Dialectical Behavior Therapy Program Research Articles

The Mental Health Toll of the COVID-19 Pandemic on Adolescents Receiving Inpatient Psychiatric Treatment.

Objective: During the COVID-19 pandemic, the prevalence of depression and anxiety among children and adolescents significantly increased, along with the number of visits to emergency departments due to suicidality and/or suicide attempts. Relatedly, health care workers experienced significant burnout and symptoms of anxiety, depression, and posttraumatic stress disorder during this time. However, the corresponding impact on psychiatric inpatient treatment has not yet been researched. We hypothesized that during the pandemic, adolescents hospitalized in an acute care psychiatric inpatient unit had increased incidents of suicide attempts and nonsuicidal self-injurious behaviors and of aggressive behaviors toward others, resulting in greater use of constant observation and restraints. Method: This study was a retrospective chart review based on electronic medical record data examining use of restraints and constant observation one year before the pandemic (March 2019 to February 2020) and 1 year following the onset of the pandemic (March 2020 to February 2021) in an acute-care adolescent (12 to 17 years old) psychiatric inpatient unit. Results: There were 571 admissions during the year before the pandemic and 500 admissions during the pandemic. The number of patients who were restrained (χ2 = 7.86, p = 0.005), number of patients who were placed on constant observation (χ2 = 13.41, p < 0.001), and number of constant observation orders per patient (χ2 = 91.90, p < 0.001) were all significantly greater during the pandemic. Conclusion: Psychiatrically hospitalized adolescents during the pandemic received more intensive interventions such as restraints and constant observation. Severe patient psychopathology and staff shortages, as well as limitations of and decreases to the dialectical behavior therapy program, may have been the contributing factor.

Clinical outcomes for sexual and gender minority adolescents in a dialectical behaviour therapy programme.

Sexuality and gender minoritised (SGM) adolescents are at increased risk of self-injury and suicide, and experience barriers to accessing mental health support. Dialectical behaviour therapy (DBT) is an effective treatment for self-injury and emotion dysregulation in adolescent populations, but few studies have published outcomes of DBT for SGM young people. This study aimed to investigate treatment outcomes and completion for SGM adolescents and their cisgender and heterosexual peers, in the National & Specialist CAMHS, DBT service (UK). Treatment completion, and opting out before and during treatment were examined for sexual and gender identity groups, as well as changes by the end of treatment in emotion dysregulation, self-injury, in-patient bed-days, emergency department attendances, and borderline personality disorder, depression and anxiety symptoms. SGM adolescents were over-represented in this service, even after considering their increased risk for self-injury. No statistically significant differences were found for treatment completion between the sexual orientation and gender identity groups, although there were patterns indicating possible lower treatment uptake and completion that warrant further investigation. Clinical outcomes for treatment-completers showed improvement by the end of DBT for each group, with few exceptions. These results are from relatively small subsamples, and it was not possible to separate by sex assigned at birth. Findings should be treated tentatively and as early indications of effect sizes to inform future studies. This study suggests that DBT could be a useful treatment for SGM adolescents in a highly specialist treatment setting.

Should discharge be collaborative? Assessing flexible discharge dates in an intensive outpatient dialectical behavior therapy program.

Should discharge be collaborative? Assessing flexible discharge dates in an intensive outpatient dialectical behavior therapy program.

Shame, suicidal ideation, and urges for non-suicidal self-injury among individuals with borderline personality disorder receiving dialectical behavior therapy: The mediating role of anger.

