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A Pilot Study of the DBT Coach: An Interactive Mobile Phone Application for Individuals With Borderline Personality Disorder and Substance Use Disorder

School of Applied and Professional Psychology, Rutgers University, Piscataway, NJ 08854, USA.
Behavior therapy (Impact Factor: 2.85). 12/2011; 42(4):589-600. DOI: 10.1016/j.beth.2011.01.003
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ABSTRACT Dialectical behavior therapy (DBT) has received strong empirical support and is practiced widely as a treatment for borderline personality disorder (BPD) and BPD with comorbid substance use disorders (BPD-SUD). Therapeutic success in DBT requires that individuals generalize newly acquired skills to their natural environment. However, there have been only a limited number of options available to achieve this end. The primary goal of this research was to develop and test the feasibility of the DBT Coach, a software application for a smartphone, designed specifically to enhance generalization of a specific DBT skill (opposite action) among individuals with BPD-SUD. We conducted a quasiexperimental study in which 22 individuals who were enrolled in DBT treatment programs received a smartphone with the DBT Coach for 10 to 14 days and were instructed to use it as needed. Participants used the DBT Coach an average of nearly 15 times and gave high ratings of helpfulness and usability. Results indicate that both emotion intensity and urges to use substances significantly decreased within each coaching session. Furthermore, over the trial period, participants reported a decrease in depression and general distress. Mobile technology offering in vivo skills coaching may be a useful tool for reducing urges to use substances and engage in other maladaptive behavior by directly teaching and coaching in alternative, adaptive coping behavior.

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    • "For example, an app can utilize the geolocation categorization of 'risk' areas for substance abusers followed by reminder 'warnings' when near these areas in which contact with a therapist or coach is then initiated (Vahabzadeh, Mezghanni, Lin, Epstein, & Preston, 2010). Recently, Rizvi et al. (2011) described an app called 'DBT Field Coach' that provided instructions, exercises, reminders and other components to help borderline patients cope with emotional crises (e.g., access to video/audio messages from the individual's therapist, games designed to distract from intense emotions and motivational images). Results of their study suggested that the application was used when needed, reduced intense emotions, reduced substance use cravings and assisted in improving symptoms of depression and distress during the treatment period. "
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    • "Regardless of the causes, smartphones have a vast potential to improve mental healthcare (see Clough and Casey 2011) and emerging evidence suggests that using apps in care is acceptable to patients and may increase engagement in therapy and enhance outcomes. For example , Rizvi et al. (2011) reported that individuals with borderline personality disorder and substance use disorder who were undergoing dialectical behavior therapy (DBT) found DBT Coach, a companion app for the therapy, highly satisfying and helpful to use. The app was also found to increase participants' use of the specific DBT skill (i.e., opposite action) it supports, reduced acute distress and urges to use substances, and decreased symptoms of depression and other psychopathology. "
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