Accepted for/Published in: JMIR Formative Research
Date Submitted: Sep 6, 2024
Date Accepted: Nov 1, 2024
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Acceptance, Safety, and Effect-Sizes in Online-Dialectical Behavior Therapy for Borderline Personality Disorder: A feasibility study
ABSTRACT
Background:
The potential of online psychotherapy is gaining increased attention. However, there is skepticism about its acceptance, safety and efficacy for patients with high emotional and behavioral dysregulation.
Objective:
This study aims to provide initial effect-size estimates on psychopathology, acceptance and safety of online Dialectical Behavior Therapy (DBT) for individuals diagnosed with Borderline Personality Disorder (BPD).
Methods:
Thirty-nine individuals meeting DSM-5 criteria for BPD received one year of outpatient online DBT at three sites in Germany and Canada. Effect size estimates were assessed using pre-post measures of BPD symptoms (BSL-23), dissociation (DSS), and quality of life (ReQoL). Safety was evaluated by analyzing suicide attempts and self-harm (DSHI). Additionally, acceptance and feasibility (AIM), satisfaction with treatment (CSQ-8), useability of the online format (UTAUT), and the therapeutic relationship (WAI) were assessed from therapists' and patients' perspectives.
Results:
Analyses showed significant and large pre-post effect sizes for BPD symptoms (d = 1.13 in the ITT, d = 1.44 in the ATP sample, p < .001) and for quality of life (d = 1.24). Dissociative symptoms showed small to non-significant reductions. Self-harm behaviors decreased significantly from 80% to 28% of all patients showing at least one self-harm behavior in the last 10 weeks (RR = 0.35). A high dropout rate of 38% was observed. One low-lethality suicide attempt was reported. Acceptance, feasibility, and satisfaction measures were high, although therapists reported only moderate useability of the online format.
Conclusions:
Online DBT for BPD showed large pre-post effect sizes for BPD symptoms and quality of life. While the online format appeared to be feasible and well-accepted, the drop-out rate was relatively high. Future research should compare the efficacy of online DBT with in-person formats in randomized-controlled trials. Overall, online DBT might offer a potentially effective alternative treatment option, enhancing treatment accessibility. However, strategies for decreasing drop-out should be considered. Clinical Trial: A preregistration of the trial is available under DRKS00027824
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