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Article history:
Received 13 February 2024
Revised 03 April 2024
Accepted 10 April 2024
Published online 10 May 2024
Journal of Adolescent and Youth
Psychological Studies
Volume 5, Issue 5, pp 14-20
Dialectical Behavior Therapy: Impact on Self-Harming Behaviors,
Bullying, and Cognitive Emotion Regulation in Delinquent Teenagers
Rashin. Abdullahi1, Tahereh. Nouri2*
1 Assistant Professor, Department of Psychology, Amin University of Police Sciences, Tehran, Iran
2 Assistant Professor. Assistant Professor, Research Institute of Law Enforcement Sciences and Social Studies, Tehran, Iran
* Corresponding author email address: nori.t1363@gmail.com
A r t i c l e I n f o
A B S T R A C T
Article type:
Original Research
How to cite this article:
Abdullahi, R., & Nouri, T. (2024).
Dialectical Behavior Therapy: Impact on
Self-Harming Behaviors, Bullying, and
Cognitive Emotion Regulation in
Delinquent Teenagers. Journal of
Adolescent and Youth Psychological
Studies, 5(5), 14-20.
http://doi.org/10.61838/kman.jayps.5.5.3
© 2024 the authors. Published by KMAN
Publication Inc. (KMANPUB), Ontario,
Canada. This is an open access article
under the terms of the Creative
Commons Attribution-NonCommercial
4.0 International (CC BY-NC 4.0)
License.
Objective: The increase in juvenile delinquency due to poor management and
regulation of emotions and self-harming behaviors under the influence of bullying
has become a significant issue in all societies. Accordingly, identifying the effects
of therapeutic approaches that can play a role in this regard seems essential.
Therefore, this study aimed to investigate the impact of Dialectical Behavior
Therapy on self-harming behaviors, bullying, and cognitive emotion regulation in
delinquent teenagers.
Methods and Materials: This quasi-experimental study included a pre-test, post-
test, and a control group. The statistical population consisted of all adolescents aged
12 to 18 years from the Tehran Juvenile Correction and Rehabilitation Center. Thirty
adolescents from the center were selected using convenience sampling and were
randomly assigned to two groups of 15 (experimental and control groups). The data
collection tools included the Self-Harm Behavior Questionnaire by Klonsky and
Glenn (2009), the Bullying Behavior Questionnaire by Espelage, Bosworth, and
Simon (2000), and the Cognitive Emotion Regulation Questionnaire by Garnefski,
Kraaij, and Spinhoven (2001). The data obtained from these questionnaires were
analyzed using covariance analysis at a significance level of 0.01 with SPSS26
software.
Findings: The results indicated that Dialectical Behavior Therapy was effective in
reducing self-harming behaviors and bullying and increasing cognitive emotion
regulation in delinquent teenagers (P < 0.01).
Conclusion: Based on these findings, it is recommended to utilize and teach
Dialectical Behavior Therapy techniques in correctional and rehabilitation centers to
enhance cognitive emotion regulation and reduce bullying and self-harming
behaviors in delinquent teenagers.
Keywords: Dialectical Behavior Therapy, Self-Harming Behaviors, Emotion Regulation,
Delinquent Teenagers.
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Abdullahi & Nouri Journal of Adolescent and Youth Psychological Studies 5:5 (2024) 14-20
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1. Introduction
uvenile Delinquency is a significant aspect of social
pathology. According to the United Nations report,
juvenile delinquency has increased by 5% annually. In Iran,
it has become a primary concern for judicial, security, and
executive authorities. In all societies, the term "delinquent"
refers to individuals who engage in actions against the law
and societal norms (Mosavi Fard, 2021). Adolescence,
encompassing ages 11 to 18, is a period of transition
involving physical growth and emotional crises (Saif, 2020).
Limited experiential repertoire and weak emotion regulation
during this critical period make adolescents susceptible to
externalizing problems such as self-harm, bullying, and
delinquency (Yeo et al., 2020).
Bullying is a type of intentional and repetitive physical,
verbal, or psychological behavior conducted by a stronger
and more powerful adolescent or group of adolescents
towards another adolescent perceived as vulnerable and
submissive, resulting in harm (DeCamp & Newby, 2014).
Olweus (1991) defines bullying as a subset of aggressive
behaviors manifesting physically, verbally, and relationally,
comprising three components: 1) intentionality, 2) repetition
over time, and 3) power imbalance (Olweus, 1993).
Researchers identify impulsivity, aggression, physical
strength, and dominant behaviors as primary traits of bullies.
