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 [ NCCMH (2009) . 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.
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ERGT had not been evaluated outside a research setting prior to this study.
“However, it has not been evaluated outside a research setting.”
From Emotion regulation group therapy for deliberate self-harm: A multi-site evaluation in routine care using an uncontrolled open trial design (2017) · cites this paper as [17]
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Torgersen, S. O. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg06 · Cited by 1 · see citing works
Chapter 13. Dialectical Behavior Therapy
Stanley, B., Brodsky, B. S., & Gratch, I. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg13 · Cited by 2 · see citing works
Chapter 3. Articulating a Core Dimension of Personality Pathology
Morey, L. C., & Bender, D. S. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg03 · Cited by 1 · see citing works
Chugani, C. D. (2015) · Digital Commons - University of South Florida (University of South Florida) · Cited by 1 · see citing works
Dorsey, S., Pullmann, M. D., Kerns, S. E. U., Deblinger, E., Lucid, L., Harrison, J. P., Thompson, K., & Berliner, L. (2018) · Implementation Science · doi:10.1186/s13012-018-0715-z · Cited by 2 · see citing works
Miga, E. M., LoTempio, E. R., Michonski, J. D., & Hunter, D. A. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-816384-9.00004-x · Cited by 1 · see citing works
Bonfà, F., Cabrini, S., Draisci, A., Limonta, G., Spotti, R., & Uber, E. (2014) · RIVISTA SPERIMENTALE DI FRENIATRIA · doi:10.3280/rsf2014-003012
Walsh, C. (2015) · University of Limerick Institutional Repository (University of Limerick) · doi:10.34961/8047
(2013) · Current Opinion in Allergy and Clinical Immunology · doi:10.1097/aci.0b013e3283619e49
Sanza, M., Campa, J., & Barone, L. (2023) · PSICOBIETTIVO · doi:10.3280/psob2023-002004
Aunon, F. M., Carretta, R. F., Lovell, J., Wolkowicz, N. R., & Decker, S. E. (2024) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2024.01.003
Joyce, M., Kells, M., Flynn, D., Wall, S., Boylan, E., & Dunne, L. (2024) · Irish Journal of Psychological Medicine · doi:10.1017/ipm.2024.1
Decker, S. E., Kroll-Desrosiers, A., Mattocks, K., Aunon, F. M., Galliford, E., Doran, N., Baird, S., Rielage, J. K., Ridley, J., Bannister, J., et al. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1495102
Chapter 5. Manifestations, Assessment, Diagnosis, and Differential Diagnosis
Skodol, A. E. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg05
Chapter 4. The Alternative DSM-5 Model for Personality Disorders
Skodol, A. E., Bender, D. S., & Oldham, J. M. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg04
Chapter 22. Antisocial Personality Disorder and Other Antisocial Behavior
Black, D. W., & Blum, N. S. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg22
Chapter 12. Psychodynamic Psychotherapies
Yeomans, F. E., Clarkin, J. F., & Levy, K. N. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg12
Gutheil, T. G. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg19
Chapter 20. Assessing and Managing Suicide Risk
Links, P. S., Boursiquot, P., & Links, M. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg20
Choi-Kain, L. W., & Hersh, R. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg15
Chapter 14. Cognitive-Behavioral Therapy
Fowler, J. C., Orme, W. H., & Hart, J. M. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg14
Chapter 2. Theories of Personality and Personality Disorders
Westen, D., & Heim, A. K. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg02
Chapter 11. Therapeutic Alliance
Bender, D. S. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg11
Chapter 8. Genetics and Neurobiology
Fred-Torres, S., Pérez-Rodríguez, M. M., New, A. S., Rosell, D. R., & Koenigsberg, H. W. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg08
Chapter 23. Personality Disorders in the Medical Setting
Nash, S. S., Sotsky, J., Hicks, C., & Muskin, P. R. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg23
Chapter 17. Pharmacological Management
Nelson, K. J., & Tsheringla, S. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg17
Chapter 1. Personality Disorders: Recent History and New Directions
Oldham, J. M. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg01
Chapter 16. Group, Family, and Couples Therapies
Ogrodniczuk, J. S., Uliaszek, A. A., Lebow, J. L., & Kealy, D. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg16
Chapter 18. Collaborative Treatment
Winkeller, V., & Schlesinger, A. B. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379699.lg18
- Authors
- Swales, M. A., Taylor, B., & Hibbs, R. A. B.
- Affiliations
- Bangor University (GB)
- Corresponding author
- Swales, Michaela Anne
- Venue
- Journal of Mental Health
- Publisher
- Informa UK Limited
- Published
- 2012-09-07
- Volume
- 21
- Issue
- 6
- Pages
- 548-555
- ISSN
- 0963-8237 (ISSN-L)
- 1360-0567
- OpenAlex
- W2161394252
- Cited by
- 112
- References
- 31
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 4 · 2023: 7 · 2022: 2 · 2021: 39 · 2020: 8 · 2019: 5 · 2018: 11 · 2017: 5 · 2016: 5 · 2015: 7 · 2014: 5 · 2013: 3
- FWCI
- 5.43
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Mental Health (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Department of Biotechnology, Ministry of Science and Technology, India
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- dialectical behavior therapy, borderline personality disorder, self-harm, program sustainability, implementation barriers, organizational support, employee turnover, routine clinical practice, evidence-based interventions
- MeSH terms
- Behavior Therapy, Borderline Personality Disorder, United Kingdom, Humans, Mental Health Services, Prospective Studies, Program Evaluation, Survival Analysis, Self-Injurious Behavior, Treatment Outcome
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