Brief Dialectical Behaviour Therapy Group Skills Training as a standalone psychotherapy for Individuals with Borderline Personality Disorder

Borderline Personality Disorder (BPD) is highly prevalent personality disorder associated with intense psychosocial distress to the patient and people around them. Highly cost intensive treatments available for this condition may not be feasible in Indian out-patient psychiatric settings. Brief Dialectical Behaviour Therapy Group Skills Training (DBT-ST) can be a judicious intervention in Indian settings due to the cost-effective nature of the treatment. However, DBT-ST have not been studied in Indian context. Thus, this research aims to study the effect of brief Dialectical Behaviour Therapy Skills Training (DBT- ST) for patient with BPD on various primary and secondary outcome variables.

A single group pre-post design will be used. The study will be conducted in two phases. The Pilot phase will include modification of brief DBT-ST schedule by Soler et al (2009) based on insights from running the DBT skills group with 4-6 participants and expert validation of the same.

The main phase will include administering the modified schedule to 30 participants diagnosed with BPD which will require running 4-6 psychotherapy groups with 6-8 participants. The screening will be done using Diagnostic interview for anxiety, mood, and obsessive-compulsive and related neuropsychiatric disorders (DIAMOND; Tolin et al., 2018) and Structured Clinical Interview for DSM-V Personality Disorders (SCID-V PD; First, 2014). The outcome variables will be assessed at baseline, mid-intervention assessment, post-intervention and at 3-months follow-up using Borderline Evaluation of Severity over Time (BEST; Pfohl & Blum, 1997),  Difficulties in Emotional Regulation Scale-18 (DERS-18; Victor & Klonsky, 2016), DBT ways of coping checklist (DBT-WCCL; Vitaliano, et. al., 1985), Depression, Anxiety and Stress Scale - 21 (DASS-21; Lovibond & Lovibond, 1995) and Global Assessment of Functioning (GAF; DSM-IV-TR, 2000). Clinical Global Impression Scale- Borderline Personality Disorder (CGI- BPD; Perez et al., 2007) will be applied pre- and post intervention whereas Deliberate Self-Harm Inventory (DSHI; Gratz, 2001) will be applied at 3 time points: pre-, post-intervention and 3 month follow up. VAS will be assessed after every session. Focus Group Discussion will be held post-intervention.

Data obtained in each phase will be recorded, coded and analysed using suitable qualitative and quantitative methods. Suitable software may be used to transcribe and organize the qualitative data from FGD. Content analysis will be used to understand the data. The quantitative data will be tabulated and subjected to statistical analysis using Statistical Package for Social Sciences (SPSS version 23). Descriptive statistics (e.g., mean, standard deviation) will be used to describe the demographical and clinical characteristics of the sample. Normality of the data will be assessed using Shapiro-Wilk test. Appropriate tests of association based on the normality of the sample will be carried out to study the association between the different variables considered in this study. The study may use hierarchical linear model to compare the data at different time points. P value less than 0.05 will be considered as statistically significant. The participants will be regularly assessed for suicidal risk. Crisis plan will be made collaboratively with participants and their consent will be taken to involve a designated contact person before commencing the treatment. In case patients require any emergency or psychiatric services, referrals and contacts will be provided for the same.