They argue that bullies adopt aggressive strategies for
resolving interpersonal conflicts and lack alternative conflict
resolution skills (Hoover et al., 1992; Olweus, 1993; Wolke
et al., 2000).
Self-Harming Behaviors in delinquent teenagers are
prevalent, affecting millions and posing a major public
health issue; lifetime prevalence among adolescents ranges
from 10 to 20 percent (Gillies et al., 2018). Self-harm often
begins and peaks during adolescence (Hetrick et al., 2020)
and is a strong predictor of suicide (Hawton et al., 2015).
Non-suicidal self-injury includes behaviors like skin
scratching, cutting, burning, head banging, and hitting
oneself (Perepletchikova et al., 2011). According to
Suyemoto's (1998) theory, understanding self-harming
behaviors requires knowing why a specific behavior occurs
at a specific time under certain consequences and by a
specific individual (Suyemoto, 1998). The functions of these
behaviors typically include reducing or escaping negative
emotions, self-punishment, or reducing numbness or
dissociative experiences (Hoffmann et al., 2021). These
behaviors are not performed with the conscious intent of
suicide or deviating from socially accepted behaviors (Favril
et al., 2020).
Research Findings indicate that delinquent teenagers are
more prone to self-harming and bullying behaviors
compared to other adolescent groups. A review study
reported the rate of self-harming behaviors in delinquent
teenagers ranging from 6 to 24 percent (Casiano et al., 2013).
Another reason for the propensity for self-harm among
delinquent adolescents is the history of abuse and
maltreatment during childhood (Favril et al., 2020).
Additionally, adolescents' lack of insight into their emotions,
especially distressing emotions that hinder social interaction,
results in their inability to regulate emotions (Safaeinaeini et
al., 2019). These adolescents typically struggle with self-
control, recognizing emotional cues, understanding others'
perspectives, and managing anger. They have not acquired
the necessary behavioral skills to provide adequate
responses and resolve conflicts (Karshki, 2013; Nadimi,
2016; Yeo et al., 2020). Emotional regulation enables
adolescents to identify emotions in themselves and others,
better manage negative emotions like sadness, anger, and
anxiety, and mitigate their adverse effects (Cooper et al.,
2015). Therefore, appropriate psychological interventions
are crucial for managing emotions and reducing bullying
behaviors that harm themselves and others.
Dialectical Behavior Therapy (DBT) is an effective
intervention in this context. DBT is a cognitive-behavioral
approach based on the principle of change, integrated with
Zen philosophy's principle of acceptance, comprising four
intervention components in its group therapy approach
(Fitzpatrick et al., 2020). DBT combines client-centered
acceptance and empathy with cognitive-behavioral problem-
solving and social skills training. These skills include 1)
mindfulness, 2) interpersonal effectiveness, 3) emotion
regulation, and 4) distress tolerance (Nadimi, 2017). Studies
have shown DBT's effectiveness in reducing bullying
behaviors and harm to others. For example, Astaneh,
Mirzaeian, and Hasanzadeh (2020) indicated that DBT
increases emotion regulation and positive affect while
reducing negative affect, aggressive behavior, and self-
injury (Astaneh et al., 2020). Alijanzadeh et al. (2014), and
Damavandian et al. (2022) showed that DBT significantly
improves self-harming behaviors, aggression, and emotional
regulation in delinquent teenagers, preventing harmful
behaviors (Damavandian et al., 2022). Yeo et al. (2020) also
confirmed DBT's impact on self-harm and emotion
regulation (Yeo et al., 2020). Perepletchikova et al. (2011)
found that DBT enhances emotion regulation and adaptive
J
Abdullahi & Nouri Journal of Adolescent and Youth Psychological Studies 5:5 (2024) 14-20
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coping skills while significantly reducing depression
symptoms, suicidal ideation, and problematic behaviors
(Perepletchikova et al., 2011). Fleischhaker et al. (2011)
examined DBT's impact on suicidal and self-harming
behaviors and borderline symptoms in adolescents, showing
significant reductions in self-harming behaviors during
treatment (Fleischhaker et al., 2011). Panoset al. (2014) also
demonstrated DBT's effectiveness in stabilizing and
controlling self-harming behaviors. Thus, this approach,
based on previous research, can reduce maladaptive
behaviors in adolescents (Panos et al., 2013). However,
further investigation is needed to determine DBT's effect on
reducing specific maladaptive behaviors in delinquent
teenagers. The findings from this research can be used for
planning to prevent and reduce bullying behaviors and
manage emotions in delinquent teenagers. If confirmed, the
findings can be implemented in educational workshops for
adolescents, preventing individual, familial, and societal
consequences and saving considerable human and material
costs imposed on relevant institutions. This study aims to
answer whether DBT training affects self-harming
behaviors, bullying, and emotional regulation in delinquent
teenagers.
