Efficacy of dialectical behavior therapy-based interventions for individuals with autism spectrum disorder: a systematic review and meta-analysis

Abstract

Background

Autism spectrum disorder (ASD) is characterized by social communication deficits and emotional dysregulation. Dialectical behavior therapy (DBT) has shown potential benefits in various psychiatric conditions; however, evidence regarding its effectiveness in individuals with ASD remains limited. This study aimed to evaluate the effects of DBT-based interventions on emotional regulation, suicidal ideation, and depressive symptoms in ASD.

Methods

Six English and Chinese databases were searched from inception to April 1, 2025. Randomized controlled trials (RCTs) comparing DBT-based interventions with control conditions in individuals with ASD were included. Data were pooled using standardized mean difference (SMD) with 95% confidence intervals (CI). Heterogeneity was assessed using the I² statistic, and subgroup analyses were conducted.

Results

Four RCTs involving 375 participants were included. Compared with controls, DBT-based interventions were associated with significant improvements in emotional regulation (SMD = − 0.89, 95% CI: −1.67 to − 0.10) and reductions in suicidal ideation (SMD = − 1.97, 95% CI: −3.02 to − 0.91) and depressive symptoms (SMD = − 2.23, 95% CI: −4.35 to − 0.11). Subgroup analysis indicated that shorter session duration (≤ 60 min) was associated with greater improvements in emotional regulation, whereas no significant effect was observed for longer sessions (> 60 min). No significant effects were found for anxiety.

Conclusion

DBT-based interventions show potential benefits in improving emotional regulation, reducing suicidal ideation, and alleviating depressive symptoms in individuals with ASD. However, the findings should be interpreted with caution due to the limited number of trials and substantial heterogeneity. Further large-scale, high-quality RCTs are warranted.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-026-04729-6.

Introduction

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by deficits in social communication, repetitive and stereotyped behaviors, and restricted interests, significantly impairing daily functioning and social integration [1]. According to the World Health Organization, the global prevalence of ASD is estimated to be approximately 1% to 2%, with a steadily increasing trend [2]. Importantly, ASD is a highly heterogeneous spectrum, with individuals presenting widely varying levels of cognitive abilities, language skills, and adaptive functioning. Furthermore, individuals with ASD experience a disproportionately high prevalence of co-occurring mood disorders, such as anxiety and depression, which often exacerbate their core behavioral challenges and significantly diminish their quality of life. Although an expanding body of research has focused on various psychotherapies for patients with ASD, traditional approaches such as behavioral therapy, structured psychoeducation, and cognitive behavioral therapy have demonstrated certain improvements in psychological symptoms, social functioning and adaptive behaviors [3, 4]. However, due to the substantial challenges ASD patients face in emotional regulation, impulse control, and stress management, associated with these comorbid mood disorders, the development of effective strategies to enhance their emotional regulation skills and adaptive behaviors remains a critical focus of contemporary psychotherapeutic research.

Dialectical Behavior Therapy (DBT), initially developed by Marsha Linehan, has gained increasing attention as an integrative psychotherapeutic approach combining cognitive-behavioral techniques, mindfulness training, and emotional regulation strategies [5]. In recent years, DBT has demonstrated significant efficacy in treating borderline personality disorder and mood disorders, leading to its application in clinical interventions for individuals with ASD [6, 7]. The core advantage of DBT lies in its “dialectical balance” approach, which integrates acceptance and change strategies to help individuals develop adaptive skills in emotional regulation, distress tolerance, and interpersonal effectiveness [8]. Over the past decade, an increasing number of studies have explored the application of DBT in ASD populations, providing a novel therapeutic perspective [9, 10]. Given the executive function deficits and emotional regulation difficulties inherent to ASD, traditional intervention approaches may have limited effectiveness. In contrast, the structured, visualized, and context-based skill training emphasized in DBT may better align with the learning characteristics of individuals with ASD [11]. Current research suggests that DBT holds promise in reducing anxiety, self-injurious behaviors, and emotional outbursts in individuals with ASD [12]. However, significant variability in intervention formats (individual vs. group-based), treatment durations (short-term vs. long-term), and outcome measures (subjective reports vs. objective assessments) across studies has led to inconsistent findings, highlighting the need for systematic, quantitative analyses to validate its overall efficacy.

