(PS8-C73) Development and Mixed Methods Evaluation of the Drop-in DBT Skills Group, a Motivational Enhancement Intervention to Promote Engagement in DBT Skills Group

Background. Global and natural disasters are associated with increased distress and need for coping skills.¹ Dialectical behavior therapy (DBT) Skills Group is an evidence-based treatment for suicide behaviors,^2,3 however individual-level barriers may limit motivation and commitment to engage in care.⁴ Pre-treatment protocols may improve motivation and increase engagement.⁵ We developed a pre-treatment protocol to increase motivation and commitment for a DBT Skills Group and evaluated its feasibility, acceptability, and preliminary efficacy.

Methods. At a Northeast United States VA Medical Center, Veterans with transdiagnostic emotional dysregulation were invited to attend a standard DBT Skills Group by their mental health providers. Those who declined this referral were invited to an optional Drop-In DBT Skills Group to gain familiarity with the skills and structure and to build motivation for the standard treatment. (‘Wait-list’ Veterans who had accepted referral to the standard DBT Skills Group and were waiting to be admitted were also invited.) The 4-session group met 1 hour per week via telehealth; attendance was encouraged but not required and Veterans could repeat the protocol once (up to 8 sessions). Each session included a mindfulness practice and one of four skills: a distress tolerance skill (STOP, Self-Soothe) or an introductory skill (Function of Emotions, Clarifying Priorities in Interpersonal Interactions). We assessed this protocol’s feasibility (Veterans attending >1 session), acceptability (Veterans attending >2 sessions), and preliminary efficacy (Veterans who had declined referral to the standard DBT Skills Group but sought referral after exposure to the Drop-In DBT Skills Group).

Results. In eight months, 44 transdiagnostic Veterans were referred to the Drop-In DBT Skills Group (including 6 on the wait list). Thirty-seven Veterans attended >1 group (84.1%; feasibility) and of these, 31 attended >2 Drop-In DBT Skills Groups (83.7%; acceptability). Of those who initially declined the standard DBT Skills Group, 13 subsequently requested a referral (48%, preliminary efficacy). Additionally, 36 Veterans who had attended at least one Drop-In DBT Skills Group were invited to attend a focus group. Respondents included 3 Veterans (33% on wait-list) who endorsed strong appreciation of the Drop-In DBT Skills Group, noting it made them more interested in joining the standard DBT Skills Group, and provided social support. Each Veteran shared that they had applied at least one of the skills they had learned.

Discussion. Results suggest the pre-treatment engagement Drop-In DBT Skills Group is feasible, acceptable, and may increase motivation and commitment for more ambivalent patients who could benefit from evidence-based treatment to build coping skills. Veterans reported valuing the group and the majority attended two or more sessions. While this project did not collect individual clinical outcomes, this evaluation indicates the Drop-In DBT Skills Group is promising for helping patients in need of coping skills increase their willingness to access needed evidence-based care. Similar models for enhancing patients’ willingness to engage in treatment after disaster or crisis are worthy of study.