonal relationships (HealthDirect, 2024).

DBT is used to treat symptoms related to BPD such as:

• feeling a sense of emptiness or hopelessness
• low self-esteem or feelings of self-hate
• strong emotions or intense mood swings
• risk-taking or impulsive behaviour
• unstable relationships
• self-harm
• suicidal thoughts or suicide attempts (Corliss, 2024; HealthDirect, 2024).

It can also be used to treat other mental health conditions such as:

• substance use disorders (SUDs)/alcohol or drug problems
• depression and anxiety
• disruptive behaviour disorders
• eating disorders, such as binge-eating or bulimia
• post-traumatic stress disorder (PTSD) (Corliss, 2024; Garey, 2024; HealthDirect, 2024).

DBT can also be used to help anyone navigate emotionally charged situations with more ease (Corliss, 2024). The efficacy of DBT in treating a variety of conditions is discussed in section 4 below.

There are four main skills learned during DBT:

• mindfulness skills
• distress tolerance skills
• emotional regulation skills
• interpersonal effectiveness (Corliss, 2024; HealthDirect, 2024).

Mindfulness is being self-aware and present in the moment (the ‘here and now’) (HealthDirect, 2024). It teaches people to pay careful attention to the nature, quality, and volume of their thoughts. The idea is to observe these thoughts as separate from oneself without identifying with their meaning (Corliss, 2024).

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Distress tolerance is learning to accept emotions in difficult or stressful situations and manage them without using harmful behaviours, using techniques such as distraction (Corliss, 2024; HealthDirect, 2024).

Emotional regulation involves being more aware of your emotions by recognising, accepting, and managing them. By understanding your emotions, you have more control over them (Corliss, 2024; HealthDirect, 2024).

Interpersonal effectiveness is learning how to communicate effectively with other people to strengthen relationships and build self-esteem. It involves setting boundaries whilst being respectful towards yourself and others (Corliss, 2024; HealthDirect, 2024).

DBT usually involves weekly one-on-one sessions with a therapist and weekly group sessions led by a therapist who teaches the specific, interconnected skills and gives homework that helps to reinforce the skills. It may also involve telephone coaching sessions with a therapist as needed (Bemmouna et al., 2022, p. 4338; Corliss, 2024; HealthDirect, 2024). The treating therapists also meet for consultation team supervision and training while delivering DBT programs (Chapman, 2006; Weiner et al., 2025, p. 309). A DBT program typically lasts for 6 to 12 months (Corliss, 2024; HealthDirect, 2024).

4. The Efficacy of Dialectical Behaviour Therapy

There is a large body of evidence suggesting that comprehensive DBT, compared to treatment as usual (TAU), is effective in reducing symptoms such as non-suicidal self-injury (NSSI) and suicidal behaviour across a range of populations (Rizvi et al., 2024, p. 1326). It has also been shown to be effective when delivered in a variety of settings, including for inpatients, outpatients, in community settings and via telehealth (Rizvi et al., 2024).

DBT has been adapted in several ways including DBT for adolescents (DBT-A), for binge- eating disorders (DBT-BED), substance use disorders (DBT-SUD), post-traumatic stress disorder (DBT-PTSD), and with a prolonged exposure protocol (DBT PE) (Rizvi et al., 2024).

The skills training component of DBT has been investigated in ‘skills training only’ studies which have shown that this component is effective as a standalone intervention for a range of disorders and symptoms including BPD, binge eating, depression, global psychosocial functioning, and suicidal and self-harm episodes (Rizvi et al., 2024, p. 1237).

4.1 Autism Spectrum Disorder and Dialectical Behaviour Therapy

Recent studies have reported positive results on the feasibility and acceptability of DBT for treating individuals with autism spectrum disorder (ASD) and without intellectual disability (ID) (see Bemmouna et al., 2022 and Bemmouna et al., 2025 for emotional dysregulation and suicidal symptoms and Ritschel et al., 2022 for general treatment including emotion regulation). It is important to note that the setting and delivery of DBT is often modified in these studies to be more accessible for individuals with ASD.

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Self-harm, suicidal ideation and suicide attempts have been reported at high rates in individuals with ASD and without ID, and adults with ASD are at a greater risk of co-occurring psychiatric disorders, self-harm and suicidal behaviours compared to the general population (Bemmouna et al., 2022, p. 4337; Bemmouna et al., 2025, pp. 1-2). Studies have also found a significant positive association between emotional dysregulation and suicidal ideation and suicidal attempts. What is more, alexithymia (the inability to recognise different emotions) has been said to interfere with emotional regulation as it is hard to regulate emotions that have not been identified (Bemmouna et al., 2022, p. 4338; Weiner et al., 2025, p. 310).

