D-BOAT: evaluation of the feasibility and preliminary clinical outcomes of a complex dialectical behavior therapy program for hospitalized adolescents—a pilot study

This pilot study examines Dialectical Behavior Opařany Adolescent Therapy (D-BOAT), the first Czech inpatient DBT-A program for adolescents with chronic self-harm and suicidal behavior. The 7–8-week program includes core DBT-A components (individual therapy, group skills training, parent groups, between-session skills practice, and staff-supported coaching). The primary aim was to assess the feasibility and acceptability of implementation, whereas the secondary aim was to explore preliminary changes in depressive and anxiety symptoms and patients’ and parents’ subjective experiences with the program. The study was conducted with 49 patients aged 13–17 years (M = 15.29; SD = 1.23; female = 95.9%) who completed the D-BOAT program. Patients completed the Children’s Depression Inventory (CDI), the Screen for Child Anxiety Related Disorders (SCARED), and a feedback questionnaire. Parents completed a feedback questionnaire. Data from patients were collected at three time points: at the end of pretreatment and immediately before the first D-BOAT cycle (T1), after the first three-week treatment cycle (T2), and after the second three-week treatment cycle (T3). Analyses were conducted on program completers only. The D-BOAT program was implemented in an inpatient setting and was positively evaluated by patients and parents. Both groups reported high satisfaction with the program and perceived usefulness of the acquired skills for everyday coping. Patients’ depressive and anxiety symptom scores decreased from T1 to T3 (CDI: 34.7–24.6; SCARED: 53.8–45.2). Despite these decreases, symptom levels remained clinically elevated at discharge, consistent with the clinical severity of the sample and the short inpatient timeframe. This study should primarily be regarded as a pilot feasibility evaluation of real-world implementation of the first Czech inpatient DBT-A program for adolescents with chronic self-harm and suicidal behavior. The findings indicate that D-BOAT was feasible to implement and acceptable to patients and parents. Decreases in depressive and anxiety symptom scores should be interpreted as preliminary outcome signals rather than evidence of treatment effectiveness, due to the uncontrolled completers-only design. Future controlled studies with longer-term follow-up and direct measures of self-harm and suicidality are needed.