Dialectical behavior therapy skills training for African American pregnant women with ACEs: a pilot study of feasibility, acceptability, and mental health barriers and attitudes

<b>Background:</b> Toxic stress contributes to socioeconomic and racial health disparities that persist across generations. Developing and implementing prenatal interventions that reduce toxic stress and associated comorbidities is warranted. Dialectical Behavior Therapy (DBT) Skills Training group interventions have demonstrated efficacy for depression and posttraumatic stress disorder (PTSD) and are scalable in diverse settings. Implementing DBT skills group interventions for African American pregnant women with adverse childhood experiences (ACEs) and current depression or PTSD symptoms is novel and has the potential to interrupt the intergenerational cycle of toxic stress by improving maternal mental health. Yet, much remains to be understood about barriers that may impact feasibility.<b>Objective:</b> This mixed-method pilot randomized controlled trial (RCT) examined barriers and attitudes toward mental health treatment, feasibility, and acceptability of an adapted 8-week DBT Skills Training group for mothers-to-be (DBTMTB) compared to waitlist control (WLC) for African American pregnant women with a history of expanded ACEs and current depression or PTSD symptoms (<i>n</i> = 30; <i>n</i> = 15 for DBTMTB, <i>n</i> = 15 for WLC).<b>Methods:</b> The study was delivered in a prenatal clinic of an urban public hospital or virtually. Pre-treatment quantitative and qualitative measures of treatment barriers and attitudes toward mental health treatment were obtained. Feasibility was measured through treatment and study retention rates. Acceptability was measured through qualitative responses on intervention acceptability.<b>Results:</b> We found a high level of barriers identified by women; stigma and time constraints were endorsed most often. Approximately half of women were receiving professional help and many reported stigma about asking others for help. Feasibility (treatment retention) was poor; only 26.7% (<i>n</i> = 4) of participants randomized to DBTMTB completed the intervention (≥6 sessions). Acceptability among treatment completers was high.<b>Conclusions:</b> Poor completion rates suggest challenges to feasibility and acceptability of DBTMTB in this population that must be addressed.