Internet-Delivered Dialectical Behavioral Therapy Skills Training for Suicidal and Heavy Episodic Drinkers: Protocol and Preliminary Results of a Randomized Controlled Trial

Abstract

BackgroundThe need to develop effective and accessible interventions for suicidal individuals engaging in heavy episodic drinking (HED) cannot be understated. While the link between alcohol use and suicidality is a complex one that remains to be elucidated, emotion dysregulation may play a key role in alcohol-related suicide risk in these individuals.ObjectiveIn the current study, an 8-week Internet-delivered dialectical behavior therapy (DBT) skills training intervention was developed and preliminarily evaluated for suicidal individuals who engage in HED to regulate emotions. The aim of the study is to evaluate the feasibility and effectiveness of the therapist-assisted and Internet-delivered intervention, and to inform the design of a subsequent full-scale study.MethodsThe study was a pilot randomized controlled trial comparing participants receiving immediate-treatment (n=30) to waitlist controls (n=29) over a period of 16 weeks. Intervention effects will be assessed longitudinally using hierarchical linear modeling and generalized estimating equations, along with analyses of effect sizes and clinically significant change. The primary outcomes are suicidal ideation, alcohol problems, and emotion dysregulation. Secondary outcomes include alcohol-related consequences, reasons for living, skills use, and depression.ResultsThe trial is ongoing. A total of 60 individuals returned their informed consent and were randomized, of whom 59 individuals were intended to treat. A total of 50 participants in the study were retained through the 16-week enrollment.ConclusionsThere is a dearth of evidence-based treatment for individuals presenting with high risk and complex behaviors. Furthermore, computerized interventions may provide a beneficial alternative to traditional therapies. The particular clinical features and treatment needs of suicidal individuals who also engage in HED constitute key domains for further investigation that are needed to consolidate the design of appropriate interventions for this high-risk population.Trial RegistrationClinicaltrials.gov NCT02932241; https://clinicaltrials.gov/ct2/show/NCT02932241 (Archived by WebCite at http://www.webcitation.org/6uJHdQsC2)

The effectiveness of telepsychology with veterans: A meta-analysis of services delivered by videoconference and phone.

“…A growing number of studies have examined this question with some studies finding that telepsychology is effective and equivalent to services delivered FTF, whereas other studies have found mixed results (Turgoose et al, 2018 [videoconferencing and phone]). Telepsychology has generally been found to be an effective treatment delivery method for common mental health conditions experienced by veterans (Bolton & Dorstyn, 2015 [videoconferencing]; Turgoose et al, 2018 [videoconferencing and phone]) including the following: PTSD and other trauma and stressor-related disorders (Wierwille et al, 2016 [videoconferencing]), anxiety (Burke et al, 2019 [internet-delivered]; Yuen et al, 2013 [videoconferencing]), depression (Sztein et al, 2018 [internet-only]), intermittent explosive disorder (Osma et al, 2016 [videoconferencing]), substance use disorders (Wilks et al, 2017 [internet-only]), etc.…”

Towards online delivery of Dialectical Behaviour Therapy: A scoping review

“…After each skill was introduced, they were presented with key points, followed by computer guided practice, and the selection of homework tasks. Participants were sent their chosen homework assignments by email and sent encouraging text messages or emails each day (Wilks et al 2017(Wilks et al , 2018. Wilks et al (2020;p.…”

“…The earliest reported trial of a therapist guided DBT intervention was a pilot study by Wilks et al (2017;Wilks et al 2018). Participants with a history of binge drinking in the past month, and with high score on the brief version of the Difficulties in Emotion Regulation Scale (DERS) (Bjureberg et al 2016) were recruited via advertisement into an 8-week therapist assisted online skills group or a waitlist control group.…”

Lessons Learned Conducting Dialectical Behavior Therapy via Telehealth in the Age of COVID-19

“…Yet, there has been limited research on the provision of DBT via telehealth. An 8-week form of internet-delivered skills training (iDBT-ST) delivered via videos and interactive tools instead of involving real-time communication with a provider delivering the skills in an interactive way ( Wilks et al, 2017 , Wilks et al, 2018 ) showed promise in reducing suicidal ideation, alcohol consumption, and emotion dysregulation. However, this relatively new intervention is not yet widely used by DBT providers ( Lungu et al, 2019 ) and, further, is not meant to encompass the full model of DBT.…”