4 - (SYM 73) Implementation and Effectiveness of Comprehensive Dialectical Behavior Therapy in the Perinatal Period

The evidence base supporting frontline interventions for perinatal mood and anxiety disorders (PMADS) has prioritized perinatal populations with mild to moderate symptoms, and has excluded individuals with high acuity concerns, such as suicidality, aggression, substance use, and interpersonal violence (Leng at al., 2023; Li et al., 2022). Dialectical Behavior Therapy (DBT) is an intervention well-positioned to fill this critical gap in care for high risk perinatal. This presentation (1) characterizes the need for an intervention to treat high-risk, acute, and complex perinatal patients, (2) describes the implementation of a comprehensive perinatal DBT program, and (3) examines the effectiveness of comprehensive DBT among a perinatal population at 6 and 12 months after intervention onset.

Data were collected from 49 patients seen in a perinatal mental health treatment center in the southeastern United States between May 2019 through July 2024. Patients were either pregnant or postpartum, experiencing PMAD symptoms, and were part of a 12-month comprehensive DBT program, including individual therapy, peer consultation, group skills training, and telephone coaching. Patients were assessed for number of psychiatric hospitalizations, suicide attempts, aggressive behavior, Child Protective Service involvement, and interpersonal violence in the year prior to and during treatment.  Patients completed self-report measures of depression, emotion dysregulation, aggressive behavior, maternal bonding, and skills acquisition (e.g., mindfulness, distress tolerance) as part of standard clinical care prior to beginning treatment (baseline), month 6, and month 12.

Rates of psychiatric hospitalizations and suicide attempts were compared for the year prior to and during treatment, with patients demonstrating a significant reduction in hospitalization and no suicide attempts during the treatment year.  A series of t-tests and repeated measures ANOVAs indicated significant reductions in depression, emotion dysregulation, and aggressive behavior, as well as improvement in mindfulness, distress tolerance, and interpersonal effectiveness skills at 12 months. Of note, all measures had clinically significant improvement at 6 months except mindfulness and adaptive interpersonal effectiveness skill use. Limitations, treatment implications, and future directions will be discussed.