(PS13-C65) Implementing DBT for Individuals with Psychosis in a Psychiatric Inpatient Setting

Dialectical Behavior Therapy (DBT) is the leading empirically supported treatment for problems in emotion regulation (ER), and its behavioral underpinnings target improvements in coping skills. While DBT was originally developed for individuals with borderline personality disorder (BPD), the approach has since been applied to many other problems for which emotion dysregulation and related behavioral control is thought to be a central area of impairment, including bipolar disorder, substance abuse, depression, and eating disorders (Linehan, 2015). Several lines of research support ER difficulties as a treatment target in individuals with psychosis (Ryan et al., 2021) and psychotic disorders might be an expected target problem for expanded application; however, individuals with psychosis have typically been excluded from Randomized Control Trials (RCTs) of DBT (Linehan, 2016) and no studies to date have directly examined the impact of standard DBT Skills Group on transdiagnostic populations experiencing psychosis (Simonson, 2022). One recent study by Ryan et al., (2021) evaluated a brief DBT-informed intervention specifically targeting ER difficulties in inpatients and outpatients with psychosis and found that DBT skills training holds promise. However, the feasibility and acceptability of DBT implementation for individuals with psychosis in a psychiatric inpatient context (e.g., amidst times of crisis, with acute symptomatology, psychotropic medication changes, brief hospital stays) remains unknown. Standalone DBT-skills training (DBT-ST) has been identified as a key mechanism accounting for treatment outcomes in standard DBT (Linehan et al., 2015; Neacsiu et al., 2014), and DBT-ST’s emphasis on teaching skills focused on emotion regulation, distress tolerance, acceptance, coping, and social functioning make it an ideal treatment for individuals with psychosis. The current observational study gathered qualitative data examining the acceptability and impact of daily adapted DBT-ST psychotherapy groups facilitated in the inpatient context. Initial findings support the utility of adapting DBT for individuals experiencing psychosis in the inpatient setting. For example, patients were observed requesting the inclusion of DBT-informed skills and concepts for daily psychology groups and patient use of DBT coping skills in the milieu and with hospital staff increased. This project provides key foundational information to guide further implementation and quantitative evaluation of DBT for psychosis in a psychiatric inpatient setting.