Borderline personality disorder (BPD) is a disorder of pervasive emotion dysregulation associated with high rates of self-injurious thoughts and behaviors (SITB). Understanding specific emotion states in relation to SITB is important for effective intervention. The current study examined whether, and how, the specific emotion of shame contributes to suicide ideation and urges to engage in non-suicidal self-injury (NSSI) both directly, and indirectly via anger, among individuals with BPD. Participants (N = 100) were enrolled in a 6-month comprehensive dialectical behavior therapy (DBT) program and provided daily ratings of shame, anger, suicide ideation, and urges for NSSI. We found that higher daily ratings of shame and anger were directly associated with higher same-day ratings of both suicidal ideation and urges for NSSI. Furthermore, anger partially mediated the relationships between shame and both suicidal ideation and urges for NSSI. These findings highlight shame and anger as potential antecedents of SITB among individuals with BPD. Clinical approaches, such as DBT, that include personalized, ongoing, clinical assessment of these specific affective states may be particularly important for treatment of SITB.

Dialectical behaviour therapy outcomes for adolescents with autism spectrum conditions compared to those without: findings from a seven-year service evaluation

Purpose Autism spectrum conditions (ASC) and borderline personality disorder (BPD) have overlapping symptom profiles. Dialectical behaviour therapy (DBT) is an established treatment for self-harm and BPD, but little research has investigated the outcomes of DBT for ASC populations. This exploratory service evaluation aims to investigate the outcomes of a comprehensive DBT programme for adolescents with a diagnosis of emerging BPD and a co-occurring ASC diagnosis as compared to those without an ASC diagnosis. Design/methodology/approach Differences from the start to end of treatment in the frequency of self-harming behaviours, BPD symptoms, emotion dysregulation, depression, anxiety, the number of A&amp;E attendances and inpatient bed days, education and work status, and treatment non-completion rates were analysed for those with an ASC diagnosis, and compared between those with an ASC diagnosis and those without. Findings Significant medium to large reductions in self-harming behaviours, BPD symptoms, emotion dysregulation and inpatient bed days were found for those with an ASC diagnosis by the end of treatment. There were no significant differences between those with an ASC and those without in any outcome or in non-completion rates. These findings indicate that DBT may be a useful treatment model for those with an ASC diagnosis, though all results are preliminary and require replication. Originality/value To the best of the authors’ knowledge, this is the first study to report the outcomes of a comprehensive DBT programme for adolescents with an ASC diagnosis, and to compare the changes in outcomes between those with a diagnosis and those without.

Amygdala-related electrical fingerprint is modulated with neurofeedback training and correlates with deep-brain activation: proof-of-concept in borderline personality disorder.

The modulation of brain circuits of emotion is a promising pathway to treat borderline personality disorder (BPD). Precise and scalable approaches have yet to be established. Two studies investigating the amygdala-related electrical fingerprint (Amyg-EFP) in BPD are presented: one study addressing the deep-brain correlates of Amyg-EFP, and a second study investigating neurofeedback (NF) as a means to improve brain self-regulation. Study 1 combined electroencephalography (EEG) and simultaneous functional magnetic resonance imaging to investigate the replicability of Amyg-EFP-related brain activation found in the reference dataset (N = 24 healthy subjects, 8 female; re-analysis of published data) in the replication dataset (N = 16 female individuals with BPD). In the replication dataset, we additionally explored how the Amyg-EFP would map to neural circuits defined by the research domain criteria. Study 2 investigated a 10-session Amyg-EFP NF training in parallel to a 12-weeks residential dialectical behavior therapy (DBT) program. Fifteen patients with BPD completed the training, N = 15 matched patients served as DBT-only controls. Study 1 replicated previous findings and showed significant amygdala blood oxygenation level dependent activation in a whole-brain regression analysis with the Amyg-EFP. Neurocircuitry activation (negative affect, salience, and cognitive control) was correlated with the Amyg-EFP signal. Study 2 showed Amyg-EFP modulation with NF training, but patients received reversed feedback for technical reasons, which limited interpretation of results. Recorded via scalp EEG, the Amyg-EFP picks up brain activation of high relevance for emotion. Administering Amyg-EFP NF in addition to standardized BPD treatment was shown to be feasible. Clinical utility remains to be investigated.

Efficacy of Dialectical Behavior Therapy in the Treatment of Borderline Personality Disorder: A Systematic Review of Randomized Controlled Trials.

