Symposia
Personality Disorders
Amanda A. Uliaszek, Ph.D.
Associate Professor
University of Toronto
Toronto, Ontario, Canada
Judith Levy-Ajzenkopf, PhD
Psychologist
Centre for Addiction and mental health
Toronto, Ontario, Canada
Nathan Kolla, MD
Psychiatrist and researcher
Centre for Addiction and mental health
Toronto, Ontario, Canada
Ryan Klein, MD
Psychiatrist
Centre for Addiction and Mental Health
Toronto, Ontario, Canada
Dialectical behavior therapy (DBT), which includes individual plus group therapy, has demonstrated efficacy in individuals with borderline personality disorder (BPD) and those experiencing suicidality. While previous research also supports its efficacy in transdiagnostic populations, further research is needed to explore mechanisms of change within these populations. In addition, recent research focused on dosage of DBT for BPD samples provides support for the reduction of standard DBT implementation timelines, however little research examining dosage has been done in transdiagnostic populations. The present study capitalizes on a three-track DBT program implemented in a hospital-based, tertiary care setting, treating a high-risk, transdiagnostic population in a 12-week day treatment program. In this case, dosage is not a function of time, but instead a function of intensity of treatment operationalized by both frequency of weekly DBT skills groups and the provision of individual DBT sessions versus biweekly therapy in the community. Here we examine a DBT-specific treatment mechanism (DBT skills use as assessed by the DBT Ways of Coping Checklist), as well as a non-specific treatment mechanism (therapeutic alliance as assessed by the Working Alliance Inventory), as mechanisms of change in affecting outcomes in symptomatology (Outpatient Questionnaire-45), general functioning (WHO Disability Assessment Schedule), and suicidal ideation (Beck Scale for Suicidal Ideation). We hypothesized that 1) an increase in DBT skills will mediate the change in outcomes, with the high intensity track showing the greatest changes in coping due to the high severity at baseline combined with the increased dosage of DBT and 2) that therapeutic alliance will mediate change in outcomes with no differential effect across tracks. Participants were all patients admitted to the program who consented to participate in research (n = 100). They completed a large questionnaire battery pretreatment, midtreatment, posttreatment, and 8-week follow-up. Initial results on the first 80 participants (blinded from clinical staff) demonstrate significant improvements in all variables from baseline to posttreatment, with no significant differences on any variable across tracks. This study, which has been preregistered, has the potential to influence triage and treatment planning decisions in real-world settings.