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Table 1 Summary of the primary outcomes of randomised controlled trials (RCTs) and pre post studies using classical statistics

From: Reviewing the availability, efficacy and clinical utility of Telepsychology in dialectical behavior therapy (Tele-DBT)

Study

Design

Participants

Technology

Experimental intervention

Comparator Interventions

Measures

Cohen’s d

Test-scores & p-values

Lopez (2020) [42, 43]

Post-only

Adults diagnosed with depression, bipolar disorder or anxiety disorder.

N: 15 + 20

Age M (SD): 40 (16)

Videoconferencing

Two weekly DBT skills training group online via Video Teleconferencing (VTC)

Two weekly DBT skills training group face to face

Efficacy

RCCS

Utility

Satisfaction

 

t (24) = 3.7, p = .001

t (24) = 1.39, p = .19

Lungu (2015) [44]

Pre-post

Adults with a wide range of psychopathology

N: 25

Age M (SD): 44 (15)

Internet delivered skills training

An 8 week online trans-diagnostic DBT skills training for Emotion Regulation (iDBT-ER)

None

Efficacy

DBT-WCCL

DERS

AAQ

PHQ-9

OASIS

KIMS

OQ-45

Utility

CSQ

d = 1.11

n.c.

n.c

d = 0.69

d = 0.89

d = 0.02

d = 1.00

F(1, 45.32) = 28.67, p <. 01

F(1, 42.73) = 30.53, p < .01

F(1, 23.64) = 21.98, p < .01

F(1, 24.35) = 22.20, p < .01

F(1, 44.30) = 9.05, p < .01

F(1, 22.49) = 18.38, p <. 01

F(1, 24.05) = 22.55, p <. 01

Navarro-Haro (2019) [45]

Pre-post

Adults diagnosed with a Generalized Anxiety Disorder according to the MINI

N: 19

Age M (SD): 44 (10)

Virtual Reality

Six one hour Mindfulness Based Intervention (MBI) group sessions plus six ten minutes additional Virtual Reality Mindfulness Skills Training (VR DBT) individual

None

Efficacy

GAD-7*

d = 1.33

β = − 4.38, p < .001

Rizvi (2011) [46]

Pre-post

Adults diagnosed with BPD and had a comorbidity with substance abuse disorders who had been in DBT treatment for at least 2 months, and their therapists.

N: 22

Age M (SD): 34 (10)

Mobile (web) Application

10 to 14 days access to DBT coach application for smartphones, to enhance generalization of the emotion regulation skill of opposite action in an interactive way, as an add-on for patients who were participating in a standard DBT program

None

Efficacy

DBT Coach Dataa

(a) emotional intensity (b) urges to use substances

Daily assessments for patientsb

(a) urge to use substances

(b) how helpful is the DBT Coach app

(c) how helpful is the Opposite Action skill

Confidence in executing opposite actionc

BDI

BSI

“Therapist Questionnaire”d

(a) patients skill use in general

(b) the use of the opposite action skill before and after using the DBT Coach application

(c) number of phone calls outside the sessions

a) d = − 1.32

b) d = − 0.90

a) d = − 0.48

d = 0.59

d = 0.55

d = 0.43

b) d = −  0.84

a) t (21) = − 6.17, p < .001

b) t (21) = − 4.22, p < .001

a) t (21) = − 2.26, p = .035

b) t (21) = − 1.14, p = .269

c) t (21) = .67, p = .508

t (21) = 2.93, p = .008

t (21) = 2.69, p = .014

t (21) = 2.49, p = .021

a) t (21) = − 1.06, p = .30

b) t (21) = − 2.79, p = .01

c) t (21) = 1.15, p = .26

Rizvi (2016) [47]

Pre-post

Adults diagnosed with BPD and had a recent history of repeated nonsuicidal self-injury (NSSI)

N: 16

Age M (SD): 28 (8)

Mobile (web) Application

DBT coach application for smartphones, a mobile web app to enhance generalization of mindfulness, emotion regulation, interpersonal effectiveness and distress tolerance skills in an interactive way, as an add-on for patients who were participating in a standard DBT program

None

Efficacy

GAF

GSI

BSI

DERS

SITB

DBT-WCCL

 

n.s.

Salamin (2020)

Pre-post

Adults diagnosed with BPD who 1) were participating in a standard DBT program in the period of interest (i.e. 8 weeks before confinement and 8 weeks during confinement) and 2) filled out the online diary cards.