Objective: Borderline personality disorder (BPD) is a serious public health problem. Dialectical Behavior Therapy (DBT) is a program that has provided encouraging results for its treatment. However, scientific evidence about its efficacy is scarce. Therefore, we aimed to describe the scientific production on the components of the DBT program and its therapeutic efficacy in the treatment of people with BPD. Method : A systematic review with relevant keywords was conducted based on studies available in Scopus, Web of Science, and PubMed until June 2023, including studies in English, research on therapeutic intervention, studies with a randomized controlled trial (RCT) design that included people with the diagnosis of BPD. Results: We found 18 RCTs, most of which supported the effectiveness of DBT for BPD. There were a total of 1,755 participants in these studies, most of whom were women. These studies looked for treating self-injurious behaviors, suicidal thoughts or ideations, number of visits to emergency services, and frequency of hospital admissions. Most studies revealed that both short-term DBT and standard DBT improved suicidality in BPD patients with small or moderate effect sizes, lasting up to 24 months after the treatment period. Furthermore, these studies showed that DBT can significantly improve general psychopathology and depressive symptoms in patients with BPD. Improvement of compliance, impulsivity, mood instability, as well as reduction in hospitalization rate are other findings observed in the trials following DBT. Conclusion: Although DBT shows efficacy in the treatment of BPD, heterogeneity in the methodologies employed is highlighted. Therefore, it is necessary to design studies from a homogeneous theoretical and methodological framework.

Comprehensive dialectical behavior therapy for adolescents in a juvenile correctional treatment center: a pilot evaluation

BackgroundIncarcerated youth commonly present with emotion dysregulation, aggression, and comorbid psychiatric disorders, yet often do not receive necessary mental health treatment while confined. It is therefore crucial to expand the evidence base regarding empirically supported mental health interventions which are feasible to implement in secure settings to address incarcerated youth's mental health needs. Through a community-academic partnership, the current pilot study evaluated a comprehensive dialectical behavior therapy program implemented in a juvenile correctional treatment center.MethodsYouth participants (N = 113) were on average 15.37 years old (SD = 1.10, range = 13–17), 68.1% boys, and identified as 69.0% Latinx, 22.1% Black, 8.0% White, and 0.9% Native American. Youth received comprehensive dialectical behavior therapy for adolescents (DBT-A), including individual therapy, skills training groups, family therapy, multi-family skills training groups, and skills coaching in the milieu by direct care staff who participated in extensive training and ongoing consultation team meetings. As part of a facility-designed program evaluation, youth completed a battery of empirically validated assessments of mental health and emotion regulation prior to and following completion of the program.ResultsResults show that comprehensive DBT-A is feasible to implement in a juvenile correctional treatment center and overall, youth improved from pre- to post-treatment in mental health symptoms and emotion regulation, with small to medium effect sizes.ConclusionThese findings build upon a growing literature showing dialectical behavior therapy is a promising intervention for treating emotion dysregulation and mental health conditions and can be successfully implemented in juvenile forensic settings.

Developing the social and emotional competence of adolescents through implementation of the STEPS-A curriculum

