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[page 150] [Research in Psychotherapy: Psychopathology, Process and Outcome 2016; 19:219]
Research in Psychotherapy: Psychopathology, Process and Outcome 2016; volume 19:150-156
Introduction
There is growing literature examining the use of di-
alectical behavior therapy (DBT; Linehan, 1993a) in nu-
merous settings with a variety of patients (Panos, Jackson,
Hasan, & Panos, 2013). DBT was originally developed as
a one-year outpatient psychosocial treatment for individ-
uals with borderline personality disorder (BPD; American
Psychiatric Association, 2000; Simpson et al., 1998). Of-
ficial DBT programs include four main components: skills
group, individual therapy, crisis coaching and DBT con-
sultation team. The skills group is where patients work
through the four modules of DBT (i.e., core mindfulness,
distress tolerance, emotion regulation, and interpersonal
effectiveness) and are given handouts and worksheets for
structured homework of practicing skills among group
sessions (Linehan, 2014). These groups typically last 1.5
to 2.5 hours per week and are led by a facilitator and co-
facilitator. In addition, patients receive individual therapy
from a DBT-trained therapist who, among other respon-
sibilities, reinforces skills learned in group through appli-
cation to personal situations as identified using
self-monitoring forms (i.e., diary/skills cards) the patient
brings to each session (Linehan, 1993b).
Another component of DBT, a 24-hr crisis coaching
phone, can be accessed at any time the patient needs
coaching or help in a crisis situation to avoid engaging in
Evaluation of a dialectical behavior therapy-informed partial hospital
program: outcome data and exploratory analyses
John E. Lothes II,1Kirk D. Mochrie,2Emalee J.W. Quickel,3Jane St. John4
1Department of Psychology, University of North Carolina Wilmington, Wilmington, NC; 2Psychology
Department, East Carolina University, Greenville, NC; 3Psychology Department, Loyola University Maryland, Baltimore, MD;
4Delta Behavioral Health, Wilmington, NC, USA
ABSTRACT
The use of dialectical behavioral therapy (DBT) among a variety of programs and patients has recently exploded. Of particular interest
is the use of DBT in partial hospital (PH) programs due to the high number of severely ill and suicidal patients who participate in these
programs. Recently, Lothes, Mochrie and St. John (2014) examined data from a local DBT-informed PH program and found significant re-
ductions in depression, anxiety, hopelessness, and degree of suffering from intake to discharge. The present study examined these same
four symptom constructs by assessing intake and discharge data for additional individuals enrolled in this DBT-informed PH program. In
addition, lengths of stay and acuity ratings were analyzed to explore the relationship between these variables and symptom constructs. Sig-
nificant symptom reduction in depression, anxiety, hopelessness, and degree of suffering from intake to discharge was found among high
and medium acuity patients, replicating the results of Lothes et al. (2014). Further, individuals with the highest acuity saw the largest re-
duction in hopelessness symptoms the longer they participated in the program (i.e., a significant interaction effect between acuity and
length of stay). This is meaningful given the connection between hopelessness and suicidal ideation/action, which is of particular concern
for those charged with treating clinical populations. DBT-informed PH programs may be a cost-effective and useful way to treat high-risk
patients who come from inpatient facilities. Future studies may wish to create follow-up periods (i.e., 3 months, 6 months) post-discharge
to assess if symptom reduction remains.
Key words: Dialectical behavior therapy; Partial hospital; Symptom reduction.
Correspondence: John E. Lothes II, Department of Psychology,
University of North Carolina Wilmington, 601 S. College Rd.,
Wilmington, NC 28403, USA.
Tel: +1.910.962.3370 - Fax: +1.910.962.7010.
E-mail: lothesj@uncw.edu
Contributions: KDM conducted literature searches and provided
summaries of previous research studies as well as helped to design
the study. JLII and JSJ were the primary data collectors and wrote
the protocol. EJWQ significantly contributed to analyzing the data,
writing the results section, and editing the manuscript. All authors
have contributed to and have approved the final manuscript.
Conflict of interest: the authors declare no potential conflict of in-
terest.
Citation: Lothes, J.E.II, Mochrie, K.D., Quickel, E.J.W., & St.
John, J. (2016). Evaluation of a dialectical behavior therapy-in-
formed partial hospital program: outcome data and exploratory
analyses. Research in Psychotherapy: Psychopathology, Process
and Outcome, 19(2), 150-156. doi: 10.4081/ripppo.2016.219
Received for publication: 13 June 2016.