N: 7

Age M (SD): 35 (12)

Telephone consultation and videoconferencing

6 weeks of individual therapy and DBT skills training by means of telephone consultation or videoconferencing. Skills training was limited to 45 min (instead of two hours) per week and was provided individually. Adaptions were necessary to continue standard DBT during lockdown.

None

Efficacy

#Suic. behaviour/ week

#NSSI/ week

#Alcohol/ week

#Binge-eating/ week

Suic. ideation/ day

Fear/ day

Shame/ day

Tension/ day

Distress/ day

n.c.

n.c.

d = − 0.42

d = − 0.34

d = − 0.01

d = − 0.17

n.s.

n.s.

F(1, 63.1) = 3.1, p = .08

F(1, 63.5) = 4.3, p = .04

β = −  0.00, p = .964

β = −  0.59, p < .001

β = −  0.48, p < .001

β = −  0.35, p = .029

β = −  4.57, p = .030

Schroeder (2018) [48]

Pre-post

Adults diagnosed with depression (52%), General Anxiety Disorder (48%), Borderline Personality Disorder (40%), PTSD (27%), Bipolar Disorder (14%)

N Tot: 73

Age M: 37

Mobile (web) Application

28 days of semi-personalized text messages in the morning to motivate people to use “Pocket Skills”, a mobile web app containing written information, videos, and a conversational agent (avatar of M. Linehan) offering information on the basics of DBT, DBT skills and a DBT diary card.

None

Efficacy

OASIS

PHQ-9

DBT-WCCL

n.c.

n.c.

n.c.

β = − 0.66, p < .001

β = − 0.79, p < .001

β = − 0.06, p < .001

Waltz (2009) [49]

RCT

Cross-over

Adults diagnosed with BPD according to SCID II, naïve to DBT

N: 15 + 15

Age M (SD): 33 (9)

Video

Video of Marsha Linehan teaching the ‘opposite action’ skill step by step from the emotion regulation module of DBT.

Episode from a serie called The Desert Speaks on the culinary, medicinal and scientific uses of pepper plants.

Efficacy

OAKQ

d = 0.8

F = 18.74, p < .001

Wilks (2018) [50]

Wilks (2017) [51]

Wilks (2020)

RCT

Cross-over

Adults diagnosed with BPD that show suicidal behaviour and heavy episodic drinking.

N: 29 + 30

Age M (SD): 38 (10)

Internet delivered skills training

Internet-delivered DBT skills training (8 sessions, consisting of mindfulness, reducing problematic drinking, emotion regulation and distress tolerance) and daily emails and/or text messaging for motivation.

Waiting list

Efficacy

SSI

AUDIT

TLFB

DERS

n.c.

β = − 1.08, p = 0.22

β = −  2.05, p = 0.09

β = 0.81, p = 0.02

β = −  4.57, p = 0.18

  1. RCCS Rovai Community Connection Scale, DBT-WCCL Dialectical Behavior Therapy Ways of Coping Checklist, DERS Difficulties in Emotion Regulation Scale, AAQ Acceptance and Action Questionnaire, PHQ-9 Patient Health Questionnaire-9, OASIS Overall Anxiety Severity and Impairment Scale, KIMS Kentucky Inventory of Mindfulness Skills, OQ-‘45 Outcome Questionnaire 45-item version, CSQ The Client Satisfaction Questionnaire, GAD-7 General Anxiety Disorder-7, BDI Beck Depression Inventory, BSI Brief Symptom Inventory & GSI, Global Severity Index (mean of all BSI items), GAF Global Assessment of Functioning via the SCID-I Structured Clinical Interview for DSM-IV Axis I Disorders, n.s not statistically significant, n.c non calculable, SITBI Self-Injurious Thoughts and Behaviors Interview, OASIS Overall Anxiety Severity and Impairment Scale, PHQ-9 Patient Health Questionnaire-9, OAKQ Opposite Action Knowledge Questionnaire, SSI Scale for Suicide Ideators, AUDIT Alcohol Use Disorders Identification Test, TLFB Timeline Follow back
  2. aevery time the DBT Coach was activated questions about emotional intensity (a) and urges to use substances (b) were assessed
  3. bshort questionnaire at the end of each day to rate their highest urge to use substances (a), how helpful the DBT Coach app (b) and the Opposite Action skill (c) were that day
  4. ca 7-item self-report measure Behavioral Confidence Questionnaire
  5. dtherapists were asked to rate their patients skill use in general (a) and the use of the opposite action skill before and after using the DBT Coach application (b). In addition, they asked therapists to count the number of phone calls outside the sessions 2 weeks before and after the use of de DBT Coach application (c)