To address this gap, the present study employs a meta-analytic approach to synthesize existing literature and systematically evaluate the efficacy of DBT-based interventions in improving emotional regulation strategy, suicidal ideation, core psychological symptoms in individuals with ASD. The findings of this study will provide evidence-based guidance for optimizing individualized intervention strategies for ASD while contributing to the advancement of transdiagnostic psychotherapeutic models.

Method

Study design

This study follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines for conducting a systematic review and meta-analysis to evaluate the effectiveness of DBT interventions for individuals with ASD [13]. The study has been registered on International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD420251023317.

Inclusion and exclusion criteria

The inclusion criteria based on the PICO framework were as follows [14]: (1) participants must be diagnosed with ASD, with no specific restrictions on age or gender; (2) the experimental group received DBT-based interventions, while the control group received routine treatment (e.g., behavioral therapy, cognitive therapy), standard psychological care, or no intervention; (3) the primary outcomes included emotional regulation strategy and suicidal ideation, while secondary outcomes included negative psychological states such as anxiety, depression, and distress; (4) the study design had to be RCTs; (5) only studies published in English or Chinese were included.

The exclusion criteria were: (1) participants with comorbid epilepsy, bipolar disorder, schizophrenia, or other psychiatric disorders; (2) studies where the intervention group received DBT combined with other treatments or did not clearly identify DBT as the core intervention; (3) studies with incomplete data or lacking relevant outcome measures; (4) non-original studies (e.g., reviews, commentaries, case reports).

Literature search

A comprehensive search was conducted in PubMed, Embase, Cochrane Library, PsycINFO, China National Knowledge Infrastructure (CNKI), and Chinese Biomedical Literature Database (CBM) to identify relevant studies in both English and Chinese. The search timeframe covered all publications from database inception to April 1, 2025. The search strategy incorporated a combination of keywords and Medical Subject Headings (MeSH) terms, including “dialectical behavior therapy,” “autism spectrum disorder,” and “randomized controlled trial.” Boolean operators (e.g., “AND,” “OR”) were applied to optimize search precision and comprehensiveness. The search strategy employed in this study, exemplified by PubMed, is detailed in Table 1. Additionally, a manual search of reference lists from relevant systematic reviews was performed to identify potential missing studies.

Table 1.

The search strategy used in this study (PubMed)

PubMed	#1: “Dialectical Behavior Therapy” [MeSH Terms] OR “DBT” [Title/Abstract] OR “Dialectical Behavioral Therap*” [Title/Abstract] OR “Dialectical Psychotherap*” [Title/Abstract] OR “Dialectical Therap*” [Title/Abstract] OR “Dialectic Behavioral Therap*” [Title/Abstract]
	#2: “Autism Spectrum Disorder” [MeSH Terms] OR “Autistic Disorder” [MeSH Terms] OR “Autism” [Title/Abstract] OR “Autistic Disorder” [Title/Abstract] OR “Asperger Syndrome” [Title/Abstract] OR “pervasive developmental disorder” [Title/Abstract]
	#3: “Randomized Controlled Trial“[Publication Type] OR “Randomized Controlled Trials as Topic“[Mesh Terms] OR “Single-Blind Method“[Mesh Terms] OR “Double-Blind Method“[Mesh Terms] OR “Placebos“[Mesh Terms] OR “Random Allocation“[Mesh Terms] OR random*[Title/Abstract] OR placebo*[Title/Abstract] OR “blind*” [Title/Abstract]
	#5: #1 AND #2 AND #3; Filters: Chinese, English
	Search Date: April 1, 2025;

Study selection and data extraction

Two independent research members (GF and PW) conducted the study selection and data extraction process. The study selection included the following steps: First, all retrieved articles were screened based on the inclusion and exclusion criteria, and studies that did not meet the eligibility criteria were excluded. Next, a detailed assessment of the remaining studies was performed to ensure data completeness and relevance. Extracted data included basic study characteristics (e.g., first author, year of publication, country of study), study design, sample size, total duration of intervention, duration of per session, follow-up duration, main outcomes (e.g., emotional regulation strategy, anxiety, depression), and post-intervention means and standard deviations (SD) for each outcome. For studies with multiple follow-up time points, data from the final follow-up were extracted.

In cases of discrepancies during data extraction, disagreements were resolved through discussion between the two members or consultation with a third member to ensure accuracy and consistency. The entire data extraction and selection process followed pre-established criteria to ensure the reliability and validity of the study findings.

