Getting DBT online down under: The experience of Australian and New Zealand Dialectical Behaviour Therapy programmes during the Covid-19 pandemic

Abstract

Dialectical Behaviour Therapy (DBT) is an intensive and multi-modal intervention developed for individuals with multiple comorbidities and high-risk behaviours. During pandemic-related lockdowns, many DBT services transitioned to delivering treatment via telehealth, but some did not. The current study sought to explore the experience of DBT teams in Australia and New Zealand who did and did not transition to telehealth during the early stages of the COVID19 pandemic, as the majority of research on DBT via telehealth has originated from North America, and focussed on therapists who did make this transition. DBT team leaders in Australia and New Zealand completed a survey with open-ended questions about the barriers they encountered to delivering DBT via telehealth, and for those teams that implemented telehealth, the solutions to those barriers. Respondents were also asked about specific barriers encountered by Indigenous and Pacific people service users. Of the 73 team leaders who took part, 56 reported providing either individual therapy, skills training or both modalities via video-call during lockdown. Themes emerging from perceived barriers affecting just DBT providers included the assessment & management of emotions and high-risk behaviours, threats to privacy and information security posed by telehealth, logistical issues related to remote sessions, and the remote management of therapy-interfering behaviour. Themes emerging from perceived barriers affecting both providers and service users included disruptions to therapeutic alliance, lack of willingness, lack of technical knowledge, lack of private spaces to do DBT via telehealth, and lack of resources. The solutions most frequently cited were the provision of education and training for therapists and service users in the use of telehealth, and the provision of resources to access telehealth. These findings are relevant to clinical delivery of DBT, as well as planning and funding for DBT telehealth services.

Engagement over telehealth: Comparing attendance and drop-out between Dialectical Behaviour Therapy delivered face-to-face and via telehealth for programs in Australia and New Zealand during the Covid-19 pandemic

“…Teams had not previously delivered DBT skills training via telehealth. Many clinicians were apprehensive about delivering DBT via telehealth and were resistant to change, which may have impacted on their enthusiasm and the quality of the treatment being provided (27,45). Some research has shown that clinicians have expressed a preference for face-to-face treatment delivery (3) and a reluctance to use telehealth for a number of reasons (8).…”

“…We invited leaders of comprehensive DBT programs across Australia and New Zealand who had pivoted to telehealth during the lockdown associated with the Covid-19 pandemic to provide de-identi ed clinic data of attendance and drop-out retrospectively. These were a subgroup of the respondents from an earlier study on the experience of providing DBT via telehealth, which provides further information about the methodology (27). Team leaders of programs who had provided individual and skills training groups prior to the Covid-19 lockdowns and during the lockdown offered group skills training via videoconference telehealth and individual therapy (in either modality of face-to-face or telehealth) were asked at the end of the online survey if they were willing to be contacted regarding a further study.…”

“…These papers report qualitative data on lessons learned in transitioning DBT to telehealth and how services and clinicians overcame (or didn't overcome) barriers (25,26,27). These published papers on 'lessons learned' call for empirical evaluation of the e cacy and effectiveness of DBT delivered via telehealth (25,26,27). In summary, currently, the published research on DBT delivered via telehealth is largely limited to clinician feedback in qualitative studies.…”

“…In addition, there is published research from survey results from clinicians and programs that had transitioned to delivery via telehealth. These papers report qualitative data on lessons learned in transitioning DBT to telehealth and how services and clinicians overcame (or didn't overcome) barriers (25,26,27). These published papers on 'lessons learned' call for empirical evaluation of the e cacy and effectiveness of DBT delivered via telehealth (25,26,27).…”

“…Research investigating digital access for First Nations' peoples is limited (38), however in both Australia and New Zealand First Nations' people experience signi cant health and economic disparities (39). In recently published research regarding barriers to engaging in DBT via telehealth (27), the most frequently reported barrier identi ed by DBT team leaders for First Nations' peoples was lack of access to resources and privacy.…”