(PS7-88) Preliminary data on a prepilot Dialectical Behavior Therapy (DBT) skills program for people with psychosis spectrum disorder and high risk of suicide

Approximately 5% of people with schizophrenia die by suicide (Bachmann, 2018; Hor & Taylor, 2010), making suicide the greatest relative risk factor for mortality in this patient population (Álvarez et al., 2022; Cassidy et al., 2018; Lu et al., 2020). Emotion dysregulation is one key factor that has been found to be strongly associated with increased suicide risk among people with psychosis spectrum disorders (Buyuksandalyaci Tunc & Gul, 2023; Palmier-Claus et al., 2013; Phalen et al., 2024). In recent years, Dialectical Behavior Therapy (DBT) has gained attention as a potential intervention for suicidality among people with psychosis spectrum disorders due to its focus on reducing suicide risk via improvements in emotion regulation  (Phalen et al., 2022).

Despite some preliminary work such as program evaluations, no randomized controlled trials (RCTs) of DBT for people with psychosis have been conducted, and in fact people with psychosis have typically been excluded from suicide-focused clinical trials of any kind (Villa et al., 2019; Goldberg et al., 2024). There is a need for RCTs of DBT for psychosis in order to evaluate this treatment approach as a potential method for reducing suicide in this population (Phalen et al., 2022).     

We are conducting an RCT of DBT skills training for people with psychosis spectrum disorders and high risk of suicide at the University of Maryland School of Medicine. As a first step, we assessed feasibility and acceptability by training community clinicians in DBT for psychosis and conducting a prepilot DBT skills group with seven patients from outpatient community mental health clinics serving low-income areas. Clinicians attended a one-day training on DBT skills group implementation (followed by ongoing training for those clinicians who volunteered to administer groups), while patients participated in a 15-week standalone DBT skills group. All participants were evaluated at baseline, and 5 participants were assessed again at post-treatment and 3-month follow-up (with two participants lost to follow-up). In addition to quantitative data, qualitative interviews were conducted asking about participants’ experiences in the group. Finally, real-world data on participant emotion was collected remotely for 7 days pre- and post-treatment using a novel Ecological Momentary Assessment (EMA) method in order to directly assess emotion dysregulation. After each week of EMA, participants were shown graphs of their mood ratings throughout the week so that they could comment on factors affecting their emotions.

In this poster, we will present results of both quantitative and qualitative analyses, including participants’ perceptions of their DBT group experience and preliminary data on acceptability and feasibility (e.g. dropout rate, group attendance, etc). While the sample size is too small for inferential statistics, we will show plots of raw participant scores over time on key outcome measures (e.g., the Difficulties in Emotion Regulation Scale [DERS-36], Columbia Suicide Severity Rating Scale [CSSRS], which on average showed improvements), crucial to understanding the effectiveness of DBT for schizophrenia patients who experience suicidal ideation.