Acceptance, Safety, and Effect-Sizes in Online-Dialectical Behavior Therapy for Borderline Personality Disorder: A feasibility study (Preprint)

BACKGROUND The potential of online psychotherapy is gaining increased attention. However, there is skepticism about its acceptance, safety and efficacy for patients with high emotional and behavioral dysregulation. OBJECTIVE This study aims to provide initial effect-size estimates on psychopathology, acceptance and safety of online Dialectical Behavior Therapy (DBT) for individuals diagnosed with Borderline Personality Disorder (BPD). METHODS Thirty-nine individuals meeting DSM-5 criteria for BPD received one year of outpatient online DBT at three sites in Germany and Canada. Effect size estimates were assessed using pre-post measures of BPD symptoms (BSL-23), dissociation (DSS), and quality of life (ReQoL). Safety was evaluated by analyzing suicide attempts and self-harm (DSHI). Additionally, acceptance and feasibility (AIM), satisfaction with treatment (CSQ-8), useability of the online format (UTAUT), and the therapeutic relationship (WAI) were assessed from therapists' and patients' perspectives. RESULTS Analyses showed significant and large pre-post effect sizes for BPD symptoms (d = 1.13 in the ITT, d = 1.44 in the ATP sample, p CONCLUSIONS Online DBT for BPD showed large pre-post effect sizes for BPD symptoms and quality of life. While the online format appeared to be feasible and well-accepted, the drop-out rate was relatively high. Future research should compare the efficacy of online DBT with in-person formats in randomized-controlled trials. Overall, online DBT might offer a potentially effective alternative treatment option, enhancing treatment accessibility. However, strategies for decreasing drop-out should be considered. CLINICALTRIAL A preregistration of the trial is available under DRKS00027824