Cited by 112Personality Disorders and PsychopathologyHealth Policy Implementation SciencePsychiatric care and mental health services

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Implementing Dialectical Behaviour Therapy: Programme survival in routine healthcare settings

Swales, Michaela Anne, Taylor, Beverley, Hibbs, Richard A. B.·2012·Journal of Mental Health

DOI 10.3109/09638237.2012.689435

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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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Front Matter
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Chapter 5. Manifestations, Assessment, Diagnosis, and Differential Diagnosis
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Chapter 4. The Alternative DSM-5 Model for Personality Disorders
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Appendix. Alternative DSM-5 Model for Personality Disorders
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Chapter 22. Antisocial Personality Disorder and Other Antisocial Behavior
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Chapter 12. Psychodynamic Psychotherapies
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Index
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Chapter 19. Boundary Issues
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Chapter 20. Assessing and Managing Suicide Risk
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Chapter 15. Good Psychiatric Management: Generalist Treatments and Stepped Care for Borderline Personality Disorder
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Chapter 14. Cognitive-Behavioral Therapy
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Chapter 2. Theories of Personality and Personality Disorders
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Chapter 11. Therapeutic Alliance
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Chapter 8. Genetics and Neurobiology
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Chapter 23. Personality Disorders in the Medical Setting
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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
ORCID: 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
DOI: 10.3109/09638237.2012.689435
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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Implementing Dialectical Behaviour Therapy: Programme survival in routine healthcare settings

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