Engagement in dialectical behaviour therapy in LBC-certified DBT programs: comparison of in-person <i>vs</i> telehealth treatment delivery

Abstract Background: Since the COVID-19 pandemic, delivering psychotherapy via telehealth has become commonplace, including with dialectical behaviour therapy (DBT); however, there is minimal research examining the difference in engagement between in-person and telehealth DBT. A multi-component intervention, DBT addresses problems associated with emotion dysregulation across a range of diagnoses, including suicidal and self-harming behaviour. Comprehensive DBT includes weekly individual and group sessions, out-of-session skills coaching, and consultation team for therapists. The DBT-Linehan Board of Certification (LBC) certifies DBT programs that demonstrate fidelity to the evidence-based model. Aims: This paper presents data drawn from LBC-certified DBT programs on the delivery of the treatment via telehealth. Primary aims were to determine differences in DBT attendance or non-completion: (1) associated with the transition to telehealth and (2) between clients attending solely in-person vs telehealth. Method: Data were analysed by cohort: (1) clients who started DBT in-person and transitioned to telehealth; (2) those who were seen solely in-person; and (3) those seen only via telehealth. Results: There was a lack of significant differences in missed sessions and treatment non-completion when comparing before and after the move to telehealth. Comparing solely in-person to telehealth, significant differences emerged with telehealth demonstrating fewer missed sessions as well as a lower rate of treatment non-completion. No differences were found when comparing adolescent and adult participants. Conclusions: Implications for telehealth delivery of DBT are provided, along with reflections on the potential impact of client characteristics that can inform future research.