Risk of bias assessment

The risk of bias in the included RCTs was assessed using the Cochrane Risk of Bias Tool (RoB 1.0) [15]. This tool evaluates bias across seven domains: selection bias, performance bias, detection bias, attrition bias, reporting bias, and other potential sources of bias. Each domain was categorized as “low risk,” “high risk,” or “unclear risk.“ [15] A comprehensive evaluation of the overall risk of bias was conducted to determine its potential impact on the conclusions of the meta-analysis.

Statistical analysis

All statistical analyses in this study were conducted using Rev Man 5.4 and STATA software. To assess the effects of DBT-based intervention on primary and secondary outcome measures in patients with ASD, we calculated the standardized mean difference (SMD) and its 95% confidence interval (95% CI). Heterogeneity among studies was assessed using the I² statistic, with an I² value greater than 50% indicating substantial heterogeneity [16]. If significant heterogeneity was detected, a random-effects model was applied for data synthesis; otherwise, a fixed-effects model was used [16]. To further explore potential sources of heterogeneity, a subgroup analysis was performed based on the duration of each DBT intervention session.

Additionally, a sensitivity analysis was conducted to test the robustness of the findings. Publication bias was evaluated using Egger’s regression test and funnel plot asymmetry. These statistical approaches ensured a comprehensive and precise assessment of the efficacy of DBT-based interventions, providing valuable evidence for future research.

Results

Literature screening results

A comprehensive search of six Chinese and English literature databases yielded a total of 137 studies. After removing duplicates, 104 studies remained. Based on the predefined inclusion and exclusion criteria, two independent researchers screened the titles and abstracts, resulting in the preliminary selection of 21 studies. Following a full-text review, four studies [17–20] were ultimately included, involving three published in English and one in Chinese. The literature screening process is illustrated in Fig. 1.

Fig. 1.

Flowchart of study selection process

Characteristic of included studies

In the four included studies [17–20], a total of 375 ASD patients were involved, with 190 in the experimental group and 185 in the control group. Among these studies, two [18, 19] focused on adult ASD patients, one [20] focused on adolescents diagnosed with ASD who also exhibited non-suicidal self-injury (NSSI), and one [17] on school-age children, with average ages ranging from 10.2 to 37.9 years. Two studies were conducted in the Netherlands, one [20] in China, and one [19] in the United States. Regarding the implementation of the intervention, all studies [17–20] provided DBT intervention via face-to-face delivery. The duration of the interventions varied across studies, ranging from 8 to 24 weeks. one study [20] limited the intervention duration to 60 min or less per session, while the other three studies [17–19] had session durations ranging from 1.5 h to 4 h. The basic characteristics of the included studies are detailed in Table 2.

Table 2.

The study characteristics of included studies (n = 4)

Author and year	Country	Study design	Participants	Sample size		Participant’s age		Intervention		Type of intervention	Intervention frequency	Outcome measured
				E	C	E	C	E	C
Clifford 2022 [17]	Netherlands	RCT	School-aged autistic children	26	24	10.2 ± 1.58	10.2 ± 1.56	Attention-based dialectical behavior Therapy	Psychoeducation support	Face-to-face	1 h per session for 9 weeks program	①Aggressive behavior problems, ②Anger coping strategies, ③Children’s quality of life, ④Perceived stress-levels; ⑤psychological well-being
Huntjens 2024 [18]	Netherlands	Pragmatic RCT	Autistic adults	63	60	36.9 ± 10.6	37.9 ± 12.1	DBT focuses on emotion regulation skill training	Treatment as usual	Face-to-face, group form	4 h per session for 26 weeks program	①Severity of suicidal ideation, ②Frequency of suicide attempts, ③Severity of depression, ④Social anxiety
Lee 2024 [19]	United States	RCT	Autistic young adults	18	18	21.9 ± 4.16	22.7 ± 4.31	Dialectical behavior skills improvement	Treatment as usual	Face-to-face, small group form	90 min per session for 8-week program	①Adaptive emotion regulation skills ②Psychological flexibility ③Emotion dysregulation
Zhang 2023 [20]	China	RCT	Adolescents with ASD	83	83	14.02 ± 1.60	13.98 ± 1.45	DBT	Treatment as usual	Face-to-face course	45–60 min per session, once a week for 8 weeks program	①Anxiety; ②Depression; ③Cognitive emotional regulation; ④Suicidal ideation

