(PS7-93) Protocol and Preliminary Feasibility/acceptability Outcomes for a Pragmatic Randomized Controlled Trial of DBT for People with Psychosis

In recent years, there has been heightened interest in the application of Dialectical Behavior Therapy (DBT) for people with psychosis, as this population tends to have high rates of suicide (Hor & Taylor, 2010; Bertolote & Fleischmann, 2002) and pervasive difficulties with emotion regulation (Khoury & Lecomte, 2021; Tully & Niendam, 2014). Since 2020, a DBT skills workbook for people with psychosis was published (Mullen, 2021), a brief DBT-informed skills group for individuals with psychosis was implemented and evaluated (Lawlor et al., 2022), and a program evaluation of DBT composed mostly of people with psychosis was carried out and published (Phalen et al., 2022). However, to our knowledge, there have been no controlled trials of DBT for people with psychosis, and in fact this group has typically been excluded from suicide-focused controlled trials of any kind (Villa et al., 2020).

The poster authors are currently carrying out a Randomized Controlled Trial (RCT) of DBT Skills Training (DBT-ST) for patients with psychotic disorder and high risk of suicide (as determined by the Suicide Behaviors Questionnaire-Revised; SBQ-R; Osman et al., 2001). This RCT is being carried out as a pragmatic trial, with patients recruited from West Baltimore community mental health clinics in predominately black neighborhoods with high deprivation. Study clinicians are exclusively drawn from volunteer staff working in the community mental health clinics at which patients are being seen, with training and supervision provided by the study team.

In this poster, we will describe the study protocol, setting, patient characteristics, and feasibility/acceptability data from a prepilot DBT group and the first cohort to complete the RCT. In addition, we will describe the process of modifying our implementation of the DBT-ST group for the RCT based on acceptability/feasibility data (including qualitative interviews) from patients in the prepilot group.
Overall, qualitative and quantitative results support the feasibility of the intervention (e.g., 100% cumulative treatment retention in the RCT) and the use of community clinicians (e.g., 100% passing competency ratings for taped sessions). While quantitative outcomes are currently blinded, qualitative interviews suggest high acceptability and patient satisfaction. Results also highlight the importance and possibility of increased accessibility to DBT in high-need, underserved communities where the model has not previously been well-disseminated.