Process evaluation of dialectical behavior therapy dissemination: Knowledge retention and recursive training effects

Abstract

Dialectical behavior therapy (DBT) can be challenging to implement with fidelity to the model. Residential treatment settings are frequently overlooked as sites of implementation for DBT despite the potential benefits. This mixed-methods process evaluation examines the impact of DBT training in five residential programs on provider DBT-specific knowledge, staff turnover rates, and staff perceptions of training impact on their practice.
Post-training staff knowledge levels varied considerably, but on average demonstrated substantial DBT-related knowledge retention. Staff turnover rates did not change significantly in four of five programs despite showing an overall trend in reduction. Qualitative results suggest substantial recursive training effects consistent with the DBT model. Themes emerged related to the impact of the training on effectiveness of practice with clients, application of DBT skills in staff personal lives, and positive effects on program culture. Results have implications for better understanding the mechanisms of successful dissemination of DBT across treatment settings.

Full text

Process evaluation of dialectical behavior therapy dissemination:
Knowledge retention and recursive training effects
Amber M. Holbrook
1
&Susan R. Hunt
2
&Mary Renata See
3
Accepted: 25 September 2020 / Published online: 6 October 2020
#Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract
Dialectical behavior therapy (DBT) can bechallenging to implement with fidelity tothe model. Residential treatment settings are
frequently overlooked as sites of implementation for DBT despite the potential benefits. This mixed-methods process evaluation
examines the impact of DBT training in five residential programs on provider DBT-specific knowledge, staff turnover rates, and
staff perceptions of training impact on their practice.
Post-training staff knowledge levels varied considerably, but on average demonstrated substantial DBT-related knowledge
retention. Staff turnover rates did not change significantly in four of five programs despite showing an overall trend in reduction.
Qualitative results suggest substantial recursive training effects consistent with the DBT model. Themes emerged related to the
impact of the training on effectiveness of practice with clients, application of DBT skills in staff personal lives, and positive
effects on program culture. Results have implications for better understanding the mechanisms of successful dissemination of
DBT across treatment settings.
Keywords Dialectical behavior therapy .Evidence-based practice .Implementation research .Process evaluation .
Implementation science
Background and Significance
Residential treatment settings are often overlooked as poten-
tial sites for provision of evidence-based interventions (James
et al. 2013). Although diverse in their structures and therapeu-
tic approaches, residential settings typically offer a 24-h, mul-
tidisciplinary care environment to clients when the acuity of
their behavioral health disorders or difficulty with daily living
skills do not permit maintenance in a less-structured setting
(Abt Associates 2008). Implementation of evidence-based
practices (EBPs) such as dialectical behavior therapy (DBT),
in residential programs that service individuals with mental
health disorders has the potential to increase the quality and
efficacy of care for this population.
DBT is a comprehensive, specialized adaptation of cogni-
tive behavioral therapy, originally developed for the treatment
of borderline personality disorder. Effective in reducing sui-
cidal and parasuicidal behaviors, while simultaneously in-
creasing treatment retention (Neacsiu et al. 2010;Panos
et al. 2014; Soler et al. 2009; Swenson et al. 2002), DBT aims
to both decrease quality-of-life interfering behaviors and en-
hance behavioral skills such as emotional regulation, distress
tolerance, and interpersonal skills (Feigenbaum 2007;
Linehan 1993). DBT has been found effective in increasing
mindfulness while decreasing symptoms of depression and
anxiety in individuals participating in partial hospitalization
services (Lothes et al. 2016; Mochrie et al. 2019). More re-
cently, emerging evidence supports DBT’s effectiveness in
treating bipolar disorder (Van Dijk et al. 2013), co-occurring
substance abuse disorders (van den Bosch et al. 2002), and
binge eating disorders (Lenz et al. 2014; Telch et al. 2001).
Wolpow et al. (2000) suggests that the therapeutic tenets
and delivery structure of DBT may be an especially good fit
with the psychiatric rehabilitation approach implemented by
many programs serving adults with chronic mental illness. In
addition to the potential to assist clients with co-morbid psy-
chological and personality disorders who populate residential
treatment programs due to the difficulty of managing
*Amber M. Holbrook
aholbrook@wcupa.edu
1
Graduate Department of Social Work, West Chester University,
Anderson Hall, West Chester, PA 19383, USA
2
Resources for Human Development, Inc, 4700 Wissahickon Avenue,
Philadelphia, PA 19144, USA
3
West Chester University, Anderson Hall, West Chester, PA 19383,
USA
Current Psychology (2022) 41:6014–6023
https://doi.org/10.1007/s12144-020-01095-3
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