Abbreviation: DBT Dialectical behavior therapy, ASD Autism Spectrum Disorder, RCT randomized controlled trial, NSSI Non-suicidal self-injury

Assessment of risk of bias

This study assessed the risk of bias in seven domains for the four included studies [17–20]. All studies [17–20] followed the principle of random allocation for participant grouping, which was assessed as low risk. In the allocation concealment domain, one study [19] did not clearly specify whether allocation concealment was implemented to ensure the fairness of randomization. Regarding blinding of participants and personnel, as well as blinding of outcome assessment, two studies [17, 19] were rated as high risk, and two studies did not clearly report key information regarding the implementation of blinding. All four studies [17–20] had a low risk in terms of outcome data integrity, despite a relatively high dropout rate during the follow-up period. In the domains of selective reporting bias and other biases, no study exhibited unclear risk of bias. Detailed study characteristics and risk of bias assessment results are presented in Fig. 2.

Fig. 2.

Quality appraisal for included studies

The efficacy of DBT-based interventions on outcomes

Emotional regulation strategies

Three studies [17, 19, 20] with 252 participants reported the efficacy of DBT-based interventions on emotional regulation strategies in ASD patients. Given the use of different assessment tools across studies (e.g., Adaptive Emotion Regulation Skills Questionnaire, Anger Emotion Coping Strategies Questionnaire, and the Cognitive Emotion Regulation Questionnaire), data were combined using SMD. The analysis revealed significant heterogeneity between studies (I² = 86%, P < 0.001), and thus a random-effects model was applied. The results indicated that the experimental group showed a statistically significant improvement in emotional regulation strategies compared to the control group after the intervention (SMD = -0.89, 95% CI: -1.67 to -0.10, P = 0.03).

To further investigate the source of heterogeneity, we conducted subgroup analysis based on the duration of each intervention session. In the subgroup with intervention duration ≤ 60 min per session, a significant improvement in emotional regulation strategies was observed in the DBT group compared with the control group (SMD = − 1.09, 95% CI: −2.06 to − 0.13, P = 0.03), although substantial heterogeneity remained (I² = 88%). In contrast, for interventions lasting > 60 min per session, no statistically significant difference was found between the two groups (SMD = − 0.42, 95% CI: −1.08 to 0.24, P = 0.21), and heterogeneity was not applicable due to the inclusion of only one study. Overall, DBT-based interventions demonstrated a statistically significant effect on improving emotional regulation strategies compared with the control condition. Detailed results are presented in Fig. 3.

Fig. 3.

Forest plot of the efficacy of DBT-based interventions in individuals with ASD on emotional regulation strategy

Suicidal ideation

Two studies [18, 20] with 289 participants reported the efficacy of DBT-based intervention on suicidal ideation in patients with ASD. Since different assessment tools were used in the studies, data were pooled using SMD. The results indicated substantial heterogeneity between the studies (I² = 93%, P < 0.001), thus a random-effects model was used for data analysis. The results showed that the experimental group improved more in suicidal ideation compared to the control group, with a statistically significant difference between the two groups (SMD = -1.97, 95% CI: -3.02 to -0.91, P < 0.001). The specific results are shown in Fig. 4.

Fig. 4.

Forest plot of the efficacy of DBT-based interventions in individuals with ASD on suicidal ideation

Depression

Two studies [18, 20] with 289 participants reported the efficacy of DBT-based intervention on depression scores in patients with ASD. Since different assessment tools were used across the studies, data were pooled using SMD. The results indicated substantial heterogeneity between the studies (I² = 98%, P < 0.001), and thus a random-effects model was applied for data analysis. The results showed that the experimental group showed greater improvement in depression compared to the control group, with a statistically significant difference between the two groups (SMD = -2.23, 95% CI: -4.35 to -0.11, P = 0.04). The specific results are shown in Fig. 5.

Fig. 5.

Forest plot of the efficacy of DBT-based interventions in individuals with ASD on depression

Anxiety

Two studies [18, 20] reported the efficacy of DBT-based intervention on anxiety in patients with ASD. Since different assessment tools were used across the studies, data were pooled using SMD. The results indicated substantial heterogeneity between the studies (I² = 98%, P < 0.01), and therefore, a random-effects model was applied for data analysis. The results showed that, although the experimental group showed improvement in anxiety compared to the control group, the difference between the two groups was not statistically significant (SMD = -1.27, 95% CI: -3.09 to 0.55, P = 0.17). The specific results are shown in Fig. 6.