AimsThis research explores the curriculum, Dialectical Behaviour Therapy (DBT)Skills in Schools: Skills Training for Emotional Problem Solving for Adolescents (STEPS-A)(Mazza et al., 2016). It aims to trial STEPS A, exploring its impact on Social Emotional Learning (SEL), in addition to understanding facilitative implementation conditions for the programme.RationaleThe rationale for the study lies within the potential of the programme to be a universally accessible tool for change in nurturing the SEL of adolescents within the secondary school context.MethodsUsing a mixed method case study design, six sessions were delivered in two mainstream mixed secondary comprehensive schools to key stage three groups by trained staff facilitators. Focus groups were carried out, alongside the Child and Adolescent Mindfulness Measure (CAMM) (Greco, Baer, &amp; Smith, 2011) and the Difficulties in Emotion Regulation Scale – Short Form (DERSF-SF) (Kaufman et al., 2016) pre and post intervention.FindingsData informed the development of an implementation framework, alongside a consultation tool for EPs to support STEPS-A planning in schools. Impact results are promising; mixed ANOVAs revealed two significant and two non-significant time* intervention interactions. Follow up t tests demonstrated intervention group changes in mindfulness and emotional regulation skills in schools 1 and 2 respectively.ImplicationsThe study has implications for the adoption of the STEPS A curriculum to support SEL within secondary schools, whereby school staff are actively supported by EPs to use an implementation framework to maximise efficacy. The encouraging impact findings provide psychological and ethical weight to the use of the framework.LimitationsDue to a small sample size and short intervention period, the need for replication of the quantitative results with a larger sample over a longer period is acknowledged. The implementation framework requires validation across contexts.ConclusionsThe study found that the STEPS-A programme, the first curriculum-based DBT programme designed to be taught in schools by teachers, was well-received by participants. It indicates that, within the context of empirically supported implementation conditions, skills which were initially designed for teaching to clinical populations as part of a comprehensive therapy programme have value and can potentially effect change for adolescents with and without additional identified needs.

Therapeutic alliance and dropout in patients with borderline pathology receiving residential dialectical behavior therapy

BackgroundThis study focused on the impact of therapeutic alliance on therapy dropout in a naturalistic sample of patients with borderline pathology receiving dialectical behavior therapy (DBT) in a residential setting. We assumed that low therapeutic alliance shortly after admission would be associated with elevated dropout.Methods44 participants with borderline pathology (≥ 3 DSM-5 borderline personality disorder criteria) in a residential DBT program completed a quality assurance questionnaire set assessing demographic information, pretreatment psychopathology and therapeutic alliance during the first seven days of their residential stay. Predictors of dropout were investigated using binary logistic regression analyses.ResultsThe dropout rate was 34.1% (n = 15). In binary logistic regression analyses with variables covering demographic and clinical characteristics, comorbidities and childhood trauma history, only the therapeutic alliance significantly predicted dropout (z = -2.371, p = .018).ConclusionsThis study supports the importance of therapy process variables, here the therapeutic alliance at the beginning of treatment, as predictors of therapy dropout in borderline pathology. If this finding is replicated, it shows the potential importance of monitoring the therapeutic relationship throughout the therapeutic process. ClinicalTrials.gov Identifier: NCT05289583, retrospectively registered on March 11, 2022.

Effects of borderline personality disorder symptoms on dialectical behavior therapy outcomes for eating disorders.

Existing literature on the effects of borderline personality disorder (BPD) and eating disorder (ED) comorbidity in terms of clinical presentation and treatment outcome has been limited and inconclusive. The present study examined whether clients with EDs and varying levels of BPD symptoms presented with more severe ED symptoms at admission, and whether they responded to dialectical behavior therapy (DBT)-based treatment. Participants (N = 176) were adults in a DBT-based partial hospitalization program for EDs at an academic medical center. Participants completed self-report measures at admission, 1-month postadmission, discharge, and 6-month follow-up. Results suggested that patients with elevated BPD symptoms at admission had greater ED symptoms during treatment, evidenced by small to moderate effect sizes. However, patients with high BPD symptoms demonstrated steeper declines in binge eating, fasting, and parasuicidal behavior early during treatment compared to patients with low BPD symptoms. Individuals with high BPD symptoms at admission (i.e., probable BPD diagnosis) were as likely to meet remission criteria and relapse as individuals with low BPD symptoms, though this null finding may be influenced by small cell sizes. Our findings also suggest that DBT skills use does not predict changes in symptoms. In sum, our findings suggest that while clients with higher BPD symptoms may improve during DBT-based partial hospitalization, their ED symptoms may remain more severe. Future studies are needed to determine whether adjunctive treatments improve outcomes for clients with EDs and comorbid BPD symptoms in DBT programs and whether skills use quality is a better predictor of ED symptom changes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Drug use and suicidal ideation in the daily lives of individuals in a dialectical behavior therapy program.

