Predictors and clinical outcomes of pretreatment length in an outpatient Veterans Affairs dialectical behavior...

Dialectical behavior therapy (DBT) pretreatment is a standard component of DBT designed to prepare patients for treatment, identify treatment goals, and build commitment. Examination of DBT pretreatment is of particular importance in naturalistic clinical settings, where clinical resources are limited, such as Veterans Affairs Medical Centers, where DBT has become more widespread. Eligible veterans (n = 89) were enrolled in an outpatient DBT program at a Midwestern Veterans Affairs Medical Centers. Thirteen potential predictors (spanning demographic, health care utilization, and clinical factors) of DBT pretreatment length, operationalized as pretreatment duration and number of pretreatment sessions, were examined. Partial least squares regression was used to identify latent components. The relationship between pretreatment length and treatment outcomes was also examined. A significant one-component solution explained 29.10% of the variance in pretreatment duration. Borderline personality disorder symptoms, past suicide attempts, past inpatient days, and past psychiatric emergency room admissions were positively associated with pretreatment duration. A significant one-component solution, consisting of the same predictors, with the exception of past suicide attempts, and the addition of race, sex, and psychiatric comorbidity, explained 18.10% of the variance in number of pretreatment sessions. Neither pretreatment duration nor number of pretreatment sessions was related to treatment attendance, completion, or symptom severity. Indicators of clinical severity and complexity predict number of days and sessions spent in DBT pretreatment. Non-White race, male sex, and psychiatric comorbidity predict greater number of DBT pretreatment sessions. Deviation from the standard four-session pretreatment approach may be needed for some veterans. (PsycInfo Database Record (c) 2026 APA, all rights reserved).