Teaching Dialectical Behavior Therapy to Psychiatry Residents: The Columbia Psychiatry Residency DBT Curriculum

Abstract

Objective Dialectical Behavior Therapy (DBT) is an evidence-based psychosocial treatment with efficacy in reducing self-harm behaviors in borderline personality disorder (BPD). This study describes and evaluates a clinical curriculum to teach DBT to psychiatry residents, developed at a large urban university hospital. The curriculum objectives are to: 1) have psychiatry residents achieve basic understanding of DBT theory and clinical skill, 2) increase residents’ ability and confidence in treating self-harm behaviors (both suicidal behavior and non-suicidal self-injury) and 3) enhance residents’ willingness to treat individuals with BPD. Methods In addition to a six-week didactic course on DBT offered to all residents (n=62), 25 elected to enroll in a year-long DBT clinical training curriculum over the course of a five-year period. The DBT clinical training consisted of 15 hours of additional didactics, ongoing conduct of individual therapy and group DBT skills training, videotaping of individual therapy sessions, and weekly supervision meetings utilizing videotape to provide feedback. Residents participating in the clinical training program videotaped baseline and later sessions, which were rated for DBT adherence. All 62 graduates of the program were surveyed regarding the impact of the training on their practice of psychiatry. Results Upon graduation, a high percentage (87% in the curriculum and 70% in the didactic course only) reported incorporating DBT into their psychiatry practice, and willingness and confidence in treating BPD and self-harm behaviors. Residents participating in the clinical training demonstrated significant improvement in their ability to utilize DBT interventions, particularly in structuring sessions, problem assessment, problem solving, and using validation and dialectical strategies. Conclusion This DBT curriculum was effective in preparing psychiatrists-in-training to incorporate evidence-based practices for effective treatment of BPD and self-harm behaviors, and can serve as a model for teaching DBT during psychiatry residency training. Limitations include a small sample size and lack of baseline survey measurement of attitudes for pre and post curriculum comparison.

Initiating a DBT consultation team: Conceptual and practical considerations for training clinics.

“…Previous research on DBT training indicates that didactic training is necessary but not sufficient to train new DBT clinicians to be highly proficient in clinical practice with high-risk clients and that experiential learning is a key component of skill acquisition (Brodsky, Cabaniss, Arbuckle, Oquendo, & Stanley, 2017; Dimeff et al, 2015; Dimeff et al, 2009). Although recent work indicates that it is possible for trainees using the full model to successfully deliver DBT to individuals with BPD (Rizvi et al, 2017), comparatively little research has focused on the value of initiating and maintaining a consultation team for new DBT clinicians.…”

Dialectical behavior therapy.

“…Promisingly, an early study conducted by Hawkins and Sinha (1998) found that frontline clinicians from diverse backgrounds (e.g., social work, psychology, medical fields) demonstrated acquisition of mastery in DBT through a community mental health setting. Since that time, research has found further support for the training of medical residents in DBT, as well as evidence for positive training outcomes when using tech-based trainings for DBT (Brodsky et al, 2017).…”

Capacitación no escolarizada en psicoterapia: problemas y perspectivas.

“…Así, en los Estados Unidos, la Accreditation Council on Graduate Medical Education sugiere la enseñanza de terapia de soporte, terapia psicodinámica y terapia cognitivo-conductual (30) ; y, en Canadá, el Royal College of Physicians and Surgeons propone la capacitación de estas mismas psicoterapias, y adicionalmente en terapia comportamental, terapia dialéctica-conductual y terapia interpersonal, entre otras (31,32) . Algunos programas de residentado incluyen también la enseñanza de otras psicoterapias basadas en evidencias (33) . Este modelo de enseñanza permite el desarrollo de un enfoque ecléctico en los residentes, en lugar de que privilegien rígidamente una sola forma de psicoterapia.…”