Fig. 6.

Forest plot of the efficacy of DBT-based interventions in individuals with ASD on anxiety

Publication bias

Since the use of funnel plots requires the inclusion of at least 10 studies, we used the Egger’s regression test to assess whether there was publication bias in the primary outcomes of this study. The result of the Egger’s regression test showed a P-value of 0.24, which is greater than 0.05, indicating no significant publication bias. Therefore, the results are considered to have high reliability.

Discussion

This meta-analysis synthesized data from four RCTs to systematically evaluate the efficacy of DBT-based intervention in patients with ASD. The findings indicate that DBT demonstrates significant clinical benefits in enhancing emotion regulation strategies, reducing suicidal ideation, and alleviating depressive symptoms. However, no statistically significant effects were observed in reducing anxiety. These results align with DBT’s core mechanism, which operates within a tripartite framework of mindfulness, acceptance, and change, enabling ASD individuals to identify emotional triggers, and reduce impulsive behaviors [5, 21]. For instance, the “CHECK” skill (describe-check-act) within the emotion regulation module directly targets the emotional reactivity issues commonly observed in ASD. Similarly, the reduction in suicidal ideation may be linked to DBT’s crisis survival strategies, which employs physiological interventions (e.g., temperature change and intense physical activity) to mitigate acute emotional distress [22]. However, the limited efficacy in anxiety reduction may reflect the unique nature of anxiety in ASD. Existing studies suggest that ASD-related anxiety often stems from the unpredictability of social interactions and sensory overload, whereas traditional DBT primarily focuses on internal emotion regulation, lacking targeted exposure training for specific environmental triggers [23, 24]. Future interventions may need to integrate elements from cognitive behavioral therapy, such as behavioral experiments, to gradually increase tolerance to uncertainty.

Compared to previous studies, this study offers a novel contribution by quantifying the efficacy of DBT on suicide risk reduction in ASD. Although ASD patients exhibit a suicide rate four to six times higher than the general population, research on suicide prevention in this group remains scarce [25]. The significant effect of DBT on reducing suicidal ideation in ASD may be attributed to its unique “life-value clarification” technique, which enhances survival motivation by helping individuals construct future goals. This approach is particularly crucial for neurodiverse populations [26, 27]. However, cultural factors may influence the intervention outcomes. For example, studies conducted in China emphasize family involvement, where parents receive simultaneous DBT training, whereas Western studies predominantly employ individual-based intervention models [28]. Differences in cultural values—such as collectivism versus individualism—may shape skill application priorities, with East Asian patients relying more on family support for crisis management, while Western patients tend to use self-soothing techniques independently [29]. These findings underscore the need for cultural adaptation when implementing DBT in ASD-related populations rather than merely replicating existing protocols.

The heterogeneity observed in this meta-analysis necessitates further methodological scrutiny. First, the lack of standardized assessment tools limits the comparability of results, which may potentially confound outcome evaluations. The broad age range (10.2–37.9 years) requires specific developmental adaptations to ensure engagement. Clinically, younger patients or those with lower cognitive levels benefit from visual aids and simplified language, while adult interventions should prioritize complex vocational and interpersonal skills. Such ‘developmental tailoring’ is essential to mitigate the confounding effects of varying cognitive and linguistic capacities across the spectrum. Additionally, subgroup analyses indicate that session duration is a key factor influencing emotion regulation outcomes: short-duration interventions (≤ 60 min per session) demonstrated significant effects (SMD = -1.09), whereas longer sessions (> 60 min) exhibited attenuated effects (SMD = -0.42). This discrepancy may be attributed to cognitive processing characteristics in ASD. Research suggests that ASD individuals exhibit deficits in sustained attention and working memory load, meaning that prolonged sessions may reduce information processing efficiency and even exacerbate anxiety [30]. Consequently, clinical practice should consider adopting a phased, small-module intervention design (e.g., focusing on one to two skills per session) rather than the traditional intensive DBT format.

Building on these findings, future research should prioritize several directions. First, developing ASD-specific DBT protocols by integrating social stories with DBT skills could facilitate understanding of complex emotional scenarios through visual narratives [31]. Second, leveraging neuroimaging techniques such as fMRI and EEG could elucidate the neural mechanisms underlying DBT, particularly its impact on hyperactivity within the default mode network during mindfulness training [32]. Third, establishing a stepped-care intervention model—tailoring intervention intensity based on baseline emotion dysregulation severity—could optimize resource allocation (e.g., self-guided DBT workbooks for mild cases and combined individual/group therapy for severe cases) [33, 34]. Finally, interdisciplinary collaboration should be encouraged to incorporate DBT into a multidimensional ASD intervention framework, such as integrating applied behavior analysis to address core symptoms while utilizing DBT to manage comorbid emotional dysregulation [35, 36].

