Acceptance and Commitment Therapy and DBT Mindfulness Skills

If you are thinking about harming yourself or in crisis, call or text 988 in the US, or call 911 in an emergency. [1] ACT and DBT are psychological therapies, not meditation courses. This page explains how they use mindfulness, what research found, and what to ask a therapist. It is information only and gives no skills instructions, because these therapies are meant to be delivered by trained clinicians.

Acceptance and commitment therapy (ACT)

ACT is described by its professional association as a psychological intervention that uses acceptance and mindfulness strategies, together with commitment and behavior change strategies, to increase psychological flexibility. [2] In that description, psychological flexibility means contacting the present moment fully and, depending on what the situation allows, changing or persisting in behavior in the service of chosen values. [2] Mindfulness here is one part of a broader therapy, rather than the main activity.

What research shows. A meta-analysis of 39 randomized trials (1,821 people with mental disorders or physical health problems) found ACT did better than control conditions, with an average effect of g = 0.57. [3] It was better than waitlist (g = 0.82), psychological placebo (g = 0.51) and treatment as usual (g = 0.64), and the comparison with established treatments such as CBT showed no significant difference. [3] Label: promising to established for some uses, mixed overall.

For anxiety disorders, a review of 23 studies (1,815 adults) found ACT and MBCT had comparable effects to CBT, while MBSR had lower effects. [4] Adverse events were reported insufficiently, and mostly the risk of bias was unclear. [4]

For chronic pain, a Cochrane review analyzed five ACT studies (443 people) and said it was very uncertain about the benefits of ACT and behavioral therapy because the evidence was of moderate to very low quality. [5] Label: insufficient evidence in that review.

Dialectical behavior therapy (DBT) and its mindfulness skills

DBT was designed for borderline personality disorder (BPD). The NHS describes it as a therapy specifically designed to treat BPD, usually with weekly individual and group sessions and an out-of-hours contact number. [6] In one study of a DBT skills group, the modules were mindfulness, distress tolerance, interpersonal effectiveness and emotion regulation. [7]

What research shows.

1. Do psychotherapies help BPD?

   Promising to established for BPD

   Cochrane review of 75 trials (4,507 people): BPD-tailored psychotherapy reduced symptom severity compared with usual care; DBT was one-third of the trials. Evidence was mostly low quality [8]

2. DBT compared with usual care

   Promising but limited

   Lower BPD severity (3 trials, 149 people) and less self-harm (7 trials, 376 people) [8]

3. Which parts matter?

   Promising; one trial

   In a 99-woman trial, arms that included skills training had greater drops in non-suicidal self-injury than DBT individual therapy plus an activities group [9]

4. Skills training on its own

   Insufficient evidence

   A review of 17 trials found preliminary support but methodological limits [10]

5. Skills group, mixed diagnoses

   Insufficient evidence

   136 people, measured before and after each module: each skills module was linked to better emotion regulation [7]

NICE (England) says that for women with BPD for whom reducing recurrent self-harm is a priority, a comprehensive DBT programme can be considered. [11] The same guideline advises against brief psychological interventions of less than 3 months specifically for BPD outside services with the right characteristics. [11] Adverse effects in the Cochrane review were unclear because of too few data. [8]

Qualifications and what to ask

Proper evidence not found, in the sources read, for a single national license for ACT or DBT as such. Therapists are usually licensed in their own profession, and the extra training varies, so ask. Questions to ask: What is your license and your training in ACT or DBT? Is this the full program or a skills group? How do you handle crises between sessions? In the NHS description, DBT includes an out-of-hours contact number. [6]

For how these therapies compare with mindfulness courses, see mindfulness-based programs, CBT and ACT compared. For anxiety care outside this library, see therapy for anxiety and stress.