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Symposia

Dissemination & Implementation Science

Adherence in Dialectical Behavior Therapy: Current Efforts and Critical Need

2 - (SYM 17) Evaluation of Therapist Adherence to Dialectical Behavior Therapy in the U.S. Department of Veterans Affairs' Suicide Prevention 2.0 Clinical Telehealth Initiative Training Program

Friday, November 21, 2025
5:27 PM - 5:48 PM CST
Location: Celestin A, Level 3
Keywords: Adherence, DBT (Dialectical Behavior Therapy), Competence
Recommended Readings: Rizvi, S. L., Bitran, A. M., Oshin, L. A., Yin, Q., & Ruork, A. K. (2024). The state of the science: Dialectical behavior therapy. Behavior Therapy. 55(6), 1233-1248. https://doi.org/10.1016/j.beth.2024.02.006,   Harned, M. S., Schmidt, S. C., Korslund, K. E., & Gaglia, A. (2023). Therapist adherence to Dialectical Behavior Therapy in routine practice: Common challenges and recommendations for improvement. Journal of Contemporary Psychotherapy. https://doi.org/10.1007/s10879-023-09601-x,   Koerner, K. (2013). What must you know and do to get good outcomes with DBT?. Behavior Therapy, 44(4), 568-579.,   Harned, M. S., Schmidt, S. C., Korslund, K. E., & Gallop, R. J. (2023). Development and evaluation of a pragmatic measure of adherence to Dialectical Behavior Therapy: The DBT Adherence Checklist for Individual Therapy. Administration and Policy in Mental Health and Mental Health Services Research, 50, 734-749.,  
Abstract Body

Dialectical Behavior Therapy (DBT; Linehan 1993) is an evidence-based psychotherapy (EBP) that is primarily used to treat borderline personality disorder and self-directed violence. Substantial efforts have been made to implement DBT around the world at the clinic, system, state, and national levels. Encouragingly, research has found that leading DBT training models result in high rates of adoption and sustainability of DBT in diverse healthcare settings (e.g., Navarro-Haro et al., 2019; Swales et al., 2012). However, little is known about the degree to which DBT is delivered with adherence once adopted. Given that higher therapist adherence to DBT leads to better outcomes for clients (Harned et al., 2022), ensuring that therapists are trained to the level of adherence is a particularly important target for implementation efforts.

To increase access to suicide prevention care, the VA’s Suicide Prevention 2.0 (SP 2.0) Clinical Telehealth Initiative is currently implementing DBT as part of a nationwide virtual program to provide EBPs for Suicide Prevention (EBP-SP) to U.S. Veterans. To support this initiative, a competency-based DBT training program was developed by subject matter experts. The VA DBT Training Program is one year, offers instruction in all four modes of DBT, and includes workshop training followed by consultation with a DBT subject matter expert. Notably, this program is the first large-scale DBT implementation effort to evaluate and require adherence among training participants. Specifically, therapists submit biweekly individual session recordings of training cases to be rated by consultants using the DBT Adherence Checklist for Individual Therapy (DBT AC-I; Harned, et al., 2021). To successfully complete the training program, therapists must deliver DBT adherently in at least 6 sessions with at least 2 adherent sessions from 2 different patients.

To date, seven cohorts of therapists (n=64 total) from 10 U.S. regions have enrolled in the DBT training program. Of the 43 therapists in cohorts 1-4, 84% successfully completed the training program, indicating that the training model is quite effective in enabling therapists to deliver DBT with adherence. This presentation will present results of the evaluation of DBT adherence scores over the course of the year-long DBT Training Program. We hypothesize that earlier sessions will be lower in adherence and that the rate of adherent sessions will increase over time. We will also assess which strategies are most often used adherently and non-adherently.