Implication for clinical practice

The results of this meta-analysis hold significant clinical relevance, especially in addressing common emotional dysregulation in individuals with ASD, including critical signals like suicidal ideation. While current evidence is somewhat tentative, DBT provides a promising and targeted psychological intervention. Therefore, clinicians may consider incorporating DBT into individualized treatment plans as an adjunctive therapy for specific emotional vulnerabilities, rather than a universal intervention for all ASD patients.

The study also found that session duration could be an important factor affecting treatment efficacy, suggesting clinicians should adjust intervention lengths to optimize outcomes. Furthermore, while DBT demonstrated significant effects on emotional regulation and depressive symptoms, no significant improvement was observed for anxiety, indicating a combined approach with other therapies may be necessary. Healthcare providers should consider the individual characteristics of ASD patients, such as age, gender, psychotherapy expectations, and disease severity. However, given the evidence base is constrained by a small number of trials (total N < 500) and limited to English and Chinese literature, these recommendations must be interpreted with caution. DBT plans should be dynamically adjusted with regular evaluations to ensure long-term effectiveness.

Limitation of the study

Despite our efforts to adopt rigorous methodologies and comprehensive analyses, certain limitations must be acknowledged. First, the total sample size across the included trials was relatively small (n = 375). Furthermore, the wide age range of participants (10.2 to 37.9 years) necessitated by the limited literature, alongside the lack of systematic control for intellectual disability and linguistic comprehension levels across the primary studies, may introduce confounding effects and limit the generalizability of the findings. We strongly advocate for future large-scale RCTs to focus on specific developmental windows (e.g., pediatric-only cohorts) to better understand these confounding effects. Second, substantial heterogeneity was observed in key outcome measures, such as emotion regulation (I²=89% to 98%), due to significant differences in intervention modalities (online/offline), session duration (ranging from ≤ 60 min to 4 h), and assessment tools. Although a subgroup analysis was conducted to explore the impact of session duration, other potential confounding factors, such as cultural background and therapist expertise, remain insufficiently addressed. Third, methodological limitations were present in some studies: three studies did not explicitly report allocation concealment, and two did not implement blinded assessments, introducing risks of performance and detection bias. Additionally, the strict exclusion of common comorbidities such as epilepsy and bipolar disorder restricts the applicability of the findings to real-world clinical settings. The follow-up periods were generally short (with a maximum of 24 weeks), lacking long-term efficacy data, and the inclusion of only English and Chinese literature may have introduced publication bias.

Conclusion

This study demonstrates that DBT-based interventions significantly improve emotional regulation strategies, reduce suicidal ideation, and alleviate depressive symptoms in individuals with ASD, highlighting its unique advantages in enhancing emotion management and mitigating self-harm risks. However, the effects of DBT on anxiety were not statistically significant, suggesting the need for integrated approaches to address the multifaceted psychological needs of ASD patients. While current evidence supports the potential of DBT in ASD populations, limitations such as small sample sizes, methodological heterogeneity, and short-term follow-up call for future large-scale, standardized studies with long-term evaluations to validate its cross-cultural and cross-age applicability and elucidate its core mechanisms.

Abbreviations

ASD

Autism Spectrum Disorder

DBT

Dialectical Behavior Therapy

RCTs

Randomized Controlled Trials

SMD

Standardized Mean Difference

CI

Confidence Interval

PRISMA

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

PROSPERO

International Prospective Register of Systematic Reviews

CBT

Cognitive Behavioral Therapy

NSSI

Non-Suicidal Self-Injury

Authors’ contributions

Guimei Fan, Xiaorui Chen was involved in research design and manuscript writing. Guimei Fan, Pei Wang and Wenjing Zhang collected data and performed data analysis. Guimei Fan and Xiaorui Chen revised and edited the draft. All the authors are in agreement with the manuscript.

Funding

No funding.

Data availability

The data of this study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

This meta-analysis is based on previously published studies and does not require ethical approval.

Competing interests

The authors declare no competing interests.