Accepted for publication: 5 October 2016.
This work is licensed under a Creative Commons Attribution Non-
Commercial 4.0 License (CC BY-NC 4.0).
©Copyright J.E. Lothes II et al., 2016
Licensee PAGEPress, Italy
Research in Psychotherapy:
Psychopathology, Process and Outcome 2016; 19:150-156
doi:10.4081/ripppo.2016.219
Non-commercial use only
[Research in Psychotherapy: Psychopathology, Process and Outcome 2016; 19:219] [page 151]
DBT-informed partial hospital program outcomes
the ineffective behaviors that resulted in referral to DBT
in the first place. The remaining component, the DBT con-
sultation team, sustains therapists in weekly meetings fa-
cilitating on-going personal practice of DBT by therapists,
providing a group mindfulness practice, supporting fi-
delity to the DBT model, and assisting therapists’ effec-
tiveness via discussions of therapist/patient treatment
interfering behaviors. Medical treatment is arranged as
needed but is not an identified component of DBT. Fully
implemented DBT programs have been shown to be ef-
fective in reducing suicidal behavior and emotion dysreg-
ulation for individuals with BPD (Linehan, 2014).
Interestingly, more recently DBT has been used to
treat a wide variety of disorders (Koerner, 2012) over
varying lengths of time (Lothes, Mochrie, & St. John,
2014). Of particular interest is the use of DBT in partial
hospital (PH) programs, which are used to help stabilize
patients after a brief inpatient stay, or as an alternative to
inpatient hospitalization (Neuhaus, 2006). PH programs
allow patients with high-risk behaviors, such as suicide
attempts, to transfer to a lower level of care after hospi-
talization. High-risk patients typically include those who
experience specific mental health disorders, such as BPD,
which are often accompanied by symptoms such as sui-
cidal ideation (Pompili, 2012).
The PH program model can be especially effective in
treating high-risk populations if effective treatment ap-
proaches are utilized. While there is a certain level of acu-
ity in terms of medical necessity (as defined by the third
party payers of each patient) that needs to be met to qual-
ify for enrollment in a PH program, very little research
has examined if acuity plays a role in how programs lead
to symptoms reduction in patients. Although not specifi-
cally identified as a component of PH programs, one ra-
tionale for these programs is to save money by reducing
future hospitalizations. In addition, PH programs can be
an opportunity for teaching patients coping skills that they
can utilize before stepping down to an intensive outpatient
program or to individual therapy, and these skills can con-
tribute to sustained stability at discharge, a strong strategy
with the potential to contribute to lowering inpatient re-
cidivism rates.
DBT may be particularly suited to PH programs due to
the high-risk patients that are typically treated in this set-
ting. Unfortunately, individuals with high-risk behaviors
have been poorly treated in the past; however, with the
emergence of DBT, therapists are better able to help reduce
these symptoms (Panos et al., 2013). DBT in a PH setting
requires an obviously modified schedule of skills delivery,
and a shortened duration of individual therapy; however,
all components of DBT are incorporated. DBT-informed
PH programs have provided preliminary evidence in reduc-
ing symptoms of anxiety and depression from intake to dis-
charge (Lothes et al., 2014); however, further research is
needed to confirm treatment outcome data. PH programs
are increasingly being required to measure treatment effec-
tiveness and patient outcomes for insurance coverage pur-
poses (Granello, Granello, & Lee, 1999; Bateman & Fon-
agy, 2003). Of particular concern is the time needed for
patients to be involved in a PH program (e.g. length of stay)
before significant symptom reduction can be found. Inter-
estingly, Bateman and Fonagy (2003) found that individu-
als who complete long-term (several months to 18 months)
PH programs use less inpatient services and have a higher
intensity and a longer duration of functional improvements
than those who seek other treatment or do not receive any
treatment. More recently, Lothes et al. (2014) conducted a
study assessing symptom reports from intake to discharge
with a sample of 38 patients enrolled in a DBT-informed
PH program. Results showed significant reductions from
intake to discharge in depression, anxiety, hopelessness,
and degree of suffering. Using DBT in PH program settings
can be effective in reducing symptoms of various mental
health disorders. To the best of our knowledge, no known
research exists that examines variables like length of stay
in the context of DBT-informed PH programs. In addition
to overall efficacy of these program models, indicators such
as length of stay that have an impact on funding and pro-
gram evaluation considerations must be examined concur-
rently. While there is a certain level of acuity in terms of
medical necessity that needs to be met to qualify for enroll-
ment into a partial hospital program, very little research has
examined if acuity plays a role in symptom reduction.
