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Multisite Implementation and Evaluation of 12-Month Standard Dialectical Behavior Therapy in a Public Community Setting

Dialectical behavior therapy (DBT) is an effective intervention for treating adults with emotional and behavioral dysregulation. The National DBT Project, Ireland was established in 2013 to coordinate the implementation of DBT across public community mental health settings at a national level. This study describes the implementation and evaluation of DBT across multiple independent sites in adult mental health services (AMHS). The Consolidated Framework for Implementation Research was used to guide this national implementation where barriers and facilitators to DBT implementation were considered. Nine AMHS teams completed DBT training and delivered the standard 12-month program. One hundred and ninety-six adults with borderline personality disorder participated in the program, and outcome measures were recorded at four time points. Significant reductions on outcome measures, including frequency of self-harm and suicidal ideation, were observed. This study highlights that DBT can be successfully implemented in community mental health settings as part of a coordinated implementation.

REFERENCES

  • Beck A. T., , Steer R. A., , & Brown G. K. (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation. Google Scholar
  • Beck A. T., , Weissman A., , Lester D., , & Trexler L. (1974). The measurement of pessimism: The Hopelessness Scale. Journal of Consulting and Clinical Psychology, 42, 861–865. Crossref MedlineGoogle Scholar
  • Bohus M., , Haaf B., , Simms T., , Limberger M. F., , Schmahl C., , Unckel C., , & Linehan M. M. (2004). Effectiveness of inpatient dialectical behavioral therapy for borderline personality disorder: A controlled trial. Behaviour Research and Therapy, 42, 487–499. Crossref MedlineGoogle Scholar
  • Bohus M., , Limberger M. F., , Frank U., , Chapman A. L., , Kühler T., , & Stieglitz R.-D. (2007). Psychometric properties of the Borderline Symptom List (BSL). Psychopathology, 40, 126–132. Crossref MedlineGoogle Scholar
  • Carmel A., , Rose M. L., , & Fruzzetti A. E. (2014). Barriers and solutions to implementing dialectical behavior therapy in a public behavioral health system. Administration and Policy in Mental Health and Mental Health Services Research, 41, 608–614. Crossref MedlineGoogle Scholar
  • Comtois K. A., , Elwood L., , Holdcraft L. C., , Smith W. R., , & Simpson T. L. (2007). Effectiveness of dialectical behavior therapy in a community mental health center. Cognitive and Behavioral Practice, 14, 406–414. CrossrefGoogle Scholar
  • Damschroder L. J., , Aron D. C., , Keith R. E., , Kirsh S. R., , Alexander J. A., , & Lowery J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4(1), 50. Crossref MedlineGoogle Scholar
  • Ditty M. S., , Landes S. J., , Doyle A., , & Beidas R. S. (2015). It takes a village: A mixed method analysis of inner setting variables and dialectical behavior therapy implementation. Administration and Policy in Mental Health and Mental Health Services Research, 42, 672–681. Crossref MedlineGoogle Scholar
  • Flynn D., , Joyce M., , Gillespie C., , Kells M., , Swales M., , Spillane A., , & Weihrauch M. (2018). Evaluating the national multisite implementation of dialectical behaviour therapy in a community setting: a mixed methods approach. Manuscript in preparation. Google Scholar
  • Flynn D., , Kells M., & Joyce M. (2018). Implementation in national systems: DBT in an Irish context. In Swales M. A. (Ed.), The Oxford handbook of dialectical behaviour therapy. New York, NY: Oxford University Press. Google Scholar
  • Flynn D., , Kells M., , Joyce M., , Corcoran P., , Gillespie C., , Suarez C., , & Arensman E. (in press). Innovations in practice: Dialectical behaviour therapy for adolescents: Multi-site implementation and evaluation of a 16-week programme in a public community mental health setting. Child and Adolescent Mental Health. Google Scholar
  • Flynn D., , Kells M., , Joyce M., , Corcoran P., , Gillespie C., , Suarez C., , & Cotter P. (2017). Standard 12 month dialectical behaviour therapy for adults with borderline personality disorder in a public community mental health setting. Borderline Personality Disorder and Emotion Dysregulation, 4, 19. Crossref MedlineGoogle Scholar
