A scoping review of Dialectical Behavior Therapy with patients with minoritized identity constructs

Dialectical Behavior Therapy (DBT) is an evidence-based psychological intervention (EBP) for reducing suicide behavior. While DBT, like many EBPs, was developed and first evaluated in largely white samples in Western contexts, it is now broadly applied. This review assessed how DBT has been adopted or adapted when used with patient populations with minoritized identity constructs.

We conducted a PRISMA-guided scoping review¹ of articles using DBT with a minoritized patient population. We used an implementation science framework, Framework for Reporting Adaptations and Modifications-Enhanced,² to characterize adaptations to the content and context of DBT application. Through PubMed, Embase and PsycINFO, we identified 273 articles where the title or abstract mentioned DBT and described a minoritized adult patient population.

We found 83.5% (228/273) articles reviewed reported adaptations to DBT content. Specifically, 66.3% (181/273), 44.6% (122/273), and 39.6% (108/273) of articles described reducing, expanding, or changing DBT content, respectively. We found that 42.1% of articles (115/273) reported adaptations to the DBT context. Moreover, 57.5% of content adaptations and 65.3% of context adaptations did not specify a reason for adaptation.

This scoping review indicates that the majority of articles of studies using DBT with patients with minoritized identity constructs made adaptations to DBT, but few provided justification for these adaptations. We encourage clinicians and clinical administrators, researchers, and policymakers to document adaptations and justifications thereof, and evaluate clinical and implementation outcomes.