Dialectical behavior therapy in autistic adults: effects on ecological subjective and physiological measures of emotion dysregulation.

Background: Although Ecological Momentary Assessment (EMA) and physiological measurements provide a valuable opportunity to evaluate therapeutic interventions in real time, no study has used this approach to assess Dialectical Behavior Therapy (DBT) in autistic adults with high levels of emotion dysregulation (ED).

Methods: In this study, 26 autistic adults were evaluated before and after participating in a standard 5-month DBT program, using Ecological Momentary Assessment (EMA). The EMA included: (1) twelve evaluations per day over a 7-day period, measuring alexithymia, emotional states, subjective arousal and emotion control; (2) continuous physiological monitoring with a wristband to record heart-rate (HR), heart-rate variability (HRV) and skin conductance levels (SCL).

Results: Following DBT, no significant differences were found with respect to negative emotions and higher conflicting emotions, but increased rates of identified emotions, positive emotions and emotion control were found. Baseline autonomic responses remained unchanged, whereas subjective arousal was found to correlate positively with HRV. Overall, these results suggest that participants showed enhanced emotion awareness and emotion regulation capabilities following DBT.

Conclusion: Our study adds to previous research showing that DBT is efficient in treating ED in autistic adults, using real-time measurements of subjective and physiological markers collected through EMA. Specifically, alexithymia measures decreased post-DBT while positive emotions and emotion control increased. Randomized controlled trials should consider using these methods to improve the assessment of the impact of DBT in the daily life of autistic individuals with ED and/or suicidal behavior.