Acceptance, Safety, and Effect Sizes in Online Dialectical Behavior Therapy for Borderline Personality Disorder: Interventional Pilot Study
BackgroundThe potential of telehealth psychotherapy (ie, the online delivery of treatment via a video web-based platform) is gaining increased attention. However, there is skepticism about its acceptance, safety, and efficacy for patients with high emotional and behavioral dy...
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JMIR Publications
2025-01-01
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| Series: | JMIR Formative Research |
| Online Access: | https://formative.jmir.org/2025/1/e66181 |
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| author | Ruben Vonderlin Tali Boritz Carola Claus Büsra Senyüz Saskia Mahalingam Rachel Tennenhouse Stefanie Lis Christian Schmahl Jürgen Margraf Tobias Teismann Nikolaus Kleindienst Shelley McMain Martin Bohus |
| author_facet | Ruben Vonderlin Tali Boritz Carola Claus Büsra Senyüz Saskia Mahalingam Rachel Tennenhouse Stefanie Lis Christian Schmahl Jürgen Margraf Tobias Teismann Nikolaus Kleindienst Shelley McMain Martin Bohus |
| author_sort | Ruben Vonderlin |
| collection | DOAJ |
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BackgroundThe potential of telehealth psychotherapy (ie, the online delivery of treatment via a video web-based platform) is gaining increased attention. However, there is skepticism about its acceptance, safety, and efficacy for patients with high emotional and behavioral dysregulation.
ObjectiveThis study aims to provide initial effect size estimates of symptom change from pre- to post treatment, and the acceptance and safety of telehealth dialectical behavior therapy (DBT) for individuals diagnosed with borderline personality disorder (BPD).
MethodsA total of 39 individuals meeting the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]) criteria for BPD received 1 year of outpatient telehealth DBT at 3 sites in Germany and Canada. Effect size estimates were assessed using pre-post measures of BPD symptoms, dissociation, and quality of life. Safety was evaluated by analyzing suicide attempts and self-harm. Additionally, acceptance and feasibility, satisfaction with treatment, useability of the telehealth format, and the quality of the therapeutic alliance were assessed from both therapists’ and patients’ perspectives. All analyses were conducted on both the intention-to-treat (ITT) and according-to-protocol (ATP) samples.
ResultsAnalyses showed significant and large pre-post effect sizes for BPD symptoms (d=1.13 in the ITT sample and d=1.44 in the ATP sample; P<.001) and for quality of life (d=0.65 in the ITT sample and d=1.24 in the ATP sample). Dissociative symptoms showed small to nonsignificant reductions. Self-harm behaviors decreased significantly from 80% to 28% of all patients showing at least 1 self-harm behavior in the last 10 weeks (risk ratio 0.35). A high dropout rate of 38% was observed. One low-lethality suicide attempt was reported. Acceptance, feasibility, and satisfaction measures were high, although therapists reported only moderate useability of the telehealth format.
ConclusionsTelehealth DBT for BPD showed large pre-post effect sizes for BPD symptoms and quality of life. While the telehealth format appeared feasible and well-accepted, the dropout rate was relatively high. Future research should compare the efficacy of telehealth DBT with in-person formats in randomized controlled trials. Overall, telehealth DBT might offer a potentially effective alternative treatment option, enhancing treatment accessibility. However, strategies for decreasing drop-out should be considered.