2. Methods and Materials
2.1. Study Design and Participants
The present study is classified as applied research. Given
that the goal is to evaluate the effectiveness of Dialectical
Behavior Therapy (DBT) techniques on self-harming
behaviors, bullying, and emotional regulation in delinquent
teenagers, a quasi-experimental pre-test and post-test design
with a control group was employed. The statistical
population included all adolescents aged 12 to 18 years at
the Tehran Juvenile Correction and Rehabilitation Center.
Using convenience sampling, 30 adolescents were selected
and randomly assigned to two groups of 15 (experimental
and control). Inclusion criteria included no drug addiction at
the time of participating in the educational program, having
been in the center for at least one month, and having at least
four months remaining until release. Exclusion criteria
included lack of willingness to participate in the study or
missing more than two sessions. After coordinating with the
officials at the correctional center, the researchers, along
with the center's experts, conducted the study. Following the
briefing of the selected participants, the educational
intervention of DBT techniques was administered, and
participants were randomly assigned to the experimental and
control groups. Pre-tests and post-test were conducted for
both groups.
2.2. Measures
2.2.1. Self-Harm Behavior
This inventory, developed by Klonsky and Glenn (2009),
is a self-report tool that assesses the frequency and functions
of non-suicidal self-injury (NSSI). It consists of two parts:
the first part screens 12 types of NSSI behaviors performed
intentionally (consciously) but without suicidal intent,
including hitting, biting, burning, tattooing, cutting, wound
picking, pinching, hair-pulling, rubbing skin against rough
surfaces, severe scratching, inserting needles into the skin,
and ingesting dangerous chemicals. The test-retest reliability
of this section over a period of 1 to 4 weeks was 0.85 (r =
0.85). The internal consistency between the test items using
Cronbach's alpha was 0.84 (Saffarinia et al., 2014; Salemi
Khameneh et al., 2018). The validity and reliability of the
questionnaire in this study were found to be 0.84 and 0.82,
respectively.
2.2.2. Cognitive Emotion Regulation
This multidimensional self-report questionnaire,
developed by Garnefski, Kraaij, and Spinhoven (2001),
contains 36 items and has forms for both adults and children.
It assesses cognitive strategies for self-blame, acceptance,
rumination, positive refocusing, refocusing on planning,
positive reappraisal, putting into perspective,
catastrophizing, and blaming others. The Persian version of
the CERQ was validated in Iran by Besharat (2009, 2011).
In this study, the content validity of the CERQ was assessed
by ten psychology experts, with Kendall's coefficient of
agreement for the subscales ranging from 82% to 94%
(Damavandian et al., 2022; Garnefski et al., 2001).
2.2.3. Bullying Behavior
Questionnaire by Espelage, Bosworth, and Simon (2004):
This questionnaire, designed to measure bullying in
adolescents, consists of 18 items rated on a 5-point Likert
scale and includes three subscales: bullying, victimization,
and fighting. High scores indicate high levels of bullying,
while low scores indicate low levels of bullying. Espelage et
al. (2004) used Cronbach's alpha to determine the
questionnaire's reliability, yielding 0.83 for the total
questionnaire and 0.87, 0.83, and 0.88 for the subscales of
bullying, victimization, and fighting, respectively. In a study
Abdullahi & Nouri Journal of Adolescent and Youth Psychological Studies 5:5 (2024) 14-20
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by Mahdavi, Dehestani, and Pasandideh (2019), Cronbach's
alpha for the subscales of bullying, victimization, and
fighting, and the total questionnaire were 0.79, 0.81, 0.77,
and 0.83, respectively (Dehestani et al., 2019; Espelage &
Swearer, 2004; Safaeinaeini et al., 2019). The reliability and
validity of the questionnaire in this study were calculated as
0.86 and 0.84, respectively.
2.3. Intervention
2.3.1. Dialectical Behavior Therapy
The DBT protocol consisted of 12 therapy sessions based
on Linehan's (1993) therapeutic protocol, detailed as follows
(Linehan, 1993):
Session 1: Introduction of group members,
familiarization with the procedure and future session
planning, and assignment of individual tasks.
Session 2: Mindfulness skills: teaching the rational mind,
the importance and necessity of mindfulness, and techniques
for observing, describing, and participating.
Session 3: Emotional mind: teaching dimensions of
emotion, emotion classification, aspects of emotion,
functions of emotion, and emotion analysis.
