Implementing Dialectical Behaviour Therapy: Programme survival in routine healthcare settings

Abstract

Background

The National Institute of Health and Clinical Excellence recommends considering Dialectical Behaviour Therapy (DBT), an efficacious treatment for borderline personality disorder, especially when reduction in self-harm is a clinical priority [. Borderline Personality Disorder: Treatment and Management. Leicester: The British Psychological Society and the Royal College of Psychiatrists]. Treatment teams began using DBT in the UK in 1994. Concerns have been raised, however, about the sustainability of DBT programmes in routine clinical practice [Pitman, A., & Tyrer, P. (2008). Implementing clinical guidelines for self-harm – highlighting key issues arising from the NICE guideline for self-harm. Psychology and Psychotherapy: Theory, Research and Practice, 81, 377–397].

Aims

This study sought to establish the sustainability of UK DBT programmes and to explore factors that impacted on effective implementation.

Method

All teams trained in DBT in the UK between 1994 and 2007 were contacted. Each team was categorised as either active or inactive. The date of programme cessation was established. Team leaders of active, and as far as possible inactive, programmes were interviewed about aspects of implementation.

Results

The survival curve demonstrated that DBT programmes ran an increased risk of failure in the second and fifth years after training. Absence of organisational support and staff turnover were the most commonly reported implementation challenges.

Conclusions

Sustainable implementation of DBT, as with other evidence-based interventions, requires organisational support that incorporates a strategy for further staff training and development.

Keywords:

• implementation
• DBT

Acknowledgement

This work is supported by KTP Grant Number 001265.

Declaration of Interest: MS is the Director of the British Isles DBT Training Team that trains practitioners in DBT with a licensed training programme. RABH is the Managing Director of Integral Business Support Ltd that delivers licensed training in DBT. MS and RABH are married.