(PS12-B39) Adapting DBT Delivery for Individuals in an Acute Psychiatric Inpatient Setting

Dialectical Behavior Therapy (DBT) is a third-wave cognitive behavioral therapy characterized by a modular and hierarchical treatment approach that includes individual psychotherapy, skills focused group therapy, telephone coaching, and a therapist consultation team (Linehan, 2015). Its original application and evidence-base thus far centers around comprehensive treatment delivered over months to years; however, there is increasing interest in and theoretical support for implementing DBT Skills Groups as a standalone treatment (Linehan, 2015). Skills teaching in areas of emotion regulation, distress tolerance, interpersonal effectiveness, and mindfulness are aligned with the treatment goals for many individuals treated in the psychiatric inpatient setting, for whom psychosocial functioning has been compromised to an extent requiring stabilization (Durrant et al., 2007). As a primary goal of acute inpatient psychiatric care consequently relates to restoring this functional capacity, discharge from the acute treatment setting hinges upon observable behavior, which may be conceptualized as the use of adaptive versus maladaptive coping skills. Importantly, then, individuals admitted for treatment on an inpatient unit are not necessarily there because of the level of their distress, but because of how they are relating to that distress. As DBT targets individuals’ relationship to distress, its adaptation may therefore offer unique benefit to short-term, high acuity treatment settings. The current observational study examines how DBT may be effectively adapted to the inpatient treatment setting, where implementation of the standard and well-researched format of traditional Comprehensive DBT is not possible. The current project gathered qualitative data examining the acceptability and impact of daily adapted DBT-ST psychotherapy groups facilitated in the inpatient context. Initial findings provide support for the utility and effectiveness of adapting DBT for the inpatient setting. For example, patients were increasingly observed to use distress tolerance and emotion regulation skills on the milieu. Patients also demonstrated increased interpersonal effectiveness, such as when asking for their needs and goals related to their treatment to be met. This project supports the rationale for adapting DBT to address the needs of individuals in an acute psychiatric inpatient unit, given the constraints of this setting (e.g., brief hospital stays, with patients in crisis, acute symptomatology, psychotropic medication changes). Modifications to existing DBT protocols are outlined to target the various treatment needs and goals of individuals in an inpatient setting.