Acceptance, Safety, and Effect Sizes in Online Dialectical Behavior Therapy for Borderline Personality Disorder:...

Area of Science:

• Psychiatry
• Psychology
• Digital Health

Background:

• Telehealth psychotherapy is gaining attention, but its efficacy and safety for patients with emotional and behavioral dysregulation remain subjects of skepticism.
• Borderline Personality Disorder (BPD) is characterized by significant emotional and behavioral dysregulation, often requiring intensive treatment.

Purpose of the Study:

• To estimate the effect sizes of symptom change from pre- to post-treatment for telehealth Dialectical Behavior Therapy (DBT).
• To assess the acceptance, safety, and feasibility of telehealth DBT for individuals diagnosed with BPD.
• To evaluate patient and therapist satisfaction and the quality of the therapeutic alliance in a telehealth DBT setting.

Main Methods:

• A total of 39 individuals with BPD received 1 year of outpatient telehealth DBT across 3 international sites.
• Effect sizes were calculated using pre-post measures of BPD symptoms, dissociation, and quality of life.
• Safety was assessed via suicide attempts and self-harm incidents, alongside patient and therapist-reported acceptance, satisfaction, and usability.

Main Results:

• Significant and large pre-post effect sizes were observed for BPD symptoms (d=1.13-1.44) and quality of life (d=0.65-1.24).
• Self-harm behaviors decreased significantly (80% to 28%), though dissociative symptoms showed minimal change.
• Acceptance, feasibility, and satisfaction were high, but the dropout rate was substantial (38%), and therapist usability ratings were moderate.

Conclusions:

• Telehealth DBT demonstrates significant efficacy in reducing BPD symptoms and improving quality of life, suggesting it as a viable treatment alternative.
• The telehealth format is generally well-accepted and feasible, but high dropout rates require attention and potential intervention strategies.
• Further research, including randomized controlled trials comparing telehealth DBT to in-person formats, is warranted to confirm efficacy and optimize treatment delivery.