Further assessment of outcome data in DBT-informed
PH programs is needed due to the relatively novel inves-
tigation of this topic. For example, the question of what
length of time is needed to achieve symptom reduction in
this population still rears its head. In addition, very little
current research has been conducted assessing acuity rat-
ings in this population. Examining acuity could provide
useful data as to which patients are more likely to have
quicker symptom reduction and progress through the pro-
gram at a faster rate, thus allowing program directors to
make better recommendations to insurance companies
about the optimal program length of stay based on indi-
vidualized patient needs; alternatively, allowing patients
to stay in the program long enough for true change to
occur may prevent relapse and save money on future hos-
pitalizations and treatment.
Given these unknowns in the literature, the current
study has two specific aims. First, the present study aims
to replicate the previous study by Lothes et al. (2014) by
measuring levels of reported depression, anxiety, hope-
lessness and degree of suffering at intake and discharge
to assess the effectiveness of a DBT-informed PH pro-
gram in the southeast region of the United States. The
present study included individuals with broader diagnoses
(e.g., eating disorders, substance dependence, psychotic
disorders) to increase generalizability. In addition, the
sample size was substantially larger providing sufficiently
more power for more in depth statistical analyses. Second,
the present study aims to include analyses that consider
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[page 152] [Research in Psychotherapy: Psychopathology, Process and Outcome 2016; 19:219]
Article
the impact of patient acuity and length of stay on symp-
tom reduction. Understanding how these variables relate
to patient outcomes may inform decisions made regarding
treatment design and implementation, as well as policy
decisions related to funding and relapse prevention.
The PH program is the same program evaluated in the
first study by Lothes et al. (2014), which is an intensive
day treatment option for adults. Patients meet 5 days per
week, for 4 hours each day. During this time they are en-
gaged in a curriculum based on Linehan’s (1993b) DBT
manual with in-depth skills training. The program has re-
cently begun to implement Linehan’s (2014) new DBT
Skills Training Manual into practice; however, the partic-
ipants for this analysis were still being taught with the pre-
vious manual. Treatment includes skills training in
mindfulness, emotion regulation, distress tolerance, and
interpersonal effectiveness, a morning check in process
group, individual therapy, 24-hour coaching phone con-
sultations, DBT team staff meetings, medication manage-
ment, and psychiatric care. All individuals running the
DBT treatment team have attended intensive Behavioral
Tech DBT trainings and interns who conducted skills
training were required to do a semester practicum of clin-
ical training on DBT at the program facility. The skills
modules were rotated through each week so that partici-
pants would be able to receive all four modules over the
course of six weeks. The present study attempts to assess
a number of constructs by examining intake and discharge
data based on length of stay and acuity ratings for indi-
viduals enrolled in this DBT-informed PH program.
First, we hypothesized that the results would replicate
those of the first study by Lothes et al. (2014) by showing
significant decreases in depression, anxiety, hopelessness,
and degree of suffering scores from intake to discharge;
to extend this analysis, we were also interested in exam-
ining the whether the program would be effective at re-
ducing symptoms for individuals with differing levels of
acuity at intake. Second, it was hypothesized that acuity
and length of stay in the program would have an interac-
tion effect on symptom reduction. Specifically, individu-
als with higher acuity ratings entering treatment that also
stayed longer in the program would have the greatest de-
gree of symptom reduction.
Materials and Methods
Participants
Participants included 113 adults, ages 18-73 [mean
(M)=38.05, standard deviation (SD)=12.90]. The sample
was predominantly female (N=84, 74.34%) and Cau-
casian (N=94, 84.07%), and was comprised of patients
who were evaluated for medical necessity for needing a
higher level of care than an intensive outpatient program
or continued individual outpatient therapy at intake and
at discharge. Participants were diagnosed based on a clin-
ical interview, assessment measures [i.e., Beck depression
inventory II (BDI-II), Beck anxiety inventory (BAI), Beck
hopelessness scale (BHS)] and review of medical records.
Table 1 presents demographic characteristics, including
diagnoses assigned according to DSM-IV-TR criteria
(American Psychiatric Association, 2000). Participants
did not receive compensation for participation.
