2 - (SYM 48) Implementation and Adaption of DBT in the Perinatal Period: A Scoping Review

Psychological distress is the most common complication of pregnancy. In turn, perinatal mood and anxiety disorders (PMADs) have received increasing attention. Yet, high-risk perinatal concerns–such as perinatal emotion dysregulation, suicidality and self-harm–remain understudied. Critically, suicide remains a leading cause of perinatal mortality, and emotion dysregulation has significant implications for the health and wellbeing of perinatal individuals and their families. Thus, effective interventions for perinatal emotion dysregulation are needed.

Dialectical behavior therapy (DBT) is a frontline treatment for emotion dysregulation and its high-risk behavioral sequelae (e.g., suicidality, self-harm, substance use). Therefore, the aim of this scoping review was to examine the extent to which DBT has been implemented within pregnancy and postpartum. Our aims were to examine the state of empirical evidence regarding: 1) the feasibility, safety and efficacy of DBT in the perinatal period, 2) adherent perinatal DBT implementation, and 3) logistical or conceptual adaptations necessary to promote the feasibility and efficacy of perinatal DBT, given the unique implications of perinatal emotion dysregulation for pregnant/postpartum individuals, their infants and families. PRISMA guidelines were followed.

Seven studies were identified; study designs included case studies and single-arm pilot trials. Most studies used DBT-informed protocols with significant adaptations. Few included multiple components of DBT (i.e., skills group, individual therapy, phone coaching, consultation team), and none met criteria for adherent delivery of comprehensive DBT. Findings suggest DBT-informed interventions may be successfully implemented to treat a range of perinatal mental health concerns, including borderline personality disorder, depression, anxiety, and posttraumatic stress, and to promote emotion regulation and parenting-related skills.

While results provide preliminary support for the use of DBT-informed interventions in the perinatal period, the literature is highly limited and empirical rigor lacking. Surprisingly, only a few of the identified studies recruited individuals with significant perinatal emotion dysregulation, suicidality, or risk behavior. Clinical implications and future research directions will be discussed, with an emphasis on the need to develop and rigorously evaluate interventions tailored to the needs of high risk-perinatal individuals and their families.