A Pilot Open Trial and Mixed Methods Evaluation of Affirmative Dialectical Behaviour Therapy (DBT) Skills Training for Malaysian LGBT Adults

Abstract

Objectives

Lesbian, gay, bisexual and transgender (LGBT) individuals are at greater risk of mental health problems relative to cisgender heterosexual people. While various evidence-based interventions exist to address the mental health needs of LGBT individuals, there is an urgent need to adapt these interventions to address stressors unique to the LGBT individual in the Global South, where LGBT identity remains highly stigmatised. This study developed and evaluated a six-session affirmative dialectical behaviour therapy (DBT) skills group to address depressive symptoms in a sample of Malaysian LGBT adults.

Methods

Seventeen LGBT adults (M_age = 26.9 years) with mild-to-severe levels of depressive symptoms were recruited from the community. Participants attended a DBT skills group for 6 weeks (2.5-h/session). They completed self-report measures on psychological symptoms, well-being and minority stress at pre- and post-intervention and a focus group discussion regarding their experience with the DBT skills group.

Results

Significant decreases in depressive symptoms, stress, borderline personality disorder symptoms, emotion dysregulation and distress due to heterosexist experiences were observed from pre- to post-intervention. There were also significant increases in self-compassion and subjective well-being. The number of DBT skills sessions attended was significantly associated with reductions in emotion dysregulation, internalised homophobia and distress due to heterosexist experiences. Thematic analyses of qualitative feedback revealed several helpful and challenging aspects of participating in the DBT skills group (e.g., time commitment, online format, and relevance and applicability of treatment content).

Conclusions

The study found that an LGBT-affirmative DBT skills group is feasible and acceptable among Malaysian LGBT adults and shows promise in improving psychological health. These findings have implications for the adaptation of DBT skills training for marginalised populations in diverse, low-resource contexts.