Depression
The BDI-II (Beck, Ward, Mendelson, Moch, & Er-
baugh, 1961) was used to assess self-report ratings of de-
pression at intake and discharge. The BDI-II is a 21-item
measure; items contain a list of statements and the partic-
ipant selects the statement that best describes them. For
each item, statements range from those that indicate no
depressive symptoms (i.e., I do not feel sad), which would
receive a code of 0, to those that indicate severe depres-
sive symptoms (i.e., I am so sad and unhappy that I can’t
stand it), which would receive a code of 3. The BDI
ranges from 0-13 (minimal), 14-19 (mild), 20-28 (mod-
erate) and 29+ (severe). The BDI is reliable and valid for
use in general adult populations (Richter, Werner, Heer-
lein, Kraus, & Sauer, 1998), as well as psychiatric popu-
lations (Beck, 1988; Beck, Steer, & Garbin, 1988).
Anxiety
The Burns anxiety inventory (BAI; Burns, 1999) was
used to assess self-report ratings of anxiety at intake and
discharge. The BAI is a 33-item measure; answer choices
for each item range from 0 (Not at all) to 3 (A lot). The
BAI ranges from 0-20 (mild), through 21-30 (moderate),
to 31+ (severe).
Table 1. Demographic information (n=113).
M SD
Age (years) 38.05 12.90
N %
Gender Male 29 25.66
Female 84 74.34
Race Caucasian 95 84.07
African American 14 12.39
Hispanic 2 1.77
Native American 1 0.88
Other 1 0.88
DSM-IV-TR diagnosis
Major depressive disorder 67 59.29
Bipolar disorders 35 30.97
Anxiety disorders 3 2.66
Substance dependence 3 2.66
Psychotic disorders 3 2.66
Eating disorders 2 1.77
M, mean; SD, standard deviation; DSM-IV-TR, diagnostic and statistical manual of mental
disorders-fourth edition-TR.
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DBT-informed partial hospital program outcomes
Hopelessness
The Beck hopelessness scale (BHS; Beck, 1988) was
used to assess self-report levels of hopelessness at intake
and discharge and is considered reliable and valid (Owen,
1992). The BHS is a 20-item true/false measure; items in-
clude statements regarding attitudes about the future (i.e.,
I look forward to the future with hope and enthusiasm).
The BHS ranges from 0-3 (minimal), through 4-8 (mild),
9-14 (moderate), to 15+ (severe).
Suffering
Self-report degrees of suffering scores were collected
on a one-item Likert scale ranging from 0 (No suffering
at all) to 10 (Worst suffering ever) at intake and discharge.
Acuity
Participants were also given an acuity rating for over-
all impairment at intake based on their scores on the BDI-
II, BAI, and BHS by assigning points from all three
measures according to each scale’s criteria of low (scoring
minimal or mild on BDI, BAI and BHS scales), moderate
(scoring moderate on BDI, BAI and BHS scales), and
high ratings (scoring severe on BDI, BAI, and BHS
scales). If someone scored in the minimal range they re-
ceived a 1, in the moderate range they received a 2, and
in the severe range they received a 3. This produced both
a continuous (i.e., ranging from 3-9) and a categorical
(i.e., low, medium or high) rating of patient acuity.
Length of stay
Length of stay was measured by total number of days
in the program, consistent with previous research
(Jiménez, Lam, Marot, & Delgado, 2004).
Procedure
All patients who came into the PH program were
asked to complete the BDI-II, BAI, BHS and reported
their degree of suffering as part of the initial intake
process. These measures were used as part of the intake
process to assess for medical necessity into the PH pro-
gram. Patients who did not meet medical necessity for the
PH program were referred to the appropriate source; often
an individual therapist or other appropriate community re-
sources. Information on referrals was not collected. Pa-
tients also filled out the BDI-II, BAI, BHS, and
self-reported degree of suffering at discharge. This infor-
mation was used initially to help re-assess for medical ne-
cessity or to help patients step-down to a more appropriate
program, such as intensive outpatient therapy or to weekly
DBT skills groups supplemented with individual therapy.
The researchers later examined this information as an
exploratory study approved by the Institutional Review
Board at the University of North Carolina, Wilmington,
NC. Since this data was not originally collected as part of
the research design, there was no data collected for patients
that did not meet medical necessity for the PH program.
