Elsevier

Behavior Therapy

Volume 42, Issue 2, June 2011, Pages 263-275
Behavior Therapy

Can Dialectical Behavior Therapy Be Learned in Highly Structured Learning Environments? Results From a Randomized Controlled Dissemination Trial1

https://doi.org/10.1016/j.beth.2010.06.004Get rights and content

Abstract

This study evaluated the efficacy of methods of training community mental health providers (N = 132) in dialectical behavior therapy (DBT) distress tolerance skills, including (a) Linehan's (1993a) Skills Training Manual for Borderline Personality Disorder (Manual), (b) a multimedia e-Learning course covering the same content (e-DBT), and (c) a placebo control e-Learning course (e-Control). Participants were randomized to a condition, and the training took place in a highly structured and controlled learning environment. Assessments were completed at baseline, post-training, and 2, 7, 11, and 15 weeks following training. The results indicate that one or both of the active DBT conditions outperformed the control condition on all outcomes except motivation to learn and use the treatment. While clinicians preferred e-DBT over the Manual and found it more helpful and engaging, the active DBT conditions generally did not differ on the primary outcomes of knowledge and self-efficacy, with the exception that e-DBT significantly outperformed the Manual on knowledge at the 15-week follow-up. E-DBT also produced the highest rate of applying and teaching the newly learned skills in clinical practice. Overall, results from this study support the efficacy of e-Learning in disseminating knowledge of empirically supported treatments to clinicians, while also indicating that treatment manuals can be effective training tools.

Section snippets

Recruitment and Screening

All procedures were approved by the Western Institutional Review Board. Participant enrollment began in February 2006 and the final follow-up assessment occurred in September 2006. Participants were recruited via phone and face-to-face contact with directors of community mental health and drug treatment agencies within Washington state. Agencies were selected based on their proximity to the research site. Directors who agreed to help with recruitment then distributed information about our

sample description

As shown in Table 1, the prototypical participant identified as a Caucasian female approximately 44 years of age, having a master's or bachelor's degree, was employed as a clinician in an outpatient community mental health center, and had 8 years of clinical experience. No group differences were found on demographic variables.

Clustering Effects

Preliminary analyses were used to describe the clustering effects due to agency membership on the primary outcome measures. There were a total of 33 clusters (agencies)

Discussion

The present study examined the efficacy of two methods of training community clinicians in DBT Distress Tolerance skills in a highly structured environment that controlled the conditions of learning. Specifically, two active training conditions (a DBT e-Learning course and content from the DBT treatment manual) were compared to a control e-Learning course. Overall, results from the trial indicate that, while e-DBT was as or more effective than the treatment manual in disseminating DBT, learners

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    [1]

    This research, as well as the development of the online training course, was funded by two Small Business Innovation Research (SBIR) grants from the National Institute of Mental Health (1 R43 MH65790-01) and the National Institute on Drug Abuse (1 R43 DA15615-01) awarded to the first author. We acknowledge and thank the following individuals and organization for their support and contributions to this research: Cecilia Spitznas, Ph.D., Enid Light, Ph.D., Kelly Koerner, Ph.D., Steve Conrad and his team at MediaPro, Inc., Brian Rash, Meredith Grabill, Michel Daliva, and Prudence Cuper.

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