Bemmouna et al. (2022) conducted a small-scale (n=7), 18-week brief DBT protocol with adults with ASD and without ID. 2 participants out of 7 dropped out during the study. Results showed that post-treatment and at follow-up 4 months later, participants’ mean scores on the self-reported Difficulties in Emotion Regulation Scale (DERS) decreased significantly. There was also a significant decrease in scores on the self-reported Beck Depression Inventory- Second Edition (BDI-II), the Beck Hopelessness Scale (BHS), and the environment domain of the Abbreviated World Health Organization Quality of Life Questionnaire (WHOQoL-BREF). However, these results (excluding the DERS results) were not maintained at follow-up. Participant scores on the eight-item General Alexithymia Factor Score (GAFS-8) did not decrease significantly, however, on their DBT diary cards and on follow-up questionnaires, participants reported a decrease in suicide attempts, suicide ideation and self-harming behaviour during the intervention and at the follow-up (Bemmouna et al., 2022, pp. 4346- 4347). It is important to note that this study was interrupted by COVID-19 and the mode of intervention delivery changed from in-person to remote for 2 months.

Bemmouna et al. (2025) expanded on these findings in a similar randomised controlled study with a larger cohort (n=63) of adults with ASD and without ID. The study comprised of an 18- week comprehensive DBT program for one condition with the control group being put on a waiting list (WL condition). Outcome measures were numerous and included:

• DERS
• BDI-II
• GAFS-8
• WHOQoL-BREF
• Beck Anxiety inventory (BAI)
• Beck Scale for Suicide Ideation (BSS)
• DBT Ways of Coping Checklist (BDT-WCCL)
• Barratt Impulsiveness Scale-short form (BIS-15)
• Beck Anxiety Inventory (BAI)
• Beck Scale for Suicide Ideation (BSS)
• DBT Ways of Coping Checklist (DBT-WCCL)

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• Five Facet Mindfulness Questionnaire (FFMQ)
• tracking of suicidal behaviours and hospitalisations

Data were collected at four time points: pre-intervention, mid-intervention, post-intervention and at a 6-month follow-up.

Results showed that DERS and GAFS-8 mean scores improved in the DBT group relative to the WL group both mid- and post-intervention with lasting improvements at follow-up. Increased mindfulness and decreased alexithymia mediated the changes found in emotional dysregulation (DERS) (Weiner et al., 2025, p. 312). Depressive symptoms (BDI-II) and the WHOQoL-BREF subscales Physical Health and Psychological Health improved in the DBT condition relative to the WL condition at post-intervention and remained stable at follow-up. The Skills Use subscale score of the DBT-WCCL increased significantly in the DBT condition compared to the WL condition both mid- and post-therapy with lasting scores at follow-up. The FFMQ total mean score for Mindfulness Skills increased significantly more in the DBT condition compared to the WL condition only post-therapy and the scores remained stable at the 6-month follow-up assessment. Other measures did not show significant differences between the two conditions. Reports from the 6-month follow-up period show that some participants who presented with NSSI and suicide ideation at the beginning of the intervention had notable improvements in the frequency of NSSI (38%) and notable improvements in or the absence of suicide ideation (35% and 24% respectively).

Huntjens et al. (2024) conducted a pragmatic randomised controlled trial (RCT) with 123 participants which showed that after a 26-week DBT intervention, suicide ideation (measured via the Suicide Ideation Attributes Scale (SIDAS)) reduced significantly in both groups post- treatment and at follow-up. The reduction was stronger in the DBT condition only at post- treatment, and this between-group difference lost statistical significance at the 12-month follow-up. Suicide attempts (measured by the Lifetime Parasuicide Count (LPC)) declined much more in the DBT condition at post-treatment but the between-group difference was no longer significant at the 12-month follow-up. BDI-II depressive symptom severity also reduced significantly more in the DBT condition at post-treatment and remained this way at the 12- month follow-up. The researchers found that social anxiety (measured using the Social Interaction Anxiety Scale (SIAS)) did decline with treatment but there was no significant differences between the two groups at any stage.