Trial RegistrationGerman Clinical Trials Register DRKS00027824; https://drks.de/search/en/trial/DRKS00027824 |
| format | Article |
| id | doaj-art-1860494480f24d6d9c0f83b7e723159c |
| institution | Kabale University |
| issn | 2561-326X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | JMIR Publications |
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| series | JMIR Formative Research |
| spelling | doaj-art-1860494480f24d6d9c0f83b7e723159c2025-01-14T21:01:12ZengJMIR PublicationsJMIR Formative Research2561-326X2025-01-019e6618110.2196/66181Acceptance, Safety, and Effect Sizes in Online Dialectical Behavior Therapy for Borderline Personality Disorder: Interventional Pilot StudyRuben Vonderlinhttps://orcid.org/0000-0003-4570-5648Tali Boritzhttps://orcid.org/0000-0002-6066-5624Carola Claushttps://orcid.org/0009-0001-6079-6632Büsra Senyüzhttps://orcid.org/0000-0002-9674-3655Saskia Mahalingamhttps://orcid.org/0009-0008-3221-9193Rachel Tennenhousehttps://orcid.org/0009-0001-5851-3912Stefanie Lishttps://orcid.org/0000-0002-8051-2756Christian Schmahlhttps://orcid.org/0000-0003-0141-0821Jürgen Margrafhttps://orcid.org/0000-0001-5207-7016Tobias Teismannhttps://orcid.org/0000-0002-6498-7356Nikolaus Kleindiensthttps://orcid.org/0000-0002-1696-2488Shelley McMainhttps://orcid.org/0000-0002-0269-5876Martin Bohushttps://orcid.org/0000-0002-1768-3608 BackgroundThe potential of telehealth psychotherapy (ie, the online delivery of treatment via a video web-based platform) is gaining increased attention. However, there is skepticism about its acceptance, safety, and efficacy for patients with high emotional and behavioral dysregulation. ObjectiveThis study aims to provide initial effect size estimates of symptom change from pre- to post treatment, and the acceptance and safety of telehealth dialectical behavior therapy (DBT) for individuals diagnosed with borderline personality disorder (BPD). MethodsA total of 39 individuals meeting the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]) criteria for BPD received 1 year of outpatient telehealth DBT at 3 sites in Germany and Canada. Effect size estimates were assessed using pre-post measures of BPD symptoms, dissociation, and quality of life. Safety was evaluated by analyzing suicide attempts and self-harm. Additionally, acceptance and feasibility, satisfaction with treatment, useability of the telehealth format, and the quality of the therapeutic alliance were assessed from both therapists’ and patients’ perspectives. All analyses were conducted on both the intention-to-treat (ITT) and according-to-protocol (ATP) samples. ResultsAnalyses showed significant and large pre-post effect sizes for BPD symptoms (d=1.13 in the ITT sample and d=1.44 in the ATP sample; P<.001) and for quality of life (d=0.65 in the ITT sample and d=1.24 in the ATP sample). Dissociative symptoms showed small to nonsignificant reductions. Self-harm behaviors decreased significantly from 80% to 28% of all patients showing at least 1 self-harm behavior in the last 10 weeks (risk ratio 0.35). A high dropout rate of 38% was observed. One low-lethality suicide attempt was reported. Acceptance, feasibility, and satisfaction measures were high, although therapists reported only moderate useability of the telehealth format. ConclusionsTelehealth DBT for BPD showed large pre-post effect sizes for BPD symptoms and quality of life. While the telehealth format appeared feasible and well-accepted, the dropout rate was relatively high. Future research should compare the efficacy of telehealth DBT with in-person formats in randomized controlled trials. Overall, telehealth DBT might offer a potentially effective alternative treatment option, enhancing treatment accessibility. However, strategies for decreasing drop-out should be considered. Trial RegistrationGerman Clinical Trials Register DRKS00027824; https://drks.de/search/en/trial/DRKS00027824https://formative.jmir.org/2025/1/e66181 |
| spellingShingle | Ruben Vonderlin Tali Boritz Carola Claus Büsra Senyüz Saskia Mahalingam Rachel Tennenhouse Stefanie Lis Christian Schmahl Jürgen Margraf Tobias Teismann Nikolaus Kleindienst Shelley McMain Martin Bohus Acceptance, Safety, and Effect Sizes in Online Dialectical Behavior Therapy for Borderline Personality Disorder: Interventional Pilot Study JMIR Formative Research |
| title | Acceptance, Safety, and Effect Sizes in Online Dialectical Behavior Therapy for Borderline Personality Disorder: Interventional Pilot Study |
| title_full | Acceptance, Safety, and Effect Sizes in Online Dialectical Behavior Therapy for Borderline Personality Disorder: Interventional Pilot Study |
| title_fullStr | Acceptance, Safety, and Effect Sizes in Online Dialectical Behavior Therapy for Borderline Personality Disorder: Interventional Pilot Study |
| title_full_unstemmed | Acceptance, Safety, and Effect Sizes in Online Dialectical Behavior Therapy for Borderline Personality Disorder: Interventional Pilot Study |
| title_short | Acceptance, Safety, and Effect Sizes in Online Dialectical Behavior Therapy for Borderline Personality Disorder: Interventional Pilot Study |
| title_sort | acceptance safety and effect sizes in online dialectical behavior therapy for borderline personality disorder interventional pilot study |
| url | https://formative.jmir.org/2025/1/e66181 |
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