Brief internet-delivered skills training based on DBT for adults with borderline personality disorder – a feasibility study

Figures & data

Table 1. Included modules of the internet-delivered skills training program.

Module	DBT skills	Description
Mindfulness	‘WHAT’ skills (Observe, Describe, Participate), Wise-mind, ‘HOW’ skills (Non-judgmentally, One mindfully, Effectively)	Skills in perceiving and describing the present
Distress tolerance	STOPP (skill in acting mindful), TIPP (skills in changing body chemistry), Distraction, Turning the mind, Half-smiling, Radical acceptance, Willing hands	Skills in tolerating distress
Emotional regulation	Identifying and labeling primary emotions, Checking facts, Acting opposite to inefficient emotions	Skills in changing inefficient emotions
Interpersonal effectiveness	Clarifying goals and priorities, DEAR MAN (being assertive and saying no), Validation	Skills in maintaining and improving the relationship to others and oneself

Table 2. Characteristics of the study population (n = 9).

Gender	Female n = 9
Age Mean (SD)	27.89 (6.31)
Marital status	Living together with partner n = 5
	Single n = 3
	Living apart from partner n = 1
Education	Elementary school n = 4
	High school n = 2
	University n = 3
Occupation	Unemployed n = 1
	Sickness benefits n = 2
	Part-time employment (25–75%) n = 4
	Student n = 2
Number of met BPD-criteria Mean (SD)	5.78 (0.83)
Criterion 1: Uncontrolled efforts to avoid	n = 6
real/Imagined abandonment
Criterion 2: Unstable and intense relationships	n = 3
Criterion 3: Identity disturbance	n = 4
Criterion 4: Impulsive/Self-destructive	n = 5
behaviors
Criterion 5: Recurrent suicidal behavior	n = 8
Criterion 6: Affective instability/Intense	n = 9
emotional swings
Criterion 7: Chronic feelings of emptiness	n = 5
Criterion 8: Inappropriate/Intense anger or	n = 5
difficulty controlling anger
Criterion 9: Stress-related paranoid ideation or	n = 5
severe dissociative symptoms
Comorbidities
Any	n = 7
Depressive disorders	n = 6
Anxiety disorders	n = 4
Asperger Syndrome	n = 1
Attention Deficit Disorder	n = 1
Bipolar Disorder	n = 1
Dissociative Disorder	n = 2
Schizophrenia, schizotypal and delusional
disorders	n = 1
Substance Abuse	n = 1

Note. BPD: Borderline personality disorder.

Table 3. Main categories and subcategories with illustrative quotes.

Category	Subcategory	Illustrative quotes
Working with internet-delivered skills training	The online format	‘I thought it was very good that it was online based, because I did not have to keep any appointments… because I think that is very hard… I thought that it was good that you had access to the material whenever you wanted.’
	DBT skills	‘I liked the audio exercises because it felt more like someone was actively participating, because someone was talking and telling you what to do.’
	Diary card	‘The diary cards were a little bit like this, I kind of thought that they were unnecessary. Or I cannot say that but for me it was kind of… I had gotten a long way in not self-harming and in the majority of them there was not any change …’
	The length of the skills training program	‘I actually think that it needs to be a little bit longer, because if I were to think of why it did not fit me, it was because it takes a while before you get into how you should answer the questions and how you should think.’
	Technical issues	‘…it was a little bit frustrating to do the assignments, because you sat and waited for something to happen, sometimes it crashed…’
Allocated time		‘… I have a pretty stressful everyday life. Things are happening all the time and then you have to squeeze in the skills training into this.’
The personal contact	Initial meeting with the therapist	‘…it was good as well to get a face on her… so then it felt easier when you wrote, knowing who it is, that was nice’.
	Helpful but scarce	‘It felt like it might as well have been Artificial Intelligence kind of… it did not feel so personal…’
Personal struggles	Difficulties in initiating and maintaining skills practice on their own	‘There was no checking and then I did not really feel like I wanted to do it.’ ‘…when it is online you can choose the time you work with it, and that was not good for me. Because it always came last on the to-do list.’
	Stress and/or pressure in doing home assignments	‘I think it was more my responsibility, that I just did not give myself enough time, and therefore it got stressful.’
	Distressing to practice skills	‘There was one skill that triggered me… I got impulses to self-harm and anxiety… but then afterwards I have looked back and thought but this is kind of good’.
	Distress from the feeling of using skills incorrectly	‘…if this does not work on you then there is something wrong with you, kind of.’
Outcomes of the skills training program	Perceived well-being	‘As you have thought that okay, the waiting time is long, but we can do something meanwhile to make it easier in some way and I thought that was very good…’
	Gained and/or maintained knowledge and skills	‘that you get yourself some time and… that you do not only act on your feelings either, and try to kind of think that okay, now I will stop here, instead of…’
	Decreased levels of self-harm	‘…so I have been able to tell my mother or my father that now… ‘I saw a pair of scissors, remove them or stay at home I do not want to be alone’, that I otherwise would have told them afterwards…’
	Personal growth	‘I felt as if I kind of grew a lot in a short time… as a person… I had a pretty immature behavior before…’
	Feelings of hope	‘I think that the whole idea with this treatment is really good, and I think that it can give a lot of people a feeling of hope, because when you hear … it is 15 months of waiting time, then you just feel a little bit like oh well.’
	Opinions on their upcoming standard DBT treatment	‘…I look forward to it after doing this short one, now I know what it is about, and what I like.’

Data availability statement

The data that support the findings of this study are available on reasonable request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.