. 2022 Jul 8;29(6):1843–1853. doi: 10.1002/cpp.2764

TABLE 2.

Summary of studies included in the review

Author/date	Overview	Design and strengths/limitations	Results: Facets of mindfulness with significance	Results: Clinical outcomes with significance
Perroud et al. (2012)	Sample: 54 individuals with BPD from an outpatient clinic Demographics: Switzerland; adults mean age 30.5; 47 female/7 male; no ethnicity data Intervention: 4‐week intensive DBT followed by standard DBT including individual work.	1‐year follow‐up study. Pre‐post measures of mindfulness and clinical symptoms. Strengths: Data collected over 1 year Limitations: No control group so unable to account for direction of change between mindfulness facets and clinical symptoms. Unable to account for effect of being in a group intervention. Unable to account for specific teaching of mindfulness as taught all DBT skills	Increase from KIMS: Accepting without judgement (p < 0.0001)	Decrease from BDI: Depression (p < 0.0001); Decrease from BHS: Hopelessness (p < 0.0001)
Soler et al. (2012)	Sample: 59 individuals with BPD from outpatient clinic Demographics: Spain; adults 18–48; 51 female/8 male; no ethnicity data Intervention: 8‐week DBT‐M	Non‐randomized control trial GPM + DBT‐M vs. GPM only. Measures of mindfulness, clinical symptoms and laboratory measure of attention. Strengths: Mindfulness specific module used to isolate mindfulness from other DBT skills Limitations: Control group GPM only so unable to account for the effect of being in a structured group intervention	Results for FFMQ not shared in the paper. However, the FFMQ subscale of non‐reactivity to inner experience was found to correlate to the amount of practice undertaken (p = 0.008).	Decreases from HDRS: Related to the amount of practice: Depression (p < 0.001); decrease from BPRS: Psychiatric symptoms (p = 0.001); Decrease from PMS: Confusion (p < 0.001); Decrease from PMS: Total mood distortion (p = 0.03)
Feliu‐Soler et al. (2014)	Sample: 35 individuals with BPD from outpatient clinic Demographics: Spain; adults 18–45; 31 female/4 male; no ethnicity data Intervention: 10‐week DBT‐M	Non‐randomized control trial of DBT‐M vs. GPM. Measures of mindfulness, clinical symptoms and laboratory measure salivary cortisol. Strengths: Mindfulness specific module used to isolate mindfulness from other DBT skills Use of objective measurement Limitations: Control group GPM only so unable to account for the effect of being in a structured group intervention Small sample size limits hypothesis testing	From EQ: Non‐significant results	Decrease from HDRS: Depression (p = 0.002); Decrease from BPRS: Psychiatric symptoms (p = 0.001) No differences in biological variables (salivary cortisol).
Elices et al. (2016)	Sample: 64 individuals with BPD from outpatient clinic Demographics: Spain, adults 18–45; 56 female/8 male; all Caucasian Intervention: 10‐week group therapy of either DBT‐M or DBT IE in outpatient setting.	Single Centre randomized trial DBT‐M vs. DBT IE. Measures of mindfulness, clinical symptoms. Strengths: Randomized between DBT modules to compare effect of content of module. Limitations: Small sample size and drop out reduced power of results	Decrease from BIS‐11: Impulsivity (p < 0.001)	Decrease form BSL‐23: Total score (p = 0.001)
Soler et al. (2016)	Sample:64 individuals with BPD from outpatient clinic (44 to completion of intervention) Demographics: Spain; adults 18–45; 41 female/3 male; no ethnicity data Intervention: 10‐week group therapy of either DBT‐M or DBT‐IE in outpatient setting	Single Centre randomized trial DBT‐M vs. DBT IE. Measures of mindfulness, clinical symptoms and laboratory measure of impulsivity. Strengths: Randomized between DBT modules to compare effect of content of modules Limitations: Unable to account for other impulsivity related disorder as no diagnostic test of ADHD, etc. Unable to account for the effect of continued prescribed medication	Increase from FFMQ: Non‐judgement (p = 0.03); Increase from FFMQ: Describing (p = 0.03); Increase from EQ: Decentring (p = 0.001)	Non‐significant results from continuous performance test‐II; GoStop impulsivity paradigm; two choice impulsivity paradigm; single key impulsivity paradigm; time paradigm test
Krantz et al. (2018)	Sample: 84 individuals with BPD from outpatient clinic Demographics: Canada; adults 18–60; 66 female/18 male; no ethnicity data Intervention: 20‐week DBT skills training (DBT‐S) programme in outpatient setting	Randomized control trial DBT‐S vs. TAU. Measures of mindfulness, clinical symptoms. Strengths: Use of non‐suicidal self‐injury as a measure of clinical impact Limitations: Control group TAU only so unable to account for the effect of being in a structured group intervention Non‐standardized treatment—shorter than standard programme	Increase from KIMS: Accepting without judgement (p = 0.03)	Decrease from modified L‐SASII: Non‐suicidal self‐injury (p = 0.04)