Substance use disorders and borderline personality disorders (BPD) often co-occur and may be concurrently treated by Dialectical Behavior Therapy (DBT). However, there is limited information on how drug use and suicidal ideation may interact in the daily lives of individuals receiving DBT treatment. This study examined the DBT diary cards of 47 individuals in a community mental health center's partial hospital and intensive outpatient program. Multilevel modeling techniques were used to examine the moderating effects of BPD symptom severity on the relationship between same day, 1-, 2-, and 3-day lagged drug use and suicidal ideation. Results indicated a significant relationship between same-day, 1-day lagged, 2-day lagged drug use and suicidal ideation. BPD was a moderator for the relationship between 1-day lagged drug use and suicidal ideation. Limitations of the study include the measure for BPD symptom severity was only collected pretreatment and the results are likely limited to the effects of cannabis use on suicidal ideation. Clinicians may need to consider the prolonged effects of drug use on suicidal ideation when conducting chain analyses on suicidal behaviors.

Treatment outcomes of Veteran men in a comprehensive dialectical behavior therapy program: Characterizing sex differences in symptom trajectories

Dialectical Behavior Therapy (DBT) is one of the primary psychosocial treatments for reducing suicidal behaviors and improving psychosocial outcomes among patients with borderline personality disorder (BPD) and has been shown to reduce BPD symptoms when delivered in a Veteran Affairs medical center setting. Despite evidence of similar rates of BPD in both men and women, the vast majority of treatment outcome research in BPD has focused on women. We sought to characterize sex differences in symptom trajectories among Veterans participating in a comprehensive DBT program. We found that Veteran men and women who entered the DBT program were diagnostically and demographically similar. Participants exhibited reductions in BPD symptoms and improvements in emotion regulation over the course of treatment. Moreover, Veteran men reported BPD symptom reductions that were not statistically inferior to those of Veteran women and exhibited a sharper reduction in these symptoms. This research provides support for the use of DBT as a psychosocial treatment for Veteran men with BPD symptoms.

A Feasibility Study Investigating Mechanisms of Change in Public Mental Health Dialectical Behaviour Therapy Programmes

AbstractFew studies have investigated the feasibility of researching brief forms of dialectical behaviour therapy (DBT) for borderline personality disorder (BPD) in public mental health settings. This study aimed to provide preliminary evidence for the feasibility of implementing DBT over a 6-month period for BPD symptoms within Australian public mental health services. Of the 79 participants with BPD recruited, 62 commenced and 24 participants completed the therapy. The participants attended one of three outpatient DBT programmes and completed measures of BPD symptoms, DBT skills-use, and difficulties with emotion regulation at baseline and after 6 months of treatment. A major challenge with feasibility identified was the high attrition rate (61%). However, for completers there were significant improvements in BPD symptoms, DBT skills-use, and difficulties with emotion regulation. These effect sizes were used to estimate the sample sizes needed by future larger trials of brief DBT for BPD in public health settings. The implementation of brief DBT for BPD patients within a public mental health outpatient setting, appears to result in significant reductions in BPD symptoms. However, further exploration of strategies to reduce drop-out rates are required.

Gender- and Sexuality-Minoritised Adolescents in DBT: A Reflexive Thematic Analysis of Minority-Specific Treatment Targets and Experience.