In 2025, Huntjens et al. published findings from a secondary analysis on the same 123 participants reported on above. Findings showed that social functioning (assessed via the Personal and Social Performance Scale (PSP)) improved significantly more in the participants undergoing DBT than those receiving TAU at post-treatment and at the 12-month follow-up. The four domains of the PSP improved as well, and the self-care domain reached statistically significant improvement at the 12-month follow-up for the DBT group. However, these improvements did not meet the threshold for clinical significance. Quality of life (assessed via the Manchester Short Assessment of Quality of Life (MANSA)) also improved significantly

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more in the participants undergoing DBT than those receiving TAU at post-treatment and at 6- month and 12-month follow-ups. No statistically significant effects were observed for traits of autism which were measured using the Social Responsiveness Scale-Adult version (SRS-A). It is important to note that the study used for Huntjens et al. (2024; 2025) was affected by COVID-19 as the intervention delivery mode went from in-person to virtual. However, the authors suggest that a sensitivity analysis confirms that this change did not have a major impact on treatment outcomes (Huntjens et al., 2024, p. 2714; Huntjens et al., 2025, p. 1342).

In another 2025 study, Costache et al. followed 26 autistic adults participating in a five-month standard DBT program. The study methodology is novel in that it evaluated participants before and after treatment using Ecological Momentary Assessment (EMA) This included evaluating participants 12 times per day over 7 days to measure alexithymia, emotional states, subjective arousal and emotion control (self-reported via surveys delivered via mobile phone), and to conduct physiological monitoring of participants’ heart-rate, heart-rate variability and skin conductance (recorded via the Empatica E4 wristband). Rates of participants reporting alexithymia (“I have an emotion I cannot name”) was three times lower post-therapy than pre- therapy. Total DERS scores and GAFS-8 scores reduced significantly, and higher rates of joy, calm and interest were recorded post-intervention but there was no significant differences in the rates of negative emotions. No significant changes were found in physiological factors pre- or post-therapy.

4.2 Dissociative Personality Disorder and Dialectical Behaviour Therapy

We did not find any studies investigating the use of DBT in the treatment of Dissociative Personality Disorder (DID) that have been published since 2016. DID has been said to be highly comorbid with BPD, with two-thirds of people with BPD meeting the criteria for DID (Foote & Van Orden, 2016; Ross, 2005; Ross et al., 2014).

It has been argued by Foote and Van Orden (2016) that DBT can be usefully adapted without significant changes to treat DID, as DID shares many similarities with BPD such as self-harm, suicidal behaviour, emotion dysregulation, identity disturbance, and dissociation. We did not find more current information confirming this proposition.

The reader may refer to section 4.3 below for information on how DBT affects individuals with BPD.

4.3 Borderline Personality Disorder and Dialectical Behaviour Therapy

DBT is often cited as one of the most effective treatments for BPD (see Corliss, 2024 and Shogren et al., 2025).

In 2024 Hernandez-Bustamante et al. conducted a systematic review of RCTs looking at the efficacy of DBT in the treatment of BPD. Among the limitations of the 18 reviewed studies were the lack of follow-up assessments, the high heterogeneity in methodology and high homogeneity amongst participants. Their results supported the efficacy of DBT in treating BPD and particularly in alleviating suicidal behaviour, self-harm, depressive symptoms,

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psychopathology, impulsivity, and mood instability. They also noted that results showed a reduction in hospitalisation rate in those undergoing DBT. However, some studies reported that DBT was not superior to the other active psychological inventions tested.

Gillespie et al. (2022) conducted a systematic review of the outcomes of DBT in individuals with BPD after one year follow up in controlled and uncontrolled studies. Generally, DBT was superior compared to the control group for reducing hospital admissions, emergency department visits, general psychopathology, dissociation, and substance use, and improving interpersonal functioning, psychosocial functioning. However, they found varied results with regards to the efficacy of DBT compared to the control groups for reduction in suicide attempts, NSSI/self-harm, psychiatric inpatient days, BPD symptom severity, and depression and anxiety. There was no difference between DBT groups and control groups in suicidal ideation and reasons for living. The authors report variability in how follow-up outcomes are reported, the time-points at which comparisons are made across studies and a general lack of long-term follow-up in RCTs.

