The Impact of Social Distancing on People with Borderline Personality Disorder: The Views of Dialectical Behavioural Therapists

Abstract

Dialectical Behavioural Therapy (DBT) is an evidence-based treatment for borderline personality disorder and other problems associated with emotional dysregulation. It has traditionally been deployed as a face-to-face programme comprised of attendance at group skills training, individual therapy and phone coaching. Social distancing measures arising from the COVID-19 pandemic led to a cessation of therapeutic programmes in many places. This survey of DBT clinicians in a regional State mental health service in Australia explored the impact of the cessation of DBT programmes in the region and obstacles to engaging with people via online platforms. Clinicians have been able to engage in DBT informed care, but it was perceived that many people have experienced a clinical deterioration or have increased their use of crisis services, which is entirely appropriate, as group skills programmes have ceased. Movement to online platforms of delivery poses problems, as some people do not have the access to internet or privacy in their home environments to engage in online therapy. Ideally, clinicians need to be supported through education, supervision and coaching in the use of telehealth interventions. Social distancing requirements has enabled an opportunity to carefully consider how programmes can be adapted to enable the extension of these programmes to those who have traditionally been unable to access them.

Impact of the COVID-19 pandemic on patients with pre-existing mood disorders

“…The impact of COVID-19-related social restrictions on healthcare delivery has led to a reduction in available psychotherapeutic input and where such therapeutic inputs have continued, these have predominantly been delivered utilising telecommunication fora. It is notable that 80% of the EUPD cohort reported limited access to mental health services, with qualitative comments suggestive of feelings of abandonment and perceptions of care being of lower quality, consistent with previous reported findings from clinicians of reduced therapeutic efficacy from online therapeutic interventions (Lakeman & Crighton 2020 ). Consequently, some individuals with EUPD are experiencing a significant increase in symptoms, engaging in maladaptive coping strategies deleterious for their mental health and have reduced access to perceived higher quality therapeutic supports.…”

Vulnerability of personality disorder during the Covid-19 crises – a multicenter survey of treatment experiences among patients referred to treatment

“…Therapy was received in a diversity of arenas (at home, outside, etc. ), but in contrast to other reports [28], privacy issues were seldom reported. Increased access to psychotherapy is an obvious advantage, but use of digital systems nonetheless, raises several ethical issues including confidentiality and security, therapist competence, emergency issues, and not least lack of research on effectiveness for patients with PD [58].…”

“…A small pilot study of older adults (N ¼ 4), described the transformation of schema-therapy [28], to an intensive online program during the Covid-19 crises [29]. Results indicated therapist satisfaction, acceptable patient adaptation, and adherence to nonverbal online formats, online groups and homework delivered by email.…”

“…An Australian survey was based on clinicians (N ¼ 28) delivering dialectical behavioral therapy when ordinary faceto-face group skills programs were closed [28]. Clinicians experienced a deterioration among patients and increased use of crises services.…”

Suicide prevention in the covid-19 era

“…Some patients had to stop care due to lack of online capabilities either by themselves of the clinicians or due to not having a private space in their homes to properly benefit from therapeutic sessions. 32% of clinicians felt that they wouldn't be able to deliver DBT as effectively without in-person sessions ( Lakeman and Crighton, 2020 ). This highlights the need for more efforts and initiatives being available to help this population who is at very high risk.…”