Borderline personality disorder is a serious mental illness starting in adolescence, and its prevalence amongst the adult population is close to 1,8%. Borderline personality disorder provokes functioning impairment and increases the risk of premature death by suicide and other causes. Many evidence-based psychotherapies have demonstrated effectiveness in reducing symptoms several clinical manifestations and the impact of BPD. To date, Dialectical
Behaviour Therapy is the most widely used as there is significant evidence supporting its effectiveness. However, implementing a full version of standard DBT is very resource intensive and lead to implementation challenges particularly in public health systems which often experience staffing and budget shortages. In response to this an adaptation of DBT has been widely implemented: DBT skills training group (DBT-ST). This adaptation is based exclusively on the DBT skills training group, it does not include individual therapy and allows for more flexibility in its delivery?. This less time-consuming adaptation varies in length (generally around 24 weeks) and has shown effectiveness in reducing BPD clinical manifestations. Hence, DBT-ST is a promising alternative which has been implemented in public health setting worldwide.
This thesis reports on the results from 1) a Scoping review of the literature on delivery and implementation aspects of DBT-ST And 2) A qualitative feasibility study of an online 13- week DBT-ST in a public hospital in a low-income area of Santiago de Chile which included two phone interventions (phone coaching and check-in calls), two additional 3-week groups (crisis survival skills and psychoeducational) and regular consultation team meetings.
The Scoping review in Chapter 2 shows a wide variety of ways of DBT-ST implementations in different countries, especially regarding the skills training group characteristics and the DBT therapists. Only some programmes included phone coaching and consultation meeting; a few DBT-ST programmes also added interventions different from the classic DBT modes that could help achieve some of the five DBT functions. The feasibility study in Chapter 3, through focus groups with therapists, showed the online enhanced 13-week DBT-ST was feasible in the context of a public hospital in Santiago; however, some concerns arose regarding the duration of group sessions and the online format; meanwhile, the consultation team meeting and the skills schedule was generally positively evaluated.
8 After gathering data from Scoping review and the therapists' perspective about this online enhanced 13-week DBT-ST programme in the Chilean public health system, this thesis gives clinical recommendations for implementing this kind of DBT adaptation with a particular emphasis on the Chilean public mental health centres. Chile has a national guideline for secondary-level mental health centres, so the "top tips" for implementing DBT-ST programmes consider this guideline also to achieve administrative feasibility. These recommendations are separated by DBT modes (skills training groups, phone interventions, consultation team meetings) but also include some suggestions for interventions that may improve even more DBT functions, such as intake interviews or case management