The Effectiveness of Dialectical Behavior Therapy on Cognitive Distortions and Suicidal Thoughts in Older Adults

Nowadays suicide among older adults has become a significant public health concern in many countries. Additionally, cognitive distortions are among the psychological challenges of aging, leading individuals to misinterpret situations in an illogical and inaccurate manner. Therefore, this study aimed to determine the effectiveness of Dialectical Behavior Therapy (DBT) in reducing cognitive distortions and suicidal thoughts among older adults in Ahvaz, Iran. This was a quasi-experimental study using a pretest-posttest design with a control group. The study population comprised all older adults in Ahvaz in 2024. The sample included 30 individuals (aged 65 to 75), selected using convenience sampling, and based on eligibility criteria of the study. Participants were randomly assigned to either the experimental or control group. The experimental group received Lineman’s DBT protocol in eight 90-minute weekly sessions. The study utilized Hamamci and Buyuk Ozturk’s Cognitive Distortion Scale, as well as Beck’s Suicide Thoughts Scale. Data were analyzed using univariate analysis of covariance (ANCOVA) in SPSS version 22. The results demonstrated a significant difference between the experimental and control groups in post-test in terms of mean score of cognitive distortions and suicidal thoughts, controlling for pre-test effects (P<.001).  Based on these findings, DBT effectively reduces cognitive distortions and suicidal thoughts in older adults, highlighting new opportunities for clinical interventions. This study suggests DBT as a viable therapeutic approach for improving cognitive distortions and mitigating suicidal ideation in older adults.
EXTENDED ABSTRACT
Introduction
A ging is a significant global health concern, making the mental and physical well-being of older adults a priority. Addressing psychological issues such as reducing cognitive distortions and suicidal thoughts has gained special importance in geriatric care. One of the therapeutic approaches that has recently garnered attention from clinicians for assisting older adults with psychological difficulties is Dialectical Behavior Therapy (DBT). Developed by Marsha Linehan, DBT integrates the principles of cognitive-behavioral therapy with acceptance-based strategies and is initially designed for treating borderline personality disorder. Given the lack of sufficient research on cognitive distortions and suicidal thoughts in older adults both domestically and internationally, and considering the importance of psychological factors in this population, this study seeks to bridge the existing research gap. Additionally, the researcher's experience as a psychologist in older care facilities underscores the significance of understanding the aforementioned variables in older adults. The findings of this study could be instrumental for policymakers, healthcare providers, older care institutions, and families in implementing effective treatment and preventive interventions. Thus, the aim of this study is to examine the effectiveness of DBT in reducing cognitive distortions and suicidal thoughts in older adults.
Method
This study was an applied study in terms of its purpose and a quasi-experimental one in terms of its method, using a pretest-posttest design with a control group. The statistical population included all older people between 65 and 75 years in Ahvaz during the second half of 2024. A total of 30 people who met the eligibility criteria of the study were selected through convenience sampling. Participants were randomly and equally assigned to an experimental group and a control group. The inclusion criteria for the study were (1) obtaining a score higher than the average on the cognitive distortions and suicidal thoughts scales, and (2) being over 65 years of age. The exclusion criteria included (1) participation in concurrent therapeutic interventions and (2) suffering from acute cognitive disorders. The Hamamchi and Buyukozturk’s cognitive distortions scale, and Beck's suicidal thoughts scale were used to collect data. The content of the therapy sessions was adapted from the teachings presented in the book titled Dialectical Behavior Therapy Techniques by McKay et al. (2007) and was held by the researcher for the experimental group in eight 90-minute weekly sessions. Each session included an introduction to its goals and topics, followed by practical exercises. Ethical considerations for this study included obtaining written consent to participate in the study, and maintaining the confidentiality of participants’ personal information. Univariate analysis of covariance (ANCOVA) was used to analyze the data in SPSS-22.
Results
Given the research methodology, ANCOVA was used to analyze the results. Levene’s test for the research variables was statistically non-significant, confirming the assumption of homogeneity of variances. Additionally, a crucial assumption of ANCOVA, homogeneity of regression coefficients, was tested by examining the interaction effect between the independent variable and the pre-test scores of each dependent variable to predict their respective post-test scores. The results indicated that the F-value was non-significant (P>.05), suggesting that this assumption was met. Furthermore, to verify the normal distribution of dependent variables, the Shapiro-Wilk test was performed. The test results confirmed the normality of the variables, as the the W statistic was not statistically significant (P>.05), showing that the data distribution met normality assumptions. As shown in Table 1, there is a significant difference between the experimental and control groups in terms of cognitive distortions. In other words, DBT has led to a meaningful reduction in the mean score of cognitive distortions in the experimental group compared to the control group. The effect size is 0.732, indicating that 73% of the individual differences in cognitive distortion scores can be attributed to DBT. Similarly, Table 1 illustrates a significant difference between the experimental and control groups in terms of suicidal thoughts. Specifically, DBT has resulted in a significant reduction in the mean score of suicidal thoughts in the experimental group compared to the control group. The effect size is 0.494, meaning that 49% of the individual differences in suicidal thought scores are due to the effectiveness of DBT. Therefore, the research hypotheses were confirmed, demonstrating the positive impact of DBT in reducing cognitive distortions and suicidal thoughts in older adults.
Conclusion
The results indicated that DBT effectively reduces cognitive distortions and suicidal thoughts in older adults. Despite the limited research on the effectiveness of DBT in addressing these issues among older adults, this study provides valuable insights. One possible explanation for these findings is that skill training in DBT helps individuals develop acceptance, fostering greater present-moment awareness. By maintaining mindful awareness of their experiences, individuals can focus their attention on the here and now rather than engaging in judgmental and reactive future, which ultimately facilitates a reduction in cognitive distortions and suicidal thoughts. The findings suggest that professionals can incorporate DBT into therapeutic practices to effectively reduce cognitive distortions and suicidal ideation in older adults. Additionally, encouraging middle-aged individuals to seek counseling services and openly discuss psychological challenges may help prevent cognitive distortions and suicidal thoughts from escalating in later life. However, this study has certain limitations, including the limited geographic scope, as participants were only from Ahvaz, reliance on self-report measures for data collection, and the lack of follow-up assessments. Future studies should explore the long-term impact of DBT across various cities, comparing its efficacy with other psychological approaches in addressing similar cognitive and emotional issues among older adults.
Ethical Considerations
Ethical Code
This article is based on the master's thesis of the first author in Personality Psychology at Islamic Azad University, Dezful Branch.
Financial Support
This research received no financial support from any funding agency.
Authors’ Contributions
Kh.T: Conceptualization, Methodology, Software, Validation, Formal analyses, Data Curation, Visualization; H.H.R: Conceptualization, Methodology, Formal analyses, Writing - Review & Editing; E. A. S: Conceptualization, Methodology, Writing - Review & Editing, Visualization.
Conflict of Interest
The authors declare no conflicts of interest.
Acknowledgments
The authors express their sincere gratitude to all participants in this study.

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