Gender- and sexuality-minoritised (GSM) adolescents are at increased risk of self-harm and suicidal behaviours compared to their cisgender and heterosexual peers. This increased risk is thought to be explained in part by exposure to stigma and societal oppression. Dialectical Behaviour Therapy (DBT) is an evidence-based intervention for self-harm and suicidal behaviour that may have advantages for supporting GSM young people in distress. No study has yet sought to understand what GSM-associated difficulties may be important to consider in DBT for adolescents, or the experiences of GSM young people in a standard DBT programme. Therefore, this study aimed to understand the experiences of GSM young people in DBT and what difficulties and dilemmas associated with their gender and sexuality diversity were thought by them to be important to target in DBT. Qualitative interviews were conducted with 14 GSM young people in a comprehensive DBT programme and were analysed using Reflexive Thematic Analysis. The analysis was supported by two further GSM young people who had finished DBT. The findings were split into three overarching themes (Identity, Impact of Others, and Space for Sexual and Gender Identity in DBT), each with themes within. The identity-based theme included "identity confusion and acceptance"; the relationship-based themes included "cis-Heterosexism" and "community connectedness"; and the space within DBT themes included "negotiating focus and targeting in DBT" and "creating safety in DBT". Findings are discussed in relation to implications and recommendations for therapists working with GSM young people within and outside of DBT.

An evaluation of value-based outcomes for women admitted to a dialectical behaviour therapy integrated practice unit: a follow-up study.

An earlier evaluation (Fox et al., ) highlighted reductions in risk behaviours and restrictive practices for women admitted to low secure dialectical behaviour therapy (DBT) unit. Since then, a value-based healthcare model has been adopted. To explore changes in health, social and psychological functioning, risk, quality of life, and in incidents of violence and restrictive practices, over the initial 12-month period of admission to a specialist DBT service. Data were extracted from electronic clinical records for 41 women with emotionally unstable personality disorder admitted to a specialist integrated practice unit (IPU) providing a comprehensive DBT programme. Secondary analysis was conducted on an anonymous dataset of routinely collected outcome measures at baseline admission, and 6 and 12 months post-admission. ANOVAs and pairwise post hoc comparisons, and non-parametric equivalents, were conducted to examine changes in outcomes. Findings showed statistically significant improvements in mental health scores on the ReQOL (p<.01), global, wellbeing, problems, functioning and risk scores on the COREOM (all p<.01), and severe disturbance, emotional wellbeing, socioeconomic status, risk and need scores on the HoNOS-Secure (all p<.05). Significant reductions in risk behaviours (p<.01) and restrictive practices (p<.01) were also apparent. The most substantiative improvements were largely demonstrated over a 12-month admission period. Admission to the DBT IPU yielded significant improvements on outcomes pertaining to quality of life, psychological distress, and risk. Importantly, these are outcomes that aligned with patients' perceptions of recovery.

Getting DBT online down under: The experience of Australian and New Zealand Dialectical Behaviour Therapy programmes during the Covid-19 pandemic.

Dialectical Behaviour Therapy (DBT) is an intensive and multi-modal intervention developed for individuals with multiple comorbidities and high-risk behaviours. During pandemic-related lockdowns, many DBT services transitioned to delivering treatment via telehealth, but some did not. The current study sought to explore the experience of DBT teams in Australia and New Zealand who did and did not transition to telehealth during the early stages of the COVID19 pandemic, as the majority of research on DBT via telehealth has originated from North America, and focussed on therapists who did make this transition. DBT team leaders in Australia and New Zealand completed a survey with open-ended questions about the barriers they encountered to delivering DBT via telehealth, and for those teams that implemented telehealth, the solutions to those barriers. Respondents were also asked about specific barriers encountered by Indigenous and Pacific people service users. Of the 73 team leaders who took part, 56 reported providing either individual therapy, skills training or both modalities via video-call during lockdown. Themes emerging from perceived barriers affecting just DBT providers included the assessment & management of emotions and high-risk behaviours, threats to privacy and information security posed by telehealth, logistical issues related to remote sessions, and the remote management of therapy-interfering behaviour. Themes emerging from perceived barriers affecting both providers and service users included disruptions to therapeutic alliance, lack of willingness, lack of technical knowledge, lack of private spaces to do DBT via telehealth, and lack of resources. The solutions most frequently cited were the provision of education and training for therapists and service users in the use of telehealth, and the provision of resources to access telehealth. These findings are relevant to clinical delivery of DBT, as well as planning and funding for DBT telehealth services.

High fidelity dialectical behaviour therapy online: Learning from experienced practitioners.

Dialectical behaviour therapy (DBT) is an effective treatment for borderline personality disorder and other problems underpinned by difficulties with emotional regulation. The main components of DBT are skills training groups and individual therapy. The COVID-19 outbreak forced a rapid adaptation to online delivery, which largely mirrored face-to-face programmes using videoconferencing technology. This study aimed to elicit and describe the experiences and learning of therapists involved in providing high-fidelity DBT programmes via the Australian DBT Institute, which established an online delivery platform called DBT Assist™ prior to the COVID-19 pandemic. The report conforms with the consolidated criteria for reporting qualitative research (COREQ). Seven therapists were interviewed. Data were transcribed and analysed thematically. Delivering skills training online, either exclusively or in hybrid form (with face-to-face individual therapy), was acceptable and even preferable to therapists and clients. It was considered safe, the programme was associated with few non-completers, and it improved the accessibility of DBT to those who might otherwise not be able to engage in a face-to-face programme. Skills training utilized a 'flipped-learning' approach which improved the efficiency of online delivery. Other unique and helpful features of the online programme were described. The best outcomes associated with online DBT are likely to be achieved through careful adaptation to the online environment in accord with the principles of DBT rather than mirroring face-to-face processes. Further research is required to determine the efficacy of online therapy relative to face-to-face, and who might be best suited to different modes of delivery.

Using Art to Undermine Epistemic Injustice in DBT Research

Through participatory Arts-Based Research, constructed within the theoretical basis of the Activity System, participants engaged with Dialectical Behavior Therapy (DBT) program content to develop a cohesive and meaningful project structure and aesthetic. Practitioner/researcher supremacy is disrupted by participatory Arts-Based Research and upheld by temporal constraints, as demonstrated by participant engagement and disruptions to participant collaboration. This research pilots a replicable framework that centers the experiences of individuals completing DBT, interrupts cycles of harm, and uplifts social knowledge construction that emanates from DBT skills training communities. DBT is a skills-based psychotherapeutic approach that prepares individuals to address problems in living that result from the development of mental disorders in environments that persistently signal that an individual is an unreliable informant of their own experience. In its standard format, DBT incorporates a group skills training component to remediate skill deficits developed in this invalidating environment. The body of literature that explores DBT skills training is structured in a way that elevates practitioner/researcher perceptions of individual progress over participants’ interpretations of their own collective experiences. Arts-Based Research is a theoretically-backed methodology that can disrupt the harmful parallels between the development of the disorders DBT is intended to treat and the dominant research paradigm into DBT.

Description of a Dialectical Behavior Therapy program in a Veterans Affairs Health Care System

A comprehensive Dialectical Behavior Therapy (DBT) program was created within a VA Health Care System for patients with recent psychiatric hospitalization, suicidality and/or significant emotion dysregulation. The program was notable for being one of a relatively small number of comprehensive DBT programs in the VA system, and for including patients with psychosis and psychotic disorder, with a majority of patients (58%) having a documented history of psychosis or endorsing psychotic symptoms in assessments. We describe the process of creating this program at a VA medical center and present preliminary program evaluation data. All patients completed assessments of suicidality (C-SSRS), emotion dysregulation (DERS), skills use and dysfunctional coping (DBT-WCCL), borderline symptomatology (BSL-23), and depression (PHQ-9) at program entry and subsequently every 6–8 weeks through program completion. Suicide attempts and hospitalizations were also tracked. Twelve patients completed multiple (up to six) assessment timepoints, allowing for evaluation of change during treatment. Patients demonstrated improvements on most measures and no hospitalizations or suicide attempts during active treatment, and the subsample with psychosis showed average improvements on every outcome measure. Eleven of 12 patients completed a full six-month rotation.