Carmona I Farres, Elices, Soler, Domínguez‐Clavé, Martín‐Banco, et al. (2019)	Sample: 65 individuals with BPD from outpatient clinic Demographics: Spain; adults18–50; 58 female/7 male; no ethnicity data Intervention: 10‐week group therapy of either DBT‐M or DBT‐IE in outpatient setting	Single centre randomized ‐ DBT‐M vs. DBT‐IE. Measures of mindfulness, clinical symptoms and fMRI of default mode network. Strengths: Randomized between DBT modules to compare effect of content of modules Use of objective measurement Limitations: No healthy control for fMRI DBT‐M module included 3 sessions from distress tolerance therefore not comparable to other DBT‐M studies	Increase from FFMQ: Non‐reactivity (p = 0.015) Increase from FFMQ: Non‐judging (p = 0.039) Increase from FFMQ: Total score (p = 0.023)	Improvements in clinical outcomes were non‐significant against outcomes for DBT‐IE. Changes were considered to be due to different mechanisms of change depending on module. Hypothesis of DMN deactivation disproved
Carmona I Farres, Elices, Soler, Domínguez‐Clavé, Pomarol‐Clotet, et al. (2019)	Sample: 70 individuals with BPD from outpatient clinic Demographics: Spain; adults 18–50; 63 female/7 male; no ethnicity data Intervention: 10‐week group therapy of either DBT‐M or DBT‐IE in outpatient setting	Design: Single centre randomized DBT‐ M vs DBT‐IE. Measures of mindfulness, clinical symptoms and laboratory measure of emotional regulation. Strengths: Randomized between DBT modules to compare effect of content of modules Use of objective measurement Limitations: Assessment of BPD not standardized so BPD symptoms may not have been equal across groups	Increase from FFMQ: Non‐judging (p = 0.001) Increase from FFMQ: Non‐reactivity (p = 0.003) Increase from EQ: Decentring (p = 0.03)	Decrease from BIS: Impulsivity (p = 0.03) Emotional Stroop task: Improvements in emotional regulation were non‐significant against outcomes for DBT‐IE.
Mitchell et al. (2018)	Sample: 35 individuals with BPD Demographics: Australia, adults, 33 female/2 male, no ethnicity data Intervention: 20‐week DBT skills training programme in outpatient setting	Correlation study pre‐post treatment. Measures of mindfulness, clinical symptoms and healthcare usage. Strengths: Sample representative of real‐ world setting Limitations: No control group so unable to account for direction of change between mindfulness facets and clinical symptoms. Unable to account for effect of being in a group intervention. Unable to account for specific teaching of mindfulness as taught all DBT skills	Increase from FFMQ: Total FFMQ score (p < 0.001); Increase from FFMQ: Observing (p = 0.027); Increase from FFMQ: Acting with awareness (p < 0.001); Increase from FFMQ: Non‐judging (p < 0.001); Increase from FFMQ: Non‐reactivity (p < 0.001)	Decrease across BSL‐23; BASIS‐32; K10; IDS: Across measures (p < 0.001)
Mochrie et al. (2019)	Sample: 212 individuals with acute mental illness using a partial hospital programme Demographics: America, adults 18–66, 140 female/69 male/3 not reported; 185 Caucasian/17 African American/5 Hispanic/4 Asian/1 unreported Intervention: DBT‐informed partial hospital programme of varying length for each individual	Pre‐post intervention data collection. Measures of mindfulness, clinical symptoms and length of stay Strengths: Larger number of participants Limitations: No control group so unable to account for direction of change between mindfulness facets and clinical symptoms. Unable to account for effect of being in a group intervention. Unable to account for specific teaching of mindfulness as taught all DBT skills Very specific application of DBT in a non‐standard DBT programme.	Increase from FFMQ: Observing, describing, Increase from FFMQ: Acting with awareness, Increase from FFMQ: Non‐judging and non‐reactivity (all p < 0.001)	Decrease from CUDOS: Depression (p < 0.001); Decrease from CUAOS: Anxiety (p < 0.001); Decrease from BHS: Hopelessness (p < 0.001) Decrease from BHS: Suffering (p < 0.001);
Zeifman et al. (2020)	Sample: 84 individuals with BPD recruited from outpatient setting Demographics: Canada; adults mean age 29.67; 66 female/18 male; no ethnicity data Intervention: 20‐week skills training programme in an outpatient setting	Randomized control trial DBT‐skills (DBT‐S) vs active wait list (TAU). Measures of mindfulness, clinical symptoms Strengths: Focussed on differences between mindfulness and distress tolerance Limitations: Control group TAU only so unable to account for the effect of being in a structured group intervention Unable to account for specific teaching of mindfulness as taught all DBT skills	Increase from KIMS: Total KIMS score (p < 0.001)	Decrease from BSL‐23: Borderline symptoms (p < 0.001); Increase from SAS‐SR social adjustment (p < 0.001)

