Effectiveness of Delivering Dialectical Behavioral Therapy Techniques by Email in Patients With Borderline Personality Disorder: Nonrandomized Controlled Trial

Abstract

Background: Borderline personality disorder is a debilitating and prevalent mental health disorder, with often inaccessible treatment options. Electronically delivered dialectical behavioral therapy could be an efficacious and more accessible intervention. Objective:We aimed to evaluate the efficacy of electronic delivery of dialectical behavioral therapy in the treatment of individuals with symptoms of borderline personality disorder.Methods: Study participants diagnosed with borderline personality disorder were offered either an email-based or in-person group format dialectical behavioral therapy skill-building program. During each session, participants were provided with both the material and feedback regarding their previous week's homework. Electronically delivered dialectical behavioral therapy protocol and content were designed to mirror in-person content. Participants were assessed using the Self-Assessment Questionnaire (SAQ) and Difficulties in Emotion Regulation Scale (DERS).Results: There were significant increases in SAQ scores from pre-to posttreatment in the electronic delivery group (F 1,92 =69.32, P<.001) and in-person group (F 1,92 =60.97, P<.001). There were no significant differences observed between the groups at preand posttreatment for SAQ scores (F 1,92 =.05, P=.83). There were significant decreases in DERS scores observed between preand posttreatment in the electronic delivery group (F 1,91 =30.15, P<.001) and the in-person group (F 1,91 =58.18, P<.001). There were no significant differences observed between the groups for DERS scores pre-and posttreatment (F 1,91 =.24, P=.63). There was no significant difference in treatment efficacy observed between the 2 treatment arms (P<.001).Conclusions: Despite the proven efficacy of in-person dialectical behavioral therapy in the treatment of borderline personality disorder, there are barriers to receiving this treatment. With the prevalence of internet access continuing to rise globally, delivering dialectical behavioral therapy with email may provide a more accessible alternative to treatment for individuals with borderline personality disorder without sacrificing the quality of care.

Towards online delivery of Dialectical Behaviour Therapy: A scoping review

“…One study was based in each of Canada, Italy and the Netherlands. Several studies were trials which addressed effectiveness of online DBT interventions (Alavi et al 2021;Austin et al 2020;Lopez et al 2020;van Spijker et al 2014;Whiteside et al 2019Whiteside et al , 2021Wilks et al 2018Wilks et al , 2020. One attempted to understand dropout from a guided DBT (Wilks et al 2020).…”

“…For example, providers suggested using editable PDF documents, sent in advance of skills groups, using the virtual whiteboard and encouraging chat, calling on individuals to make contributions, commencing groups early to allow clients to join and chat, and agreeing on how therapy interfering behaviours were managed by facilitator. Alavi et al (2021) trialled an asynchronous skills training intervention in which those who elected not to attend a face-to-face group were emailed 30-40 powerpoint slides each week (a 15-week programme) with skills content and homework sheets to be completed before seeing an individual therapist and before the next weeks material was sent. Wilks et al (2018) recruited participants to an 8-week skills training online intervention consisting of modules of approximately 50 min duration.…”

“…There were no significant differences between groups and no significant reduction in emotion regulation scores (Wilks et al 2018). Alavi et al (2021) recruited 107 individuals with a confirmed diagnosis of BPD who elected to attend either a face-to-face skills group (n = 52) or an e-DBT group (n = 53). The content and format of the e-DBT group mirrored the face-to-face group and consisted of slides, handouts and homework being emailed to participants and homework was required to be returned to the individual therapist before the next weeks slides were sent.…”

“…In the naturalistic DBT programmes, risk was managed in much the same way as in conventional DBT programmes. Alavi et al (2021) informed participants that therapists would read their emails once a week and they could not respond to crisis, that in case of emergencies then they should contact emergency services. Some of Zalewski et al (2021) survey respondents noted that undertaking risk assessments were more challenging via tele-health but quoted one respondent as saying that suicide risk had been managed remotely (via phone coaching) since the conception of DBT.…”

Feasibility, Acceptability and Preliminary Efficacy of Dialectical Behavior Therapy for Autistic Adults without Intellectual Disability: A Mixed Methods Study

“…In other clinical samples than autistic adults, previous findings suggest that DBT may have a significant positive effect on some (i.e., “Strategies” and “Goals”) or all of the DERS subscales (e.g. Gibson et al, 2014 ; Neacsiu et al, 2014 ; Alavi et al, 2021 ). In our study, on the “Clarity” subscale, the mean score did not improve significantly, but on the intra-individual level, the RCIs of four participants showed a reliable improvement.…”