Results
Results replicated the first study conducted by Lothes
et al. (2014). See Table 2 for average symptom raw scores
at intake and discharge. Raw scores are displayed to pro-
vide the greatest degree of clinical utility to practitioners.
At intake, average depression, anxiety, and hopelessness
scores for this sample fell in the severe, severe, and mod-
erate ranges, respectively; at discharge, average depres-
sion, anxiety, and hopelessness scores for this sample fell
in the mild, moderate, and mild ranges, respectively. A se-
ries of paired samples t-tests demonstrated significant
changes in symptom reports for all four dependent vari-
ables: depression [t(112)=13.47, P<.001, 95% confidence
interval (CI) (15.65, 21.04)]; anxiety [t(112)=11.00,
P<.001, 95% CI (19.21, 27.65)]; hopelessness [t
(112)=11.85, P<.001, 95% CI (5.13, 7.19)]; and suffering
[t(112)=12.91, P<.001, 95% CI (2.98, 4.06)] (Figure 1).
The next goal of the current research was to see if the
program was differentially effective for patients at differ-
ent acuity levels. The program was effective at decreasing
all four symptoms categories in high and medium acuity
patients. According to a series of paired samples t-tests
conducted with all high acuity clients (N=82), depression
scores significantly decreased by 22.62 (SD=13.56) points
on average [t(81)=15.10, P<.001, 95% CI (19.64,
25.60)]; anxiety scores significantly decreased by 28.27
(SD=22.21) points on average [t(81)=11.46, P<.001,
95% CI (22.60, 32.11)]; hopelessness scores significantly
decreased by 7.61 (SD=5.27) points on average [t
(81)=13.09, P<.001, 95% CI (6.45, 8.77)]; and suffering
scores significantly decreased by 3.87 (SD=2.84) points
on average [t(81)=12.31, P<.001, 95% CI (3.24, 4.49)].
Table 2. Descriptive statistics (n=113).
M SD
Acuity 7.39 1.73
Days in program 22.35 13.13
Depression intake 33.00 12.99
Depression discharge 14.65 12.42
Anxiety intake 49.69 22.17
Anxiety discharge 26.26 21.23
Hopelessness intake 11.15 5.75
Hopelessness discharge 4.99 5.00
Suffering intake 6.53 2.31
Suffering discharge 3.01 2.69
M, mean; SD, standard deviation. Ms and SDs reflect raw scores on associated symptom
measures.
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According to a series of paired samples t-tests con-
ducted with all medium acuity clients (N=29), depression
scores significantly decreased by 6.97 (SD=10.36) points
on average [t(28)=3.62, P=.001, 95% CI (3.02, 10.91)];
anxiety scores significantly decreased by 13.86
(SD=22.90) points on average [t(28)=3.26, P=.003, 95%
CI (5.15, 22.57)]; hopelessness scores significantly de-
creased by 2.28 (SD=4.38) points on average [t(28)=2.80,
P=.009, 95% CI (0.61, 3.94)]; and suffering scores sig-
nificantly decreased by 2.59 (SD=2.88) points on average
[t(28)=4.83, P<.001, 95% CI (1.49, 3.68)]. There were
only two clients that started the program in the low acuity
category, so their data was unable to be statistically ana-
lyzed separately. However, they showed clinically mean-
ingful decreases in all four-symptom areas as well. Their
depression scores changed from an average of 10.00 to
2.00, anxiety scores changed from an average of 6.00 to
4.50, hopelessness scores changed from an average of
4.00 to 1.00, and suffering scores changed from an aver-
age of 3.00 to 0.00. However, these changes should be in-
terpreted with caution.
To assess the possibility that length of stay might inter-
act with patient acuity to produce symptom change, a series
of moderated hierarchical linear regression analyses were
conducted. Length of stay and patient acuity at intake were
entered in step 1, and the interaction between length of stay
and acuity in step two. The results showed that there was
no interaction effect between acuity ratings at the start of
the program and length of time spent in the program on de-
pression, anxiety, or suffering score change. However, a
moderated, hierarchical linear regression analysis showed
that there was a significant interaction between acuity at
the start of the program and length of time spent in the pro-
gram on hopelessness score change [F (3, 109)=15.74,
P<.001; Figure 2]. For ease of interpretation, acuity and
length of stay are depicted as ±1 SD from the mean in Fig-
ure 2; continuous measures of these variables were entered
into the regression analyses. The final model (predictors:
acuity, length of stay, interaction term) explained 30.2% of
the variability in hopelessness change. The addition of the
interaction term explained an additional 4.20% of the vari-
ability in hopelessness change (P=.012).
