Objective: Dialectical behavior therapy (DBT) is a widely disseminated evidence-based treatment for patients with borderline personality disorder (BPD). This evaluation of a community psychiatry residency rotation compared a DBT training program to a standard care training program to determine the levels of confidence in treating patients with BPD, willingness to treat patients with BPD, and attitudes towards this patient population.
Methods: Participants were 57 psychiatry residents who completed a 3-month community psychiatry rotation in a DBT clinic (N = 33), or standard care clinic (N = 24) based in a partial hospitalization program in a community mental health center. A mixed method design was used to collect qualitative and quantitative data on participants' experiences working with BPD and patients at high-risk for suicide. Participants were asked several open-ended questions to determine what aspect of their community psychiatry rotation influenced their level of confidence in treating, and willingness to treat BPD, non-suicidal self-injurious behaviors, and suicidal behaviors.
Results: Compared to training in the standard care condition, the DBT condition demonstrated significantly higher rates of willingness to treat, and confidence in treating patients with BPD, and confidence in treating non-suicidal self-injury. There were no significant differences between the two conditions in the level of confidence in treating suicidal patients. Four themes emerged from a qualitative content analysis examining the benefits of the training program, including (1) exposure to high-risk patients, (2) team-based treatment structure, (3) formal didactic training, and (4) individual or group supervision.
Conclusion: Participants receiving DBT training had more willingness to treat and confidence in treating patients with BPD compared to participants receiving training in the standard care clinic. Team-based structure of DBT and exposure to high-risk patients were two themes from the training that impacted these variables across both study arms, according to participant self-report. Internal validity of the study was limited by the lack of randomization and pre-post design. External validity of the study was strengthened due to the setting of a community mental health clinic and resident training program.
Keywords: Dialectical behavior therapy; Psychotherapy; Residents.