Utilizing Mobile Technology for DBT Skills Generalization with BPD-SUD Clients

DESCRIPTION (provided by applicant): Substance use disorders (SUD) co-occurring with borderline personality disorder (BPD) pose serious and complex public health problems. Dialectical Behavior Therapy for Substance Abusers (DBT) is an efficacious psychosocial treatment for substance dependent individuals with BPD (Linehan, 1993a, b;Lynch et al., 2007). This is a Phase I Small Business Innovation Research (SBIR;R43/44) grant application to NIDA to support the development of an innovative product: the DBT Field Coach, a mobile technology program installed on a smart phone designed to enhance effective generalization of DBT Skills (Linehan, 1993b) in individuals with BPD and SUD. The current application represents a cooperative partnership between the Principal Investigator's small business concern, Behavioral Tech Research, Inc., a company with an impressive history of developing innovative training programs for psychosocial treatments, and the New School for Social Research. The proposed DBT Field Coach will substantially aid in the generalization of DBT skills in the clients'natural environment when they most need assistance. The focus of Phase I will be limited to developing and testing the DBT Field Coach with one DBT skill from the emotion regulation module - Opposite Action (OA). This Phase 1 project is divided into two parts: 1) an initial formative evaluation, characterized by an iterative process of developing the prototype using extensive feedback from target end-users and 2) a summative evaluation involving a randomized controlled feasibility trial (n=30) to evaluate the program's efficacy at increasing frequency and effectiveness of OA skill use, self-efficacy in applying the skill, and retention of content knowledge. Participants will consist of DBT-naove individuals with BPD and SUD recruited from treatment programs in New York City and will be randomized to either the DBT Field Coach condition or to a treatment-as-usual text-based handouts condition. All participants will initially learn OA via an efficacious instructional video designed by treatment developer, Marsha Linehan, for patients with BPD, including those with SUD and will be encouraged to practice the skill. After two weeks, participants will be reassessed in a post-training follow-up. In the event of a successful Phase I test of feasibility, we will substantially expand the DBT Field Coach and its evaluation in Phase II, to include the other DBT skills from all four modules (mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness) as well as unique tools designed to promote effective skills use. Furthermore, we will expand the features available in the DBT Field Coach. If effective, mobile technology offering in-vivo skills coaching may be a powerful tool for reducing urges to use substances and engage in other maladaptive behavior by directly teaching and coaching in alternative, adaptive coping behavior. When used as a treatment adjunct for clients in DBT programs, a DBT Field Coach mobile technology device may also (1) expedite and/or improve clinical outcomes by offering BPD-SUD clients "on-demand" skills coaching and (2) reduce therapist