Dialectical Behaviour Therapy: changing lives and saving resources

Bray, J.1, Heerebrand, S.2, Roberts, R. 2, Ulbrich,C.1 & Edwards, S. 2

1 Eastern Community Mental Health, CALHN, SA Health, 2Adelaide University

 

Objective: Borderline Personality Disorder (BPD) is a significant mental illness, associated with an increased risk of self-harming and suicidal behaviours. The prevalence of BPD in mental health settings is up to 23% in outpatient settings, and 43% in inpatient settings. The standard application of Dialectical Behavior Therapy (DBT) for the treatment of BPD has substantial evidence demonstrating efficacy. However, this treatment option is limited within SA Health. This study aimed to evaluate the effectiveness of an established, shorter and more available intervention, DBT skills training group (DBT-ST), in a publicly-funded community mental health setting.

Method: Participants (114 people with BPD) attended an 18-20 week DBT-ST in a community mental health setting between 2010 and 2016. The study utilised a quasi-experimental design with a within-persons waitlist control group. Primary outcomes were: BPD symptoms, general psychological distress, depression, and rate of Emergency Department (ED) presentations and psychiatric inpatient bed-days.

 

Results: Participants showed a clinically significant reduction in BPD symptoms, general psychological distress and depression. The waitlist control group showed no significant improvement in BPD symptoms. The rate of ED presentations was significantly reduced by approximately 50%. There was an emerging trend for a reduction in psychiatric inpatient bed-days however there was insufficient power to assess this.

Conclusion: Participation in DBT-ST has been shown to be an effective and accessible treatment for people with BPD, which can be life changing. Additionally, given the prevalence of BPD, DBT-ST can create substantial cost saving for SA Health as DBT-ST participants have decreased contacts with ED.


Jemma Bray

Jemma Bray is a Clinically Endorsed Psychologist and Board Approved Supervisor in Central Adelaide Local Health Network (CALHN), specializing in the area of Mental Health. Jemma is a Senior Clinical Psychologist in Community Mental Health and the inaugural CALHN Dialectical Behaviour Therapy (DBT) Coordinator. Jemma has many years’ experience working with people with chronic and complex mental illness in Community Mental Health and Acute Inpatient settings. Jemma is passionate about working with people with Borderline Personality Disorder and is a comprehensively trained DBT therapist with several years of experience providing group and individual therapy to this high risk population. Jemma has been actively involved with quality improvement activities in CALHN and regularly provides education to SA Health staff to further their learning and development. Jemma has been published in the area of trauma and is involved with ongoing research of current Community Mental Health psychological practice including the DBT Program.

Sharon Heerebrand

Sharon Heerebrand is a Clinical Psychology Registrar. Sharon completed her Masters in Clinical Psychology at the University of Adelaide in early 2019, and graduated from SA Health’s Allied Health Professional Practice Program in December 2019. Sharon completed a thesis titled “Effectiveness of brief dialectical behaviour therapy skills training for borderline personality disorder” which analysed retrospective data collected over 6.5 years of the Eastern Community Mental Health service’s DBT Skills Training Group. Sharon is interested in working with people with complex mental health presentations, particularly with consumers with diagnoses of personality disorder.  Sharon is currently employed at Western Psychosocial Rehabilitation program where she provides individual and group based psychological interventions to consumers with chronic and severe mental health diagnoses. Sharon has a specific focus on reducing psychological barriers to improving daily functioning through symptom management and reduction, and interpersonal skills development in accordance with each individual consumer’s personal psychosocial rehabilitation goals.

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