More recent studies have shown that DBT interventions can lead to significant reductions in emotional dysregulation (see Shogren et al., 2025), reductions in the probability of engaging in suicidal communications (see Bitran et al., 2025), self-harm (see Vonderlin et al., 2025), dissociation symptoms (see Hüsing et al., 2025 and Vonderlin et al., 2025), depression, persistent somatic symptoms (PSS), BPD symptoms and PTSD symptoms (see Hüsing et al., 2025), and an increase in quality of life (see Vonderlin et al., 2025). Small sample sizes, a lack of follow-ups, heterogenous measurement tools for symptoms under investigation and the confound of the COVID-19 pandemic occurring during data collection are some of the limitations affecting the studies described here.

4.4 Other Conditions and Dialectical Behaviour Therapy

A 2024 systematic review and meta-analysis was conducted by Prillinger et al. on the efficacy of DBT for PTSD. Results showed that PTSD symptom severity and depressive symptoms were reduced in all PTSD-specific DBT treatments. For studies in which participants had co- occurring PTSD and BDP, BPD symptoms were reduced via DBT-PTSD as well, but not significantly more than in the control treatments.

In a systemic review by Jones et al. (2023), results showed that DBT may be effective in improving depression, mania and emotional dysregulation, manic symptoms, psychosocial functioning, and mindfulness in individuals with bipolar disorder. However, the quality of evidence is limited by small sample sizes, high risk of bias and methodological heterogeneity, and larger (RCTs) are required to confirm results (Jones et al., 2023).

Warner and Murphy (2022) conducted a systematic review on DBT skills training (DBT-ST) for individuals with SUDs. Findings showed preliminary support for DBT-ST reducing substance use and enhancing emotional regulation. However, the quality of the reviewed studies ranges from low to high, and the review authors urge for more RCTs to be conducted to confirm preliminary findings.

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5. Funding Options for Dialectical Behaviour Therapy in Australia

In most Australian states, DBT programs can be accessed through both the public and private mental health system (SANE, 2017).

Some public hospitals may off DBT programs. A case manager, mental health professional or GP can assist with referral options (SANE, 2017).

Private DBT programs are also available and can be accessed via a referral from a psychiatrist from the specific hospital or clinic providing the program. Prices will vary depending on the service chosen. Private health insurance may cover psychiatric admissions (SANE, 2017).

The Australian BPD Foundation has created a guide for accessing treatment in NSW which includes DBT programs including private, public and youth programs. Many of these services offer DBT programs. We did not find similar lists for other Australian states and territories.

The Australian BPD Foundation provides a list of services for BPD treatment in each Australian state and territory. Many of these lists include DBT services. Links to these lists can be found below:

• Australian Capital Territory list of services for BPD treatment
• New South Wales list of services for BPD treatment
• Northern Territory list of services for BPD treatment
• Queensland list of services for BPD treatment
• South Australia list of services for BPD treatment
• Tasmania list of services for BPD treatment
• Victoria list of services for BPD treatment
• Western Australia list of services for BPD treatment

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6. Dialectical Behaviour Therapy Experts in Australia

Expert Name (Clinic)	Expertise	Clinic Location	Contact Information
Sandi Plummer (DBT Canberra)	- provides DBT training for patients and therapists - developed modules for the Canberra DBT Program	ACT	sandip@homemail.com.au 0414 372 888
Australian DBT Institute	- Australia’s longest established provider of education, mentoring and development of mental health professionals in Dialectical Behaviour Therapy (DBT)	NSW, QLD, VIC, Online	cpd@dbtinstitute.com.au (03) 9586 8484
Dr Kirby Sainsbury (The Psychological Health Centre)	- completed training in DBT with Behavioral Tech	NSW	info@psychologicalhealthcentre.com.au 0481 308 742
Luke Nox (Darwin Psychology Services)	- trained in DBT	NT	reception@darwinpsychology.com.au (08) 8932 8460

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Expert Name (Clinic)	Expertise	Clinic Location	Contact Information
Dr. Sarah Swannell (DBT Brisbane)	- coordinated the outpatient DBT Program at The Prince Charles Hospital - advanced training in DBT	QLD	dbtbrisbane@gmail.com (07) 3856 0004
Nadia Del Col (Willow Tree Psychology and Wellbeing)	- experience facilitating DBT groups - provides individual DBT	SA	info@willowtreepsychology.com.au (08) 8331 3936
Ms Rebecca Pitts (Salamanca Psychology)	- worked within tertiary mental health services delivering group therapy programs including DBT	TAS	(03) 6224 1644
Dr Amber Fougere (Inner Eastern Psychology)	- completed intensive training in Dialectical Behaviour Therapy (DBT) with Behavioral Tech	VIC	contact@innereasternpsychology.com.au (03) 9088 1990
Chris Hepworth (Hepworth Psychology Clinic)	- clinical Lead on the DBTeen Program in WA - coordinates and delivers DBT programs	WA	chris@hepworthpsychologyclinic.com.au 0451 078 154

