4 - (SYM 17) How Can We Enhance DBT Adherence?: Examining the Impact of Client Factors

DBT is the gold-standard treatment for individuals with Borderline Personality Disorder (BPD) and suicidal behaviors. However, its highly comprehensive, complex, and principle-based protocol often serves as a barrier to its dissemination and implementation. Recent research (Harned, et al., 2024) examining adherence to DBT among therapists in routine practice reported that the therapists, on average, delivered DBT slightly below adherence.  Moreover, 45.6% of the sessions were coded as non-adherent. While this research emphasizes the need for more targeted efforts to enhance adherence to DBT, little is known about potential factors that are impacting therapists’ ability to deliver DBT adherently. Harned and colleagues (2024) identified 10 DBT core strategies that had low adherence; among these were implementation of the suicidal behaviors protocol, use of direct confrontation, and use of informal exposure. This study examines client factors that potentially impact the DBT therapist’s administration of these core strategies.

We will examine the impact of four pre-treatment client-related features- i.e., suicidal behaviors, BPD severity, emotion dysregulation, and anger - on therapist DBT adherence from the Feasibility of a Shorter Treatment and Evaluating Responses (FASTER) DBT trial (McMain, et al., 2022). 240 suicidal individuals with BPD received standard DBT and 64 DBT-trained therapists delivered the intervention. Therapist adherence to DBT was assessed using the DBT Adherence Coding Scale Computed Global Scores (DBT ACS; Linehan & Korslund, 2003). A random selection of 335 individual sessions and 62 group sessions have been coded by trained adherence coders. We will first present descriptives of the adherence scores for both the individual and skills group sessions. Next, using the individual session data, we will present the results of a regression analysis in which total frequency of client pre-treatment suicidal behavior, BPD severity (measured by the Borderline Symptom List- 23), levels of emotion dysregulation (measured by the Difficulties in Emotion Regulation Scale), and anger (measured by the State and Trait Anger Expression Inventory) are entered as the predictors and client-associated adherence Computed Global Scores from the DBT ACS are entered as the outcome variable. Results of this study will inform potential client-related clinical obstacles to adherence. Implications for the training of adherence to DBT will be discussed.