A Randomized Controlled Trial of an Online Dialectical Behavior Therapy Skills Intervention for War-Related Distress

Objective: Living in war-afflicted regions involves long-term detrimental consequences for emotional wellbeing. Given the prevalence of ongoing conflicts worldwide, there is a pressing need to evaluate brief interventions that can be disseminated quickly and broadly to improve coping with war-related stress. This study examined the efficacy of an online dialectical behavior therapy (DBT) distress tolerance skills intervention for improving emotional well-being among women experiencing elevated distress amid war. Method: The study was conducted during the Israel–Hamas war and recruited 149 women whose first-degree relatives or spouses were deployed. Participants were randomly assigned to one of three conditions: (a) radical acceptance—training in a DBT skill promoting acceptance of reality, (b) relaxation—training in DBT skills fostering body relaxation, and (c) active control—monitoring distressing events without implementing DBT skills. The intervention included an online workshop to learn the skills and three home training sessions over 1 week to practice the skills for coping with personal distressing events. Measures of emotional distress were assessed at baseline, postintervention, 3-week follow-up, and during the home training sessions. Results: During the home training, practicing radical acceptance and relaxation skills led to improvements in negative and positive affect. However, only radical acceptance produced significant pre-to-post intervention reductions in stress, depression, and emotion regulation difficulties, with benefits persisting at follow-up. Conclusions: A brief online radical acceptance intervention is a cost-effective and accessible tool for coping with acute war-related stress. It may offer rapid emotional support in high-stress situations like war.What is the public health significance of this article? This study suggests that an online dialectical behavior therapy-based distress tolerance skills intervention effectively reduces emotional distress in women experiencing high levels of war-related STS. Brief, accessible, and cost-effective online interventions can serve as a crucial first-line response during large-scale crises.