Author/date

Overview

Design and strengths/limitations

Results: Facets of mindfulness with significance

Results: Clinical outcomes with significance

Perroud et al. (2012)

Sample: 54 individuals with BPD from an outpatient clinic

Demographics: Switzerland; adults mean age 30.5; 47 female/7 male; no ethnicity data

Intervention: 4‐week intensive DBT followed by standard DBT including individual work.

1‐year follow‐up study. Pre‐post measures of mindfulness and clinical symptoms.

Strengths: Data collected over 1 year

Limitations: No control group so unable to account for direction of change between mindfulness facets and clinical symptoms.

Unable to account for effect of being in a group intervention.

Unable to account for specific teaching of mindfulness as taught all DBT skills

Increase from KIMS: Accepting without judgement (p < 0.0001)

Decrease from BDI: Depression (p < 0.0001);

Decrease from BHS: Hopelessness (p < 0.0001)

Soler et al. (2012)

Sample: 59 individuals with BPD from outpatient clinic

Demographics: Spain; adults 18–48; 51 female/8 male; no ethnicity data

Intervention: 8‐week DBT‐M

Non‐randomized control trial GPM + DBT‐M vs. GPM only. Measures of mindfulness, clinical symptoms and laboratory measure of attention.

Strengths: Mindfulness specific module used to isolate mindfulness from other DBT skills

Limitations: Control group GPM only so unable to account for the effect of being in a structured group intervention

Results for FFMQ not shared in the paper. However, the FFMQ subscale of non‐reactivity to inner experience was found to correlate to the amount of practice undertaken (p = 0.008).

Decreases from HDRS: Related to the amount of practice: Depression (p < 0.001); decrease from BPRS: Psychiatric symptoms (p = 0.001);

Decrease from PMS: Confusion (p < 0.001);

Decrease from PMS: Total mood distortion (p = 0.03)

Feliu‐Soler et al. (2014)

Sample: 35 individuals with BPD from outpatient clinic

Demographics: Spain; adults 18–45; 31 female/4 male; no ethnicity data

Intervention: 10‐week DBT‐M

Non‐randomized control trial of DBT‐M vs. GPM. Measures of mindfulness, clinical symptoms and laboratory measure salivary cortisol.

Strengths: Mindfulness specific module used to isolate mindfulness from other DBT skills

Use of objective measurement

Limitations: Control group GPM only so unable to account for the effect of being in a structured group intervention

Small sample size limits hypothesis testing

From EQ: Non‐significant results

Decrease from HDRS: Depression (p = 0.002);

Decrease from BPRS: Psychiatric symptoms (p = 0.001)

No differences in biological variables (salivary cortisol).

Elices et al. (2016)

Sample: 64 individuals with BPD from outpatient clinic

Demographics: Spain, adults 18–45; 56 female/8 male; all Caucasian

Intervention: 10‐week group therapy of either DBT‐M or DBT IE in outpatient setting.