Discussion
The purpose of the current study was to replicate and
add to the findings of Lothes et al. (2014) by assessing
the effectiveness of a DBT-informed PH program on de-
pression, anxiety, hopelessness and degree of suffering
based on patient length of stay and acuity ratings at intake.
The present study results were able to successfully repli-
cate Lothes et al. (2014) by showing significant decreases
in depression, anxiety, hopelessness, and degree of suf-
fering from intake to discharge for all participants. Thus,
integrating DBT into PH programs’ treatment protocol ap-
pears to be an effective method at decreasing symptoms
that are associated with a wide variety of diagnoses and
clinical concerns, including suicidal ideation and action.
Additionally, it was found that length of stay in the
program moderated the relationship between acuity and
change in hopelessness such that those who were most
acute and stayed in the program for the longest had the
greatest reduction in perceived hopelessness. This sug-
gests that severely acute patients may benefit from staying
longer in a PH program than less acute patients. In addi-
tion, preemptively assessing for hopelessness levels could
prove more useful than anxiety or depression scores in de-
termining length of stay needed in the program. Thus, a
one-size-fits-all conceptualization of treatment in PH pro-
grams that is currently being practiced by insurance com-
panies warrants some consideration. Perhaps some
patients need more time in a PH program to receive the
benefits of treatment. In addition, researchers have noted
that significant declines in depression, anxiety, and hope-
lessness are important factors in the reduction of suicide
Figure 1. Change in hopelessness scores by acuity level and
length of stay.
Figure 2. Change in symptoms from intake to discharge.
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[Research in Psychotherapy: Psychopathology, Process and Outcome 2016; 19:219] [page 155]
DBT-informed partial hospital program outcomes
risk, suggesting that a longer length of stay in a PH pro-
gram may reduce the risk for suicide and the risk of return
to an inpatient facility among this population (Neuhaus,
2006; Pompili et al., 2012); however, further studies are
needed to specifically assess this.
The results of this study replicated and extended those
of Lothes et al. (2014), suggesting that patients with
higher levels of acuity may need longer lengths of stay to
experience the same symptom reduction effect in a DBT-
informed PH program as those with lower levels of acuity.
The promising outcome is that there is still a significant
decline in ratings of depression, anxiety, hopelessness and
degrees of suffering from start to discharge, even for the
most highly rated patients on these measures. Length of
inpatient stay after exposure to DBT-informed treatment
may be reduced and should be assessed in future studies.
Economically, DBT could be a factor in looking at the re-
duction of overall treatment cost to the patient since at-
tendance to a PH program is considerably more cost
efficient than an inpatient stay (McMain et al., 2009).
Batcheler (2005) reported on a pre-post study of DBT in
New Zealand, finding a reduction in hospital days used
(25.04 to 4 to 1.09 days) when comparing 12 months pre-
treatment, 12 months of DBT treatment, and 12 months
post DBT treatment, respectively. Using a DBT-informed
PH program as first choice instead of an inpatient facility
may also be a cost savings method of treatment as well.
The study has several limitations. First, there is a lack
of generalizability due to not having a control group.
However, the researchers felt it would be ethically inap-
propriate to deprive high-risk patients of care by placing
them on a control-waiting list. Also, the researchers at-
tempted to reach out to other non-DBT PH programs to
use as a comparison group. None of the clinics contacted
were willing to let us collect data on their programs. In
the future, comparison studies to other PH programs are
recommended. Second, the measures used are all self-re-
port and therefore may not have accurately assessed spe-
cific levels of psychological impairment at intake and
discharge. Finally, data was not gathered on how many
coaching phone calls were made by each patient, how
many hospitalizations occurred while in program, or how
many relapses of problem behaviors occurred (e.g., cut-
ting, using, drinking, purging). Also not assessed was
medication compliance.
Conclusions
Ideally, follow up studies (e.g., 3 months, 6 months
and/or 12 months post discharge) are recommended for
future studies to examine if depression, anxiety, hopeless-
ness, and degree of suffering are still significantly below
intake level. Further, it is suggested for follow up studies
to examine rates of return to inpatient facilities. Finally,
it may prove useful to examine differences in symptom
reduction between more traditional cognitive behavioral
therapy models of PH programs compared to DBT-in-
formed PH programs.
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