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Teaching Dialectical Behavior Therapy to Psychiatry Residents: The Columbia Psychiatry Residency DBT Curriculum

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Abstract

Objective

Dialectical behavior therapy (DBT) is an evidence-based psychosocial treatment with efficacy in reducing self-harm behaviors in borderline personality disorder (BPD). This study describes and evaluates a clinical curriculum to teach DBT to psychiatry residents, developed at a large urban university hospital. The curriculum objectives are to (1) have psychiatry residents achieve basic understanding of DBT theory and clinical skill, (2) increase residents’ ability and confidence in treating self-harm behaviors (both suicidal behavior and non-suicidal self-injury), and (3) enhance residents’ willingness to treat individuals with BPD.

Methods

In addition to a 6-week didactic course on DBT offered to all residents (n = 62), 25 elected to enroll in a year-long DBT clinical training curriculum over the course of a 5-year period. The DBT clinical training consisted of 15 h of additional didactics, ongoing conduct of individual therapy and group DBT skills training, videotaping of individual therapy sessions, and weekly supervision meetings utilizing videotape to provide feedback. Residents participating in the clinical training program videotaped baseline and later sessions, which were rated for DBT adherence. All 62 graduates of the program were surveyed regarding the impact of the training on their practice of psychiatry.

Results

Upon graduation, a high percentage (87 % in the curriculum and 70 % in the didactic course only) reported incorporating DBT into their psychiatry practice, as well as willingness and confidence in treating BPD and self-harm behaviors. Residents participating in the clinical training demonstrated significant improvement in their ability to utilize DBT interventions, particularly in structuring sessions, problem assessment, problem solving, and using validation and dialectical strategies.

Conclusion

This DBT curriculum was effective in preparing psychiatrists-in-training to incorporate evidence-based practices for effective treatment of BPD and self-harm behaviors and can serve as a model for teaching DBT during psychiatry residency training. Limitations include a small sample size and lack of baseline survey measurement of attitudes for pre- and post-curriculum comparison.

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Authors and Affiliations

  1. Columbia University College of Physicians and Surgeons, New York, NY, USA

    Beth S. Brodsky, Deborah L. Cabaniss, Melissa Arbuckle, Maria A. Oquendo & Barbara Stanley

Authors
  1. Beth S. Brodsky
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  2. Deborah L. Cabaniss
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  3. Melissa Arbuckle
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  4. Maria A. Oquendo
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  5. Barbara Stanley
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Corresponding author

Correspondence to Beth S. Brodsky.

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Disclosures

Dr. Brodsky receives book royalties from Wiley-Blackwell publishers for the book “The Dialectical Behavior Therapy Primer: How DBT can inform clinical practice.”

Dr. Cabaniss receives book royalties from Wiley-Blackwell publishers for the books “Psychodynamic Psychotherapy” and “Psychodynamic Formulation.”

Dr. Arbuckle reports no conflict of interest.

Dr. Oquendo receives royalties for the commercial use of the Columbia-Suicide Severity Rating Scales and an honorarium as President-Elect of the American Psychiatric Association. Her family owns stock in Bristol Myers Squibb.

Dr. Stanley receives royalties for the commercial use of the Columbia-Suicide Severity Ratings Scales and royalties from Wiley-Blackwell publishers for the book “The Dialectical Behavior Therapy Primer: How DBT can inform clinical practice.”

Additional information

Supported by NIMH Education Programs of Excellence in Scientifically Validated Behavioral Treatment (R25), 5R25MH084787-02 (MPIs: Brodsky and Stanley)

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Brodsky, B.S., Cabaniss, D.L., Arbuckle, M. et al. Teaching Dialectical Behavior Therapy to Psychiatry Residents: The Columbia Psychiatry Residency DBT Curriculum. Acad Psychiatry 41, 10–15 (2017). https://doi.org/10.1007/s40596-016-0593-0

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  • DOI: https://doi.org/10.1007/s40596-016-0593-0

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