Feasibility and Acceptability of an E-learning Dialectical Behavior Therapy Skills Course

The Treatment Acceptability and Adherence Scale was used to assess ratings of perceived effectiveness, trustworthiness, and likelihood of adherence using a 7-point Likert scale from 1 (disagree strongly) to 7 (agree strongly). Items are summed to create a total score, with higher ratings indicating higher acceptability and adherence.

The Intervention Usability Scale is a 10-item measure to assess the ease of accessing and usability of the intervention. Items are rated on a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree). A total score is created by summing the items and higher ratings indicate higher usability of the intervention.

The Credibility and Expectancy Scale is used to assess whether participants had favorable opinions of the intervention and its potential effectiveness before starting treatment. In line with previous work, the first three items were used to evaluate credibility (using a 9-point Likert scale) whereas a single item (item 4) was used to evaluate expectancy of clinical improvement (using a 11-point Likert scale from 0% to 100%). The last two items are not scored.

The Patient Health Questionnaire Depression Subscale (PHQ-9) is a 9-item self-report measure used to assess depressive symptoms over the past two weeks. Items are rated on a 4-point Likert scale from 0 (not at all) to 3 (nearly every day). Items are summed to create a total score. Higher scores indicate greater depressive symptoms.

The Generalized Anxiety Disorder 7 Questionnaire (GAD7) is a 7-item self-report measure used to assess generalized anxiety symptoms over the past two weeks. Items are rated on a 4-point Likert scale from 0 (None at all) to 3 (Nearly Every Day). Items are summed to create a total score, with higher scores indicating greater symptoms.

The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) short form is a 12-item self-report measure assessing functional disability over the past month in several domains (cognition, mobility, self-care, getting along with others). Items are rated from 0 (none) to 4 (extreme or cannot do). Items are scored to create a total score. Higher scores indicate higher functional disability.

The National Institute on Drug Abuse (NIDA) Assist is used to assess alcohol, smoking, and substance use involvement. This measure was used to assess alcohol, tobacco, cannabis, cocaine, amphetamine-type stimulants, inhalants, sedatives/sleeping pills, hallucinogens, and opioids. Each class of substance was rated for frequency over the past month using an ordinal scale: 0 (Never); 1 (Once or twice); 2 (3 or 4 times); 3 (5, 6, or 7 times); 4 (2 or 3 times a week); 5 (4 or 5 times a week); and 6 (Daily or almost daily). Ratings can be analyzed in terms of use at the binary level overall (indicating any substance used vs. no substances used) or at the class level (indicating one class was used vs. not used). Ratings can also be summed across substance classes with higher scores interpreted as greater frequencies of substance use.

The Difficulties in Emotion Regulation Scale, Short Form (DERS-16; Kaufman et al., 2016) is a 16-item self-report measure, with excellent internal consistency, assessing emotion dysregulation based on a six-facet model first described by Gratz and Roemer (2004). Items are rated on a 5-point Likert scale from 1 (Almost Never) to 5 (Almost Always) and a total score is derived from summing the items (after reverse- scoring certain items). Higher scores reflect greater difficulties regulating emotions.

The DBT Ways of Coping Checklist (Neacsiu et al., 2010) is a 59-item self-report measure that assesses the frequency of maladaptive and adaptive skills used to manage difficult situations over the past month, with good internal consistency and test-retest reliability. In this study, the investigators only use the 38-item adaptive skills subscale, which includes skillful behaviors often learned in DBT without using DBT-specific language. Items were rated on a 4-point Likert scale from 0 (Never Used) to 3 (Regularly Used).

The Mindful Awareness and Attention Scale (MAAS) is a 15-item measure of mindful attention and awareness, which is a primary target of DBT skills training. Items were rated on a 6-point Likert scale from 1 (Almost Never) to 6 (Almost Always). Higher scores reflect higher levels of dispositional mindfulness ability.