Insular spontaneous activity changes after dialectical behavior therapy skills training for depressed patients with non-suicidal self-injury: a randomized controlled trial

AI Summary

DBT-ST yielded greater reductions in NSSI and depressive symptoms among adolescents with nsMDDs compared with social support, with large effect sizes.
Post-intervention DBT-ST reduced right insula ALFF and left insula ReHo; right insula ALFF reduction correlated with depressive symptom improvement.
Both DBT-ST and social support improved clinical symptoms overall, but untracked medication changes may confound observed neural alterations.

BMC Psychiatry. 2026 Jun 4. doi: 10.1186/s12888-026-08254-z. Online ahead of print.

ABSTRACT

BACKGROUND: Non-suicidal self-injury (NSSI) frequently co-occurs with major depressive disorder (MDD). This study aims to investigate the efficacy of dialectical behavior therapy skills training (DBT-ST) in treating major depressive disorder with non-suicidal self-injury (nsMDDs) under routine medication, as well as its modulatory effects on neural mechanisms.

METHODS: This assessor-masked, multicenter, randomized controlled trial enrolled 80 patients with nsMDDs from outpatient or inpatient departments of four hospitals. Participants were randomly assigned to receive either DBT-ST or social support group therapy (SSGT) once weekly for 13 weeks. NSSI severity, depressive severity, and spontaneous brain activity were assessed in both training groups before and after the intervention. The data analysis was conducted using SPSS 23 and MATLAB 2013a.

RESULTS: Findings demonstrated that both intervention groups were effective in alleviating clinical symptoms. Subgroup analyses by age revealed that DBT-ST demonstrated more significant improvements in NSSI behavior (B = 1.15, p < 0.001, d = -1.24) and depressive symptoms (B = 22.22, p < 0.001, d = -1.61) among adolescents (13 ~ 17 years old). Resting-state data revealed that following intervention, the DBT-ST group exhibited significantly reduced amplitude of low-frequency fluctuations (ALFF) in the right insula (F = 11.85, p = 0.003, d = 0.93) and regional homogeneity (ReHo) in the left insula (F = 18.48, p < 0.001, d = 1.24). Furthermore, following intervention, improvement in depressive symptoms within the DBT-ST group showed a significantly correlated with the reduction in ALFF in the right insula (r = 0.694, p = 0.038).

CONCLUSIONS: DBT-ST may demonstrate superior applicability for improving clinical symptoms in adolescents with nsMDDs. Concurrently, DBT-ST may modulate abnormal spontaneous brain activity within neural circuits associated with nsMDDs. However, as this study did not track medication changes during the intervention period, the confounding effect of medication on neural alterations cannot be ruled out.

TRIAL REGISTRATION: ClinicalTrials No.: NCT04094623, retrospectively registered 13 September 2019.

PMID:42243789 | DOI:10.1186/s12888-026-08254-z

Document this CPD