Implementation of a Mobile DBT App and Its Impact on Suicidality in Transitional Age Youth with Borderline Personality Disorder: A Qualitative Study

Abstract

Contemporary performance and accessibility are features that enable mobile devices to be increasingly beneficial in the context of optimizing the treatment of psychiatric disorders. Smartphones have the potential to effectively support psychotherapeutic interventions among adolescents and young adults who require them. In the present study, the use and subjective influence of a smartphone app with content from dialectical behavior therapy (DBT) was investigated among transitional age youth (TAY) with borderline personality disorder, focusing on suicidality and non-suicidal self-injury (NSSI), in a natural setting. A longitudinal qualitative approach was used by means of individual semi-structured interviews, where participants were asked about their experiences and associated emotions before and after a testing period of 30 days. A total of 13 TAY with a diagnosed borderline personality disorder between the ages of 18 and 23 were included. Six overarching themes were identified through qualitative text analysis: (1) experiences with DBT skills, (2) phenomenon of self-harm, (3) feelings connected with self-harm, (4) dealing with disorder-specific symptoms, (5) prevention of self-harm, and (6) attitude toward skills apps. In general, the provision of an app with DBT content achieved a positive response among participants. Despite a small change in the perception of suicidality and NSSI, participants could imagine its benefits by integrating their use of the app as a supportive measure for personal psychotherapy sessions.

E-Mental Health for People with Personality Disorders: A Systematic Review

“…The majority of intervention studies ( k = 12 out of 16, 75.00%) used DBT techniques. Specifically, nine out of the 16 intervention studies (56.25%) were based on DBT (i.e., the interventions were DBT) [ 23 – 27 •, 30 , 32 , 34 , 35 ], and three (18.75%) were DBT-informed (i.e., included DBT elements) [ 29 , 31 , 37 •]. Only four intervention studies (25.00%) did not use DBT techniques [ 22 •, 28 , 33 , 36 ].…”

“…In terms of the delivery format, most studies used smartphone apps to deliver the interventions. Twelve (63.16%) studies were smartphone app-based [ 17 ••, 23 , 24 , 27 •, 28 , 30 – 32 , 34 , 36 – 38 •], five (26.32%) were Internet-based [ 22 •, 25 , 29 , 33 , 35 ], one (5.26%) was email-based [ 26 ], and one review (5.26%) examined various forms of technology (e.g., virtual reality, mobile apps, computer-assisted) [ 18 ••]. The vast majority of the studies ( k = 18 out of 19, 94.74%) were conducted in North America and Europe, only one study [ 24 ] was conducted in Argentina.…”

“…Samples were on average majority female (83.06%). Among the 19 samples included, nine (56.25%) had BPD diagnosis [ 18 ••, 22 •, 23 , 26 , 28 , 31 – 34 ], six (37.50%) had common symptoms of BPD (e.g., self-injury, suicidality) [ 17 ••, 24 , 25 , 27 •, 29 , 35 ], one (6.25%) included various PDs (not limited to BPD) [ 30 ], two (12.50%) included people assisting in technology development [ 36 , 37 •], and one (6.25%) focused on smartphone apps rather than participants [ 38 •].…”

“…There were six eligible single-group intervention studies. Four were DBT-based [ 30 , 32 , 34 , 35 ], one was DBT-informed [ 31 ], and one was non-DBT (schema therapy) [ 33 ]. In terms of the delivery format, four were app-based [ 30 – 32 , 34 ] and two were Internet-based [ 33 , 35 ].…”

The Use of Computer-Driven Technologies in the Treatment of Borderline Personality Disorder: A Systematic Review

“…This mixed-method study, using in-depth interviews and questionnaires, revealed that such applications may make many of the therapeutic techniques in DBT treatment easier. Similarly, Schiffler et al designed a study that included 13 transitional age youth (18-23 year old patients) diagnosed with BPD and assessed their experiences and associated emotions before and after a testing period of 30 days while using a mobile DBT application [28]. However, they highlighted that this mobile application did not bring about any changes in the subjective view of suicidality.…”