Provider Perspectives on Delivering Dialectical Behavior Therapy via Telehealth During COVID-19 in the Department of Veterans Affairs

Dialectical Behavior Therapy (DBT) is an evidence-based psychotherapy (EBP) for repeated suicidal and nonsuicidal self-injury and Borderline Personality Disorder. There has been little research on the effectiveness or implementation of DBT via telehealth. However, literature has demonstrated that other EBPs delivered via telehealth are just as effective as in person. DBT differs from these EBPs in complexity, inclusion of group sessions, length of treatment, and focus on individuals at high risk for suicide. The coronavirus disease 2019 (COVID-19) pandemic caused mental health care services across the country and Department of Veterans Affairs (VA) to transition to telehealth to reduce infection risk for patients and providers. This transition offered an opportunity to learn about implementing DBT via telehealth on a national scale. We conducted a survey of DBT team points of contact in VA (N = 32) to gather information about how DBT via telehealth was being implemented, challenges and solutions, and provider perceptions. The majority reported that their site continued offering the modes of DBT via telehealth that they had offered in person. The predominant types of challenges in transitioning to telehealth were related to technology on the provider and patient side. Despite challenges, most providers reported their experience was better than expected and had positive perceptions of patient acceptability. Skills group was the more difficult mode to provide via telehealth. Providers endorsed needing additional tools (e.g., means to get diary card data electronically). Multiple benefits of DBT via telehealth were identified, such as addressing barriers to care including distance, transportation issues, and caregiving and work responsibilities. Impact Statement The transition to telehealth during the coronavirus disease 2019 (COVID-19) pandemic offered an opportunity to learn about implementing Dialectical Behavior Therapy (DBT) via telehealth on a national scale in the Department of Veterans Affairs. In a survey of DBT team points of contact (N = 32), the predominant challenges were related to technology, most reported their experience was better than expected, and they had positive perceptions of patient acceptability. Multiple benefits of DBT via telehealth were identified, such as addressing barriers to care including distance, transportation issues, and caregiving and work responsibilities.