(PS13-C64) Implementing Dialectical Behavior Therapy (DBT) Without Excluding People with Psychosis

People with a history of psychosis and/or psychotic disorder tend to experience significant emotion dysregulation (Khoury & Lecomte, 2021; Tully & Niendam, 2014) and a very high risk of completed suicide (Hor & Taylor, 2010; Bertolote & Fleischmann, 2002). This combination of risk factors is suggestive of the potential benefit of DBT, a suicide-focused intervention that is thought to operate primarily through improvements in emotion regulation (Ritschel, Lim, & Stewart, 2015). Unfortunately, as is common with most suicide-focused interventions of any kind (Villa et al., 2020), clinical implementations and trials of DBT have usually excluded people with psychosis, thus limiting access to this potentially life-saving intervention.

One approach that has been taken to improve access is to implement DBT specifically for people with psychosis. To that end, a DBT skills workbook for people with psychosis was recently published (Mullen, 2021), and a brief DBT-informed skills group for individuals with psychosis was implemented and evaluated (Lawlor et al., 2022). While promising, a dedicated program for people with psychosis has drawbacks because (1) patients with psychosis are a small minority at most clinics, and (2) there is no affirmative evidence that people with versus without psychosis benefit differently from unmodified or "standard" DBT (Phalen et al., 2022).

In this poster, we will present feasibility and outcomes data from two clinical implementations of DBT—a standalone skills group and a full model program—that neither excluded nor restricted to people with psychosis/psychotic disorder. Despite not specifically seeking out people with psychosis, individuals with active psychosis and/or psychotic disorder formed the majority of both groups. Dropout rates were 27% for the standalone skills group and 8% for the full model program, which was comparable or better than other published implementations of DBT (cf. Comtois et al., 2007; Feigenbaum et al., 2012; Priebe et al., 2012). Patient characteristics will be presented in tables for both groups. For the full model DBT program, comprehensive outcomes data were collected, which will be presented in figures and tables. Effect sizes ranged from medium (d=-0.64 on the Borderline Symptom List-23) to large (d=-1.0 on the Difficulties in Emotion Regulation Scale) and there was no evidence that patients with and without psychosis benefitted differently from treatment, although there was a trend-level greater improvement in emotion regulation for individuals with a history of psychosis. Overall, we believe our experiences support the feasibility of including people with psychosis in clinical implementations of DBT.