Effectiveness of Delivering Dialectical Behavioral Therapy Techniques by Email in Patients With Borderline Personality Disorder: Nonrandomized Controlled Trial
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Abstract
Background: Borderline personality disorder is a debilitating and prevalent mental health disorder, with often inaccessible treatment options. Electronically delivered dialectical behavioral therapy could be an efficacious and more accessible intervention. Objective: We aimed to evaluate the efficacy of electronic delivery of dialectical behavioral therapy in the treatment of individuals with symptoms of borderline personality disorder. Methods: Study participants diagnosed with borderline personality disorder were offered either an email-based or in-person group format dialectical behavioral therapy skill-building program. During each session, participants were provided with both the material and feedback regarding their previous week’s homework. Electronically delivered dialectical behavioral therapy protocol and content were designed to mirror in-person content. Participants were assessed using the Self-Assessment Questionnaire (SAQ) and Difficulties in Emotion Regulation Scale (DERS). Results: There were significant increases in SAQ scores from pre- to posttreatment in the electronic delivery group (F1,92=69.32, P<.001) and in-person group (F1,92=60.97, P<.001). There were no significant differences observed between the groups at pre- and posttreatment for SAQ scores (F1,92=.05, P=.83). There were significant decreases in DERS scores observed between pre- and posttreatment in the electronic delivery group (F1,91=30.15, P<.001) and the in-person group (F1,91=58.18, P<.001). There were no significant differences observed between the groups for DERS scores pre- and posttreatment (F1,91=.24, P=.63). There was no significant difference in treatment efficacy observed between the 2 treatment arms (P<.001). Conclusions: Despite the proven efficacy of in-person dialectical behavioral therapy in the treatment of borderline personality disorder, there are barriers to receiving this treatment. With the prevalence of internet access continuing to rise globally, delivering dialectical behavioral therapy with email may provide a more accessible alternative to treatment for individuals with borderline personality disorder without sacrificing the quality of care. Trial Registration: ClinicalTrials.gov NCT04493580; https://clinicaltrials.gov/ct2/show/NCT04493580
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In other clinical samples than autistic adults, previous findings suggest that DBT may have a significant positive effect on some (i.e., "Strategies" and "Goals") or all of the DERS subscales.
“In other clinical samples than autistic adults, previous findings suggest that DBT may have a significant positive effect on some (i.e., “Strategies” and “Goals”) or all of the DERS subscales (e.g. Gibson et al., 2014; Neacsiu et al., 2014; Alavi et al., 2021).”
From Feasibility, Acceptability and Preliminary Efficacy of Dialectical Behavior Therapy for Autistic Adults without Intellectual Disability: A Mixed Methods Study (2022) · cites this paper as Alavi et al., 2021
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- Authors
- Alavi, N., Stephenson, C., & Rivera, M.
- Affiliations
- Queen's University (CA)
- Corresponding author
- Alavi, Nazanin
- Venue
- JMIR Mental Health
- Publisher
- JMIR Publications Inc.
- Published
- 2021-04-30
- Volume
- 8
- Issue
- 4
- Pages
- e27308
- ISSN
- 2368-7959 (ISSN-L)
- PMC
- PMC8122286
- OpenAlex
- W3135445184
- Cited by
- 24
- References
- 24
- Citations by year
- 2025: 7 · 2024: 6 · 2023: 6 · 2022: 4 · 2021: 1
- FWCI
- 2.90
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR Mental Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Queen's University
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- dialectical behavior therapy, borderline personality disorder, online therapy, emotion regulation, treatment accessibility, homework feedback, self-assessment questionnaire, Difficulties in Emotion Regulation Scale
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