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7. References

Bemmouna, D., Coutelle, R., Weibel, S., & Weiner, L. (2022). Feasibility, Acceptability and Preliminary Efficacy of Dialectical Behavior Therapy for Autistic Adults without Intellectual Disability: A Mixed Methods Study. Journal of Autism and Developmental Disorders, 52(10), 4337–4354. https://doi.org/10.1007/s10803-021-05317-w

Bemmouna, D., Rabot, E., Coutelle, R., Lefebvre, F., Weibel, S., & Weiner, L. (2025). Dialectical Behaviour Therapy to Treat Emotion Dysregulation in Autistic adults without Intellectual Disability: A Randomised Controlled Trial. Psychotherapy and Psychosomatics, 1–18. https://doi.org/10.1159/000544717

Bitran, A. M., Kleiman, E. M., & Rizvi, S. L. (2025). Suicidal Communications in Adults with Borderline Personality Disorder: Clinical Correlates and Treatment Response to Dialectical Behavior Therapy. Archives of Suicide Research, 1. https://doi.org/10.1080/13811118.2025.2512455

Chapman, A. L. (2006). Dialectical behavior therapy: current indications and unique elements. Psychiatry (Edgmont (Pa. : Township)), 3(9), 62–68. https://pmc.ncbi.nlm.nih.gov/articles/PMC2963469/

Corliss, J. (2024). Dialectical behavior therapy: What is it and who can it help? Harvard Health Publishing. https://www.health.harvard.edu/blog/dialectical-behavior-therapy-what-is-it-and- who-can-it-help-202401223009

Costache, M. E., Gioia, F., Vanello, N., Greco, A., Capobianco, A., Weibel, S., & Weiner, L. (2025). Dialectical behavior therapy in autistic adults: effects on ecological subjective and physiological measures of emotion dysregulation. Borderline Personality Disorder and Emotion Dysregulation, 12(1), Article 14. https://doi.org/10.1186/s40479-025- 00288-1

Foote, B., & Van Orden, K. (2016). Adapting Dialectical Behavior Therapy for the Treatment of Dissociative Identity Disorder. American Journal of Psychotherapy, 70(4), 343–364. https://doi.org/10.1176/appi.psychotherapy.2016.70.4.343

Garey, J. (2024). DBT: What Is Dialectical Behavior Therapy? Child Mind Institute. https://childmind.org/article/dbt-dialectical-behavior-therapy/#structured-therapy-sessions

Gillespie, C., Murphy, M., & Joyce, M. (2022). Dialectical Behavior Therapy for Individuals With Borderline Personality Disorder: A Systematic Review of Outcomes After One Year of Follow-Up. Journal of Personality Disorders, 36(4), 431–454. https://doi.org/10.1521/pedi.2022.36.4.431

HealthDirect. (2024). Dialectical behaviour therapy (DBT). https://www.healthdirect.gov.au/dialectical-behaviour-therapy-dbt

Hernandez-Bustamante, M., Cjuno, J., Hernández, R. M., & Ponce-Meza, J. C. (2024). Efficacy of Dialectical Behavior Therapy in the Treatment of Borderline Personality

Dialectical Behaviour Therapy Page 12 of 15 OFFICIAL

[Research type]

OFFICIAL For Internal Use Only

Disorder: A Systematic Review of Randomized Controlled Trials. Iranian Journal of Psychiatry, 19(1), 119–129. https://doi.org/10.18502/ijps.v19i1.14347

Huntjens, A., van den Bosch, L. (Wies), Sizoo, B., Kerkhof, A., Smit, F., & van der Gaag, M. (2025). Secondary effects of dialectical behaviour therapy on social functioning, quality of life, and autism traits in autistic adults with suicidality. Autism: The International Journal of Research and Practice, 29(5), 1333–1345. https://doi.org/10.1177/13623613241302875