  • Flynn D., , Kells M., , Joyce M., , Suarez C., , & Gillespie C. (2018). Dialectical behaviour therapy for treating adults and adolescents with emotional and behavioural dysregulation: Study protocol of a coordinated implementation in a publicly funded health service. BMC Psychiatry, 18(1), 51. Crossref MedlineGoogle Scholar
  • Fruzzetti A. E., , Waltz J. A., & Linehan M. M. (1997). Supervision in dialectical behavior therapy. In Watkins C. E. (Ed.), Handbook of psychotherapy supervision (pp. 84–100). New York, NY: John Wiley & Sons. Google Scholar
  • Government of Ireland. (2006). A vision for change: Report of the Expert Group on Mental Health Policy. Dublin, Ireland: Stationery Office. Google Scholar
  • Jacobson N. S., , Roberts L. J., , Berns S. B., , & McGlinchey J. B. (1999). Methods for defining and determining the clinical significance of treatment effects: Description, application, and alternatives. Journal of Consulting and Clinical Psychology, 67, 300–307. Crossref MedlineGoogle Scholar
  • Jones S., , Thornicroft G., , Coffey M., , & Dunn G. (1995). A brief mental health outcome scale: Reliability and validity of the Global Assessment of Functioning (GAF). British Journal of Psychiatry, 166, 654–659. 10.1192/bjp.166.5.654 Crossref MedlineGoogle Scholar
  • Koerner K. (2011). Doing dialectical behavior therapy: A practical guide. New York, NY: Guilford Press. Google Scholar
  • Linehan M. M. (1993a). Cognitive behavioral therapy of borderline personality disorder. New York, NY: Guilford Press. Google Scholar
  • Linehan M. M. (1993b). Skills training manual for treating borderline personality disorder. New York, NY: Guilford Press. Google Scholar
  • Linehan M. M., , Comtois K. A., , Murray A. M., , Brown M. Z., , Gallop R. J., , Heard H. L., , & Lindenboim M. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63, 757–767. Crossref MedlineGoogle Scholar
  • McMain S. F., , Links P. S., , Gnam W. H., , Guimond T., , Cardish R. J., , Korman L., , & Streiner D. L. (2009). A randomized trial of dialectical behavior therapy versus general psychiatric management for borderline personality disorder. American Journal of Psychiatry, 166, 1365–1374. Crossref MedlineGoogle Scholar
  • Neacsiu A. D., , Rizvi S. L., , Vitaliano P. P., , Lynch T. R., , & Linehan M. M. (2010). The dialectical behavior therapy Ways of Coping Checklist: Development and psychometric properties. Journal of Clinical Psychology, 66, 563–582. MedlineGoogle Scholar
  • Pasieczny N., , & Connor J. (2011). The effectiveness of dialectical behaviour therapy in routine public mental health settings: An Australian controlled trial. Behaviour Research and Therapy, 49, 4–10. Crossref MedlineGoogle Scholar
  • Prendergast N., , & McCausland J. (2007). Dialectical behaviour therapy: A 12 month collaborative program in a local community setting. Behaviour Change, 24(1), 24–35. CrossrefGoogle Scholar
  • Spielberger C. D. (1988). Manual for the State-Trait Anger Expression Inventory (STAXI-2). Odessa, FL: Psychological Assessment Resources. Google Scholar
  • Stiglmayr C., , Stecher-Mohr J., , Wagner T., , Meiβner J., , Spretz D., , Steffens C., , & Renneberg B. (2014). Effectiveness of dialectic behavioral therapy in routine outpatient care: The Berlin Borderline Study. Borderline Personality Disorder and Emotion Dysregulation, 1(1), 20. Crossref MedlineGoogle Scholar
  • Stoffers J. M., , Völlm B. A., , Rücker G., , Timmer A., , Huband N., , & Lieb K. (2012). Psychological therapies for people with borderline personality disorder. Cochrane Database of Systematic Reviews, 2012(8). 10.1002/14651858.CD005652.pub2 CrossrefGoogle Scholar
  • Swales M. A., , Taylor B., , & Hibbs R. A. (2012). Implementing dialectical behaviour therapy: Programme survival in routine healthcare settings. Journal of Mental Health, 21, 548–555. Crossref MedlineGoogle Scholar
  • Swenson C. R., , Torrey W. C., , & Koerner K. (2002). Implementing dialectical behavior therapy. Psychiatric Services, 53, 171–178. Crossref MedlineGoogle Scholar