During the COVID-19 lockdown, clinicians with standard DBT programs have had to quickly learn about and adapt telehealth services while ensuring client safety. Published qualitative studies provide insights into the barriers and benefits of DBT services via telehealth.
Standard in-person DBT IOP sessions involve skill review and discussion of diary cards, which track symptoms and maladaptive behavior intensity over time. Patients also learn and practice DBT skills for core mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness.
Accessibility
Many programs offering dialectical behavior therapy (DBT) have pivoted to telehealth during the COVID-19 pandemic to increase access and equity of treatment for clients who experience borderline personality disorder (BPD) and severe emotion dysregulation. Despite the increased demand, there is limited research regarding the telehealth implementation of DBT for these complex clients.
The results of this study indicate that clinicians reported both benefits and barriers to telehealth DBT for BPD and severe emotion dysregulation. Barriers included difficulties with technology, loss of in-person connection, and privacy concerns, while benefits included increased access to treatment, client satisfaction, and clinician mastery.
Participants also suggested screening clients to verify that telehealth mental health counseling is acceptable. It is crucial because certain patients might not be candidates for telehealth, just as other patients might not be candidates for in-person therapy.
Flexibility
DBT is an intensive program that requires clients to attend weekly individual and group therapy. Attendance is a crucial metric for determining client progress and effectiveness.
The study’s clinicians found more attendance and access to telehealth-delivered DBT for depression. For clients who might not otherwise be able to participate in DBT owing to geographic restrictions, lack of transportation, and other personal obstacles, therapists indicated that telemedicine was an accessible option.
In addition, telehealth allowed for more flexibility in scheduling sessions. For example, one clinician reported having “nearly zero cancellations or no-shows” because they could hold sessions conveniently for their clients. It reduced stress and disruptions for their clients during a highly stressful time. The findings from this study indicate that telehealth may be a viable option for DBT delivery in the future.
Confidence
DBT is a powerful treatment for depression that helps people learn new skills to deal with distressing emotions and behaviors. It teaches individuals tools to increase their quality of life and improve their relationships by teaching them to control their emotions, tolerate difficult situations, and practice healthy coping skills.
Clinicians practicing DBT before and during the COVID-19 lockdowns were invited to participate in an online survey that included items assessing familiarity and comfort with telehealth services. Participants were also asked if they would participate in a follow-up study comparing client attendance rates of DBT delivered via videoconference telehealth and face-to-face.
Clinicians collected client data via de-identified spreadsheets and sent them to the research team for collation. Attendance was defined as the percentage of scheduled sessions attended by a client.
Ease of scheduling
Online sessions are easy to schedule. If you have a busy schedule, check the therapist’s availability for telehealth and in-person sessions to ensure your needs can be met. Also, it is helpful to be prepared for your first session by checking your internet connection and ensuring that your video and audio work well. It’s crucial to find a quiet and distraction-free place for your session.
Clients were as likely to attend DBT skills training and individual therapy sessions via telehealth as in-person during the COVID-19 pandemic, and this data should reassure clinicians considering moving their group programs to a remote format. However, more significant data are needed to determine whether telehealth is associated with the same clinical outcomes as face-to-face treatment.
Affordability
Whether you have insurance or not, the cost of therapy can quickly add up. Fortunately, there are several ways to help lower your costs. For example, many therapists offer a sliding scale where your rate depends on what you can afford. Some post-secondary schools also offer discounted rates to see their students in training, and community mental health clinics are often free or low-cost.
During the COVID-19 pandemic, several treatment programs pivoting to telehealth provided dialectical behavior therapy (DBT) for complex clients. Despite these challenges, DBT via telehealth has been widely adopted, and clinicians’ attitudes remain cautiously optimistic. Client satisfaction with telehealth DBT has been described as high. It may be partially due to reduced stress from not having to travel to a traditional office setting.