Single Centre randomized trial DBT‐M vs. DBT IE. Measures of mindfulness, clinical symptoms.

Strengths: Randomized between DBT modules to compare effect of content of module.

Limitations: Small sample size and drop out reduced power of results

Decrease from BIS‐11: Impulsivity (p < 0.001)

Decrease form BSL‐23: Total score (p = 0.001)

Soler et al. (2016)

Sample:64 individuals with BPD from outpatient clinic (44 to completion of intervention)

Demographics: Spain; adults 18–45; 41 female/3 male; no ethnicity data

Intervention: 10‐week group therapy of either DBT‐M or DBT‐IE in outpatient setting

Single Centre randomized trial DBT‐M vs. DBT IE. Measures of mindfulness, clinical symptoms and laboratory measure of impulsivity.

Strengths: Randomized between DBT modules to compare effect of content of modules

Limitations: Unable to account for other impulsivity related disorder as no diagnostic test of ADHD, etc.

Unable to account for the effect of continued prescribed medication

Increase from FFMQ: Non‐judgement (p = 0.03);

Increase from FFMQ: Describing (p = 0.03);

Increase from EQ: Decentring (p = 0.001)

Non‐significant results from continuous performance test‐II; GoStop impulsivity paradigm; two choice impulsivity paradigm; single key impulsivity paradigm; time paradigm test

Krantz et al. (2018)

Sample: 84 individuals with BPD from outpatient clinic

Demographics: Canada; adults 18–60; 66 female/18 male; no ethnicity data

Intervention: 20‐week DBT skills training (DBT‐S) programme in outpatient setting

Randomized control trial DBT‐S vs. TAU. Measures of mindfulness, clinical symptoms.

Strengths: Use of non‐suicidal self‐injury as a measure of clinical impact

Limitations: Control group TAU only so unable to account for the effect of being in a structured group intervention

Non‐standardized treatment—shorter than standard programme

Increase from KIMS: Accepting without judgement (p = 0.03)

Decrease from modified L‐SASII: Non‐suicidal self‐injury (p = 0.04)

Carmona I Farres, Elices, Soler, Domínguez‐Clavé, Martín‐Banco, et al. (2019)

Sample: 65 individuals with BPD from outpatient clinic

Demographics: Spain; adults18–50; 58 female/7 male; no ethnicity data

Intervention: 10‐week group therapy of either DBT‐M or DBT‐IE in outpatient setting

Single centre randomized ‐ DBT‐M vs. DBT‐IE. Measures of mindfulness, clinical symptoms and fMRI of default mode network.

Strengths: Randomized between DBT modules to compare effect of content of modules

Use of objective measurement

Limitations: No healthy control for fMRI

DBT‐M module included 3 sessions from distress tolerance therefore not comparable to other DBT‐M studies

Increase from FFMQ: Non‐reactivity (p = 0.015)

Increase from FFMQ: Non‐judging (p = 0.039)

Increase from FFMQ: Total score (p = 0.023)

Improvements in clinical outcomes were non‐significant against outcomes for DBT‐IE. Changes were considered to be due to different mechanisms of change depending on module.

Hypothesis of DMN deactivation disproved

Carmona I Farres, Elices, Soler, Domínguez‐Clavé, Pomarol‐Clotet, et al. (2019)

Sample: 70 individuals with BPD from outpatient clinic

Demographics: Spain; adults 18–50; 63 female/7 male; no ethnicity data

Intervention: 10‐week group therapy of either DBT‐M or DBT‐IE in outpatient setting

Design: Single centre randomized DBT‐ M vs DBT‐IE. Measures of mindfulness, clinical symptoms and laboratory measure of emotional regulation.

Strengths: Randomized between DBT modules to compare effect of content of modules

Use of objective measurement

Limitations: Assessment of BPD not standardized so BPD symptoms may not have been equal across groups

Increase from FFMQ: Non‐judging (p = 0.001)

Increase from FFMQ: Non‐reactivity (p = 0.003)

Increase from EQ: Decentring (p = 0.03)

Decrease from BIS: Impulsivity (p = 0.03)

Emotional Stroop task: Improvements in emotional regulation were non‐significant against outcomes for DBT‐IE.

