Clinical Round Table 6 - Balancing Fidelity and Fit: Understanding Adaptations of Dialectical Behavioral Therapy for Marginalized Individuals

The primary goals of this clinical roundtable are to discuss reasons, methods, and effectiveness of Dialectical Behavioral Therapy adaptations for marginalized individuals. DBT is an effective transdiagnostic treatment for emotion dysregulation, self-harm, and suicidality, and has become increasingly widely used. While DBT is thus often delivered to diverse individuals, the “when”, “what”, and “how” of cultural adaptation for DBT are underexplored (Haft et al., 2022) and vary widely in clinical practice. These variations highlight considerations in the application of DBT for marginalized people, including whether to: adopt DBT as is or develop adaptations, conduct pilot testing or engage in large-scale dissemination, and adapt an intervention proactively or reactively (Wiltsey-Stirman et al., 2019). Scholars encourage a radical synthesis between each of these binary choices to develop treatment interventions that are both culturally relevant and clinically meaningful (Koerner et al., 2007). While cultural adaptation is recommended when contextual factors influence symptoms or treatment effectiveness, DBT inherently possesses several elements which position it as particularly useful when approaching experiences of systemic oppression (Oshin & Rizvi, 2025). With the goal of delivering the most effective treatment to those experiencing complex environmental invalidation, we will explore how to recognize variables that would necessitate adaptation, leverage frameworks to develop targeted adaptations, and prioritize maintaining the “active components” of DBT. Our five presenters will turn to evidence from their mixed-methods, community-based, technology-enabled, or controlled research testing the effectiveness of culturally-adapted DBT to answer these questions. As each presenter has culturally adapted variations in DBT (e.g., full-model, single-session, group) they will discuss 1) approaches and feasibility of approaches to adaptation 2) components of DBT intentionally preserved, and 3) methods used to measure effectiveness of adaptation. Presenters will integrate their clinical expertise and research, exploring the implications of their work for real-world application of DBT with minoritized individuals.