Dialectical Behavioral Therapy for Emotional Dysregulation in Youth with Substance Use Disorders In Kiambu, Kenya

Abstract

This study explored the effectiveness of Dialectical Behavioural Therapy (DBT) in treating emotional dysregulation among youth with substance use disorder (SUD) in rehabilitation centers. Emotional dysregulation is the difficulty in identifying and managing emotional experiences in an adaptive manner. It contributes to substance cravings and relapse, yet limited research exists on DBT’s impact in Kenyan rehabilitation settings. This study focused on four rehabilitation centers in Kiambu County to bridge this gap. The study evaluated DBT’s role in improving emotional regulation, reducing substance cravings, and managing comorbid affective disorders to enhance mental well-being of the youth. Specific objectives included assessing DBT’s impact on emotional dysregulation, examining its effect on substance cravings, and determining its contribution to psychological stability. Grounded in Linehan's DBT Theory of Change, the Biopsychosocial-Cultural framework, and Schachter’s Two-Factor Theory, a quasi-experimental design was employed with intervention and control groups. A total of 108 participants were purposively selected, with 68 receiving structured DBT sessions incorporating group skills training, while the control group underwent Treatment as Usual (TAU). Data was collected using validated instruments, including the Difficulties in Emotion Regulation Scale (DERS) and the Brief Substance Craving Scale (BSCS). The study found that emotional dysregulation was highly prevalent among the youth in rehabilitation centres in Kiambu, Kenya, with 89.8% of respondents exhibiting mild to severe symptoms. Depression affected 94.2% of participants with ED, of which 72.8% had severe levels, while anxiety was comorbid with ED at 75.2%, with 33.3% reporting moderate and 22.9% severe symptoms. Emotional dysregulation was significantly correlated with both depression (r = .473, p < .001) and anxiety (r = .372, p < .001) and also showed a strong association with substance cravings (r = .37, p < .001). Socio-demographic factors had limited predictive power; gender was the only significant variable, with females scoring higher on emotional dysregulation (B = 5.996, p = .050), and income level was linked to difficulty accessing emotion regulation strategies (χ² = 12.798, p = .025). Dialectical Behavioural Therapy (DBT) demonstrated substantial effectiveness, with the experimental group showing significant reductions in emotional dysregulation (t(33) = 17.86, p < .001, d = 3.06), depression (t(32) = 17.30, p < .001, d = 3.01), and anxiety (t(32) = 8.16, p < .001, d = 1.42) from baseline to midline, with gains sustained through endline. These findings underscore the high burden of emotional and psychological distress in this population and the therapeutic value of DBT in addressing these challenges.