Mitchell et al. (2018)

Sample: 35 individuals with BPD

Demographics: Australia, adults, 33 female/2 male, no ethnicity data

Intervention: 20‐week DBT skills training programme in outpatient setting

Correlation study pre‐post treatment. Measures of mindfulness, clinical symptoms and healthcare usage.

Strengths: Sample representative of real‐ world setting

Limitations: No control group so unable to account for direction of change between mindfulness facets and clinical symptoms.

Unable to account for effect of being in a group intervention.

Unable to account for specific teaching of mindfulness as taught all DBT skills

Increase from FFMQ: Total FFMQ score

(p < 0.001);

Increase from FFMQ: Observing (p = 0.027);

Increase from FFMQ: Acting with awareness (p < 0.001);

Increase from FFMQ: Non‐judging (p < 0.001);

Increase from FFMQ: Non‐reactivity (p < 0.001)

Decrease across BSL‐23; BASIS‐32; K10; IDS: Across measures (p < 0.001)

Mochrie et al. (2019)

Sample: 212 individuals with acute mental illness using a partial hospital programme

Demographics: America, adults 18–66, 140 female/69 male/3 not reported; 185 Caucasian/17 African American/5 Hispanic/4 Asian/1 unreported

Intervention: DBT‐informed partial hospital programme of varying length for each individual

Pre‐post intervention data collection. Measures of mindfulness, clinical symptoms and length of stay

Strengths: Larger number of participants

Limitations: No control group so unable to account for direction of change between mindfulness facets and clinical symptoms.

Unable to account for effect of being in a group intervention.

Unable to account for specific teaching of mindfulness as taught all DBT skills

Very specific application of DBT in a non‐standard DBT programme.

Increase from FFMQ: Observing, describing,

Increase from FFMQ: Acting with awareness,

Increase from FFMQ: Non‐judging and non‐reactivity (all p < 0.001)

Decrease from CUDOS: Depression (p < 0.001);

Decrease from CUAOS: Anxiety (p < 0.001);

Decrease from BHS: Hopelessness (p < 0.001)

Decrease from BHS: Suffering (p < 0.001);

Zeifman et al. (2020)

Sample: 84 individuals with BPD recruited from outpatient setting

Demographics: Canada; adults mean age 29.67; 66 female/18 male; no ethnicity data

Intervention: 20‐week skills training programme in an outpatient setting

Randomized control trial DBT‐skills (DBT‐S) vs active wait list (TAU). Measures of mindfulness, clinical symptoms

Strengths: Focussed on differences between mindfulness and distress tolerance

Limitations: Control group TAU only so unable to account for the effect of being in a structured group intervention

Unable to account for specific teaching of mindfulness as taught all DBT skills

Increase from KIMS: Total KIMS score (p < 0.001)

Decrease from BSL‐23: Borderline symptoms (p < 0.001);

Increase from SAS‐SR social adjustment (p < 0.001)

Abbreviations: BASIS‐32, Behaviour and Symptom Identification scale; BDI, Beck Depression Inventory; BHS, Beck Hopelessness Scale; BIS‐11, Barrat Impulsiveness Scale; BPD, Borderline Personality Disorder; BPRS, Brief Psychiatric Rating Scale; BSL‐23, Borderline Symptoms List; CUAOS, Clinically Useful Anxiety Outcome Scale; CUDOS, Clinically Useful Depression Scale; DBT‐IE, Taught interpersonal effectiveness module only; DBT‐M, Taught mindfulness module only; DBT‐S, Taught all of the DBT vie skills modules; DERS, Difficulties in Emotional Regulation Scale; EQ, Experiences Questionnaire; FFMQ, Five Facet Mindfulness Questionnaire; GPM, General Psychiatric Management; HDRS, Hamilton Depression Rating Scale; IDS, Inventory for Depressive Symptomatology; K10, Kessler Psychological Distress Scale; KIMS, Kentucky Inventory of Mindfulness Skills; Modified L‐SASII, Suicide attempt self‐injury interview; PMS, profile of mood states; SAS‐SR, Social Adjustment Scale–Self‐Report; SCL‐90‐R, Global Severity Index of the Symptom Checklist‐90—Revised.