Session 4: Wise mind: techniques for reinforcing the wise
mind, fundamental acceptance, effective mindfulness in
daily life, overcoming obstacles.
Session 5: Distress tolerance: distress tolerance through
basic acceptance techniques, breathing observation,
awareness practice, and gentle smiling.
Session 6: Distress tolerance: change strategies such as
distraction techniques, self-soothing, and positive imagery.
Session 7: Interpersonal effectiveness skills, including
assertiveness, maintaining relationships, and preserving self-
respect.
Session 8: Relaxation techniques, being present in the
moment, cost-benefit analysis, and coping strategies,
including activity and participation skills.
Session 9: Identifying emotion in the moment, reducing
physical and cognitive vulnerability, increasing positive
emotions, and learning comparison and emotion skills.
Session 10: Awareness of emotion without judgment,
emotional confrontation, acting opposite to emotional
impulses, problem-solving, and three suppression, thought,
and sensory skills.
Session 11: Behavioral styles, unhealthy emotional
habits, inability to identify needs, harmful relationships, and
erroneous beliefs; teaching emotional regulation skills,
reducing emotional distress, and improving positive
emotions.
Session 12: Awareness of events, assertiveness, listening,
refusal, negotiation, conflict resolution, summary, and post-
test administration.
2.4. Data analysis
Descriptive statistics, covariance analysis, and the
Levene test were used for data analysis with SPSS-24
software.
3. Findings and Results
Descriptive statistics for the mean and standard deviation
of variables related to the study participants are shown in
Table 1:
Table 1
Descriptive Statistics of Variables in Control and Experimental Groups
Variables
Groups
Pre-Test Mean (SD)
Post-Test Mean (SD)
Self-Harming Behaviors
Experimental
147.73 (15.107)
94.80 (17.465)
Control
102.80 (11.602)
102.60 (16.181)
Bullying
Experimental
162.24 (17.43)
99.21 (19.53)
Control
169.17 (13.84)
168.67 (13.21)
Emotion Regulation
Experimental
69.07 (11.517)
97.40 (13.861)
Control
70.20 (15.048)
67.80 (8.143)
According to the findings in Table 1, the mean scores for
self-harming behaviors, bullying, and emotion regulation in
the control group were almost identical in both pre-test and
post-test, indicating no significant differences. However, in
the experimental group, the mean scores for self-harming
behaviors, bullying, and emotion regulation showed notable
differences between the pre-test and post-test. Based on
these results, the training of Dialectical Behavior Therapy
techniques in the experimental group helped reduce self-
harming behaviors and bullying while increasing emotion
regulation.
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To examine the normality of variable distribution, the
Kolmogorov-Smirnov test was used, showing that all
variables were not significant in both pre-test and post-test
conditions, indicating a normal distribution of data. Levene's
test for equality of variances indicated that the homogeneity
of variances for self-harming behaviors (F = 0.674, p = 0.28),
bullying (F = 0.845, p = 0.36), and cognitive emotion
regulation (F = 4.938, p = 0.23) was established.
Therefore, after confirming the assumptions, analysis of
covariance (ANCOVA) was used to compare the means.
Table 2
ANCOVA Results for Research Variables
Variables
Source
Sum of Squares
df
Mean Square
F
Significance
Effect Size
Power
Self-Harming Behaviors
Pre-Test
735.057
1
735.057
3.240
0.03
0.107
0.411
Group
15961.813
1
15961.813
70.357
0.01
0.723
1.000
Error
36.3
59
124.94
Bullying
Pre-Test
839.425
1
839.425
4.34
0.001
0.789
0.587
Group
1823.762
1
1823.762
78.268
0.001
0.624
1.000
Error
2451.69
59
82.11
Emotion Regulation
Pre-Test
633.922
1
633.922
5.736
0.024
0.175
0.637
Group
6738.189
1
6738.189
60.967
0.01
0.693
1.000
Error
4375.06
59
15.31
The findings in Table 2 show that the F-statistic for self-
harming behaviors is 70.357, for bullying is 78.268, and for
cognitive emotion regulation is 60.967, all with a
significance level of 0.01, which is less than 0.05. Therefore,
the ANCOVA results indicate that the mean scores for self-
harming behaviors, bullying, and cognitive emotion
regulation in the experimental group have significantly
changed with the introduction of DBT technique training (p
< 0.01).
