The Dialectical Behavior Therapy Adherence Coding Scale (DBT ACS): Psychometric properties.

Abstract

The Dialectical Behavior Therapy Adherence Coding Scale (DBT ACS) is an observer-rated measure used to evaluate the extent to which therapists deliver individual and group DBT with adherence to the manual. Despite its frequent use in clinical trials of DBT, relatively little is known about its psychometric properties. The present study utilized data from six clinical trials conducted in research and community settings with a variety of patient populations. Across these studies, the DBT ACS was used to code a total of 1,271 DBT individual therapy sessions and 180 DBT group sessions. Results indicate the DBT ACS computed global score has good internal consistency (α = .81) and excellent interrater reliability (ICC = .93). A confirmatory factor analysis found that a single factor yielded acceptable goodness of fit indices. The DBT ACS discriminated between DBT and another treatment and between research and community therapists. Across studies, variability in adherence scores was attributable more to therapists (33%) than to patients (15%). Both therapist and patient variability were higher in effectiveness than efficacy trials. Generalizability coefficients indicated that 5 sessions are needed to estimate a dependable adherence score at the patient level, whereas 9-15 sessions are needed to achieve adequate generalizability at the therapist level. Fewer sessions were needed to yield dependable scores for community therapists compared to research therapists. The DBT ACS appears to be a reliable, valid, and dependable method of assessing therapist adherence to individual and group DBT across diverse treatment settings, therapist types, and patient populations. Public Significance StatementDialectical Behavior Therapy (DBT) is an evidence-based psychotherapy for individuals at high risk for suicide as well as those with borderline personality disorder. This study shows that the Dialectical Behavior Therapy Adherence Coding Scale is an effective measure for determining whether therapists deliver DBT according to the manual.

Applying new RDoC dimensions to the development of emotion regulation: Examining the influence of maternal emotion regulation on within-individual change in child emotion regulation

“…The current study focuses on participants enrolled prior to the global pandemic (i.e., between October 2017 and January 2020). (Harned, Korslund, Schmidt, & Gallop, 2021) was used to code randomly selected DBT skills group sessions for adherence and all scored sessions were deemed adherent. Participants randomized to the DBT condition completed, on average, 30 weekly sessions over the course of a year (63% of the 48-week treatment protocol), consistent with treatment compliance in seminal RCTs demonstrating the efficacy of DBT (Linehan et al, 2006;Lynch, Trost, Salsman, & Linehan, 2007).…”

Towards optimal treatment selection for borderline personality disorder patients (BOOTS): a study protocol for a multicenter randomized clinical trial comparing schema therapy and dialectical behavior therapy

“…In case of emergency, the standard emergency procedures of each center will be followed. Although outside of office hours availability is considered to be an essential element of DBT by some authors [ 113 , 234 ], the link between telephone consultation and outcome in DBT has not been evaluated [ 95 , 235 ]. There is some preliminary support for the importance of telephone consultation [ 236 ].…”

“…The absence of competence ratings may threaten the validity of our results [ 109 ]. Moreover, treatment adherence will be assessed by trained master psychology students, whereas for DBT, adherence ratings by reliably trained therapists are considered the gold standard [ 240 , 241 ]. However, students will receive a training from experienced therapists.…”

“…Individual ST sessions will be rated on an adapted version of the Therapy Adherence and Competence scale for ST for BPD [ 111 ] and group ST sessions will be rated on the Group Schema Therapy Rating Scale – Revised [ 112 ]. Individual DBT sessions will be rated on the Dutch translation of the observer-rated version of the DBT Adherence Checklist for Individual Therapy [ 113 ]. An observer-rated instrument will be developed to assess the skills training groups.…”

The temporal relationships between therapist adherence and patient outcomes in dialectical behavior therapy.

“…Finally, in an RCT of DBT for women with BPD, posttraumatic stress disorder (PTSD), and recent SIB, Harned et al (2014) found that lower therapist adherence was related to patients requesting to be reassigned to a new therapist. Of note, these studies were comprised of relatively small samples ( n ’s = 7–26) and only one study (Harned et al, 2014) used the DBT Adherence Coding Scale (DBT ACS; Linehan & Korslund, 2003), the only measure that has been found to be reliable and valid in assessing adherence to DBT (Harned, Korslund, et al, 2021).…”