Huntjens, A., van den Bosch, L. M. C. (Wies), Sizoo, B., Kerkhof, A., Smit, F., & van der Gaag, M. (2024). The effectiveness and safety of dialectical behavior therapy for suicidal ideation and behavior in autistic adults: a pragmatic randomized controlled trial. Psychological Medicine, 54(10), 2707–2718. https://doi.org/10.1017/S0033291724000825

Hüsing, P., Löwe, B., & Biedermann, S. V. (2025). Persistent somatic symptom severity in patients with borderline personality disorder: Trauma-related symptoms as mechanism for improvement during inpatient dialectical behavior therapy. Journal of Psychosomatic Research, 194, Article 112151. https://doi.org/10.1016/j.jpsychores.2025.112151

Jones, B. D. M., Umer, M., Kittur, M. E., Finkelstein, O., Xue, S., Dimick, M. K., Ortiz, A., Goldstein, B. I., Mulsant, B. H., & Husain, M. I. (2023). A systematic review on the effectiveness of dialectical behavior therapy for improving mood symptoms in bipolar disorders. International Journal of Bipolar Disorders, 11(1), Article 6. https://doi.org/10.1186/s40345-023-00288-6

Prillinger, K., Goreis, A., Macura, S., Hajek Gross, C., Lozar, A., Fanninger, S., Mayer, A., Oppenauer, C., Plener, P. L., & Kothgassner, O. D. (2024). A systematic review and meta-analysis on the efficacy of dialectical behavior therapy variants for the treatment of post-traumatic stress disorder. European Journal of Psychotraumatology, 15(1), 2406662. https://doi.org/10.1080/20008066.2024.2406662

Ritschel, L. A., Guy, L., & Maddox, B. B. (2022). A pilot study of dialectical behaviour therapy skills training for autistic adults. Behavioural and Cognitive Psychotherapy, 50(2), 187– 202. https://doi.org/10.1017/S1352465821000370

Rizvi, S. L., Bitran, A. M., Oshin, L. A., Yin, Q., & Ruork, A. K. (2024). The State of the Science: Dialectical Behavior Therapy. Behavior Therapy, 55(6), 1233–1248. https://doi.org/10.1016/j.beth.2024.02.006

Ross, C. A. (2005). A PROPOSED TRIAL OF DIALECTICAL BEHAVIOR THERAPY AND TRAUMA MODEL THERAPY. Psychological Reports, 96(3), 901–911. https://doi.org/10.2466/PR0.96.3.901-911

Ross, C. A., Ferrell, L., & Schroeder, E. (2014). Co-Occurrence of Dissociative Identity Disorder and Borderline Personality Disorder. Journal of Trauma & Dissociation, 15(1), 79–90. https://doi.org/10.1080/15299732.2013.834861

Dialectical Behaviour Therapy Page 13 of 15 OFFICIAL

[Research type]

OFFICIAL For Internal Use Only

Sane. (2017). Dialectical behaviour therapy (DBT). https://www.sane.org/information-and- resources/facts-and-guides/dialectical-behaviour-therapy-dbt#factsheet

Shogren, N. P., Tirpak, J. W., Porter, N. P., Kaplan, C., Ronzio, B., Au, J. S., & Fruzzetti, A. E. (2025). Dialectical Behavior Therapy for Adolescents with Borderline Personality Disorder: Emotion Dysregulation, Abuse, and Treatment Outcomes. Evidence-Based Practice in Child and Adolescent Mental Health, 10(1), 1–13. https://doi.org/10.1080/23794925.2024.2306625

Vonderlin, R., Boritz, T., Claus, C., Senyüz, B., Mahalingam, S., Tennenhouse, R., Lis, S., Schmahl, C., Margraf, J., Teismann, T., Kleindienst, N., McMain, S., & Bohus, M. (2025). Acceptance, Safety, and Effect Sizes in Online Dialectical Behavior Therapy for Borderline Personality Disorder: Interventional Pilot Study. JMIR Formative Research, 9, e66181. https://doi.org/10.2196/66181

Warner, N., & Murphy, M. (2022). Dialectical behaviour therapy skills training for individuals with substance use disorder: A systematic review. Drug and Alcohol Review, 41(2), 501–516. https://doi.org/10.1111/dar.13362

Weiner, L., Bemmouna, D., Costache, M. E., & Martz, E. (2025). Dialectical Behavior Therapy in Autism. Current Psychiatry Reports, 27(5), 307–318. https://doi.org/10.1007/s11920- 025-01596-7

Dialectical Behaviour Therapy Page 14 of 15 OFFICIAL

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