4. Discussion and Conclusion
The present study aimed to investigate the impact of
training Dialectical Behavior Therapy (DBT) techniques on
self-harming behaviors, bullying, and cognitive emotion
regulation in delinquent teenagers. The results indicated that
training in DBT techniques reduces bullying and self-
harming behaviors in delinquent teenagers. These findings
align with the prior research (Astaneh et al., 2020; Casiano
et al., 2013; Damavandian et al., 2021, 2022; Fleischhaker et
al., 2011; Gillies et al., 2018; Perepletchikova et al., 2011;
Safaeinaeini et al., 2019).
To explain these findings, one can refer to the functional
role of harmful behaviors. According to this theory,
intrapersonal functioning follows automatic negative
reinforcement and automatic positive reinforcement.
Harmful and bullying behaviors may be activated by
automatic negative reinforcement aimed at stopping
undesirable emotional and cognitive states such as escaping
frustration, reducing emotional pain, expressing anger
towards others, and reducing tension, or by automatic
positive reinforcement to create certain internal states.
Additionally, adolescents may engage in self-harming and
bullying behaviors seeking positive social reinforcement to
gain attention and access specific social resources
(Safaeinaeini et al., 2019; Saffarinia et al., 2014). DBT
training strengthens logical thinking and self-respect in
adolescents, enabling them to read emotional cues,
understand others' perspectives, manage anger, and acquire
behavioral skills needed for adequate responses, conflict
resolution, and suppression of negative thoughts and
feelings about themselves and others.
The study's findings also indicate that DBT techniques
effectively enhance cognitive emotion regulation in
delinquent teenagers. These results are consistent with the
prior research findings (Alijanzadeh et al., 2014; Cooper et
al., 2015; Damavandian et al., 2021, 2022; Fleischhaker et
al., 2011; Perepletchikova et al., 2011; Yeo et al., 2020). To
explain the effectiveness of DBT in cognitive emotion
regulation, one can refer to Suyemoto's (1998) theory.
According to this theory, the occurrence of any behavior,
including harmful behaviors, is performed at a specific time,
under specific consequences, and by a specific individual
(Suyemoto, 1998). DBT techniques cause neurobiological
changes in the hippocampus, cingulate, and prefrontal
cortex. Reduced activity in the prefrontal cortex,
parahippocampus, and cingulate in response to negative
emotional stimuli is a result of this educational intervention.
Considering the changes in the activation of the cingulate
and its significant role in highlighting emotional stimuli,
Abdullahi & Nouri Journal of Adolescent and Youth Psychological Studies 5:5 (2024) 14-20
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using cognitive strategies plays an important role in reducing
negative emotions (Yeo et al., 2020).
Given that exposure to distressing stimuli increases
amygdala activity and mental arousal, this educational
intervention helps regulate emotions more than cognition by
creating a gap between mental arousal and increased
amygdala activity. Additionally, the skills acquired by
adolescents during DBT training, such as mindfulness,
interpersonal effectiveness, emotion regulation, and distress
tolerance, especially mindfulness exercises, help adolescents
free themselves from automatic and negative thoughts,
playing a significant role in cognitive emotion regulation.
This therapy seems to improve cognitive emotion regulation
skills in adolescents by increasing positive mood. By
enhancing attention, awareness, and acceptance of emotions,
it modifies individuals' cognitive emotion regulation
strategies. It can reduce bullying behaviors in delinquent
teenagers by considering the elements of negative and
positive automatic reinforcement intrapersonally and
socially. Therefore, controlling the intrapersonal and
interpersonal consequences of these behaviors can help
reduce bullying and harm in delinquent teenagers.
5. Limitations & Suggestions
The present study, like many others, faced limitations.
Due to not considering gender variables and the different
statistical population (delinquent teenagers), generalizing
the findings to the entire population should be done with
caution. Future research should consider these limitations.
Based on the results, it is suggested that officials at
correctional and rehabilitation centers incorporate DBT
technique training into their educational planning to enhance
emotion regulation and reduce such behaviors in delinquent
teenagers.
Acknowledgments
We would like to express our appreciation and gratitude
to all those who cooperated in carrying out this study.
Declaration
In order to correct and improve the academic writing of
our paper, we have used the language model ChatGPT.
Declaration of Interest
The authors of this article declared no conflict of interest.
Ethics Considerations
The study protocol adhered to the principles outlined in
the Helsinki Declaration, which provides guidelines for
ethical research involving human participants.
Transparency of Data
In accordance with the principles of transparency and
open research, we declare that all data and materials used in
this study are available upon request.
Funding
This research was carried out independently with
personal funding and without the financial support of any
governmental or private institution or organization.
Authors’ Contributions
All authors contributed equally.
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