Evaluation of a Modified Dialectical Behavior Therapy Program

Standard DBT includes four modes of intervention: weekly individual psychotherapy; weekly skills group; 24 hour phone consultation to the patient; and consultation team meetings. The skills group is focused on teaching skills (mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness), and facilitating the replacement of maladaptive behaviors with adaptive behaviors (Neasciu, Rizvi, & Linehan, 2010). Individual therapy sessions focus on reducing target problem behaviors (e.g., life threatening behavior, therapy interfering behavior, quality of life interfering behaviors). Phone consultation is to aid the client in generalizing skill use to their every day life. The consultation team meetings are for the therapists, to provide support, and to aid therapists in staying adherent to a DBT frame of treatment.

This project will be utilizing a convenience sample. Patients are referred to the program by their psychiatrist/family doctor. They are assessed by a Clinical Psychologist to determine if they meet criteria for a diagnosis of Borderline Personality Disorder via clinical interview and a semi-structured diagnostic interview. They must also meet the inclusion/exclusion criteria for participation in the program, which are as follows:

Inclusion criteria

• 18 years or older
• Borderline personality disorder diagnosis
• Chronic suicidal ideation or parasuicidal acts, or other self-destructive, impulsive behaviors
• Must be willing to sign DBT contract and commit to 6-month duration of treatment of both individual therapy and skills training group.

Exclusion criteria

• Active psychosis
• Severe developmental delays, cognitive impairment or learning disabilities
• No violent behaviors will be tolerated. Patients with a history of dangerous or aggressive behaviors towards others, history of medical harm to previous therapists may not be considered.

Following this, they must agree to participate in the program and to the program requirements (weekly individual therapy, skills group, etc). Once this has occurred, they will be approached by a research assistant to discuss with them their voluntary participation in this research study. Once consent is provided, the patient will complete several baseline measures. These same measures will be completed at post treatment (6 months) and then again at 12 months and 18 months for follow-up. Each patient will also complete a weekly diary card, which asks them to record several aspects of daily functioning, as well as self-harm urges and behaviors, and use of skills taught in DBT.

Inclusion criteria

• Diagnosis of Borderline Personality Disorder
• Chronic suicidal ideation or parasuicidal acts, or other self-destructive, impulsive behaviors
• Must be enrolled in dialectical behavior therapy program

Exclusion criteria

• Active psychosis
• Severe developmental delays, cognitive impairment or learning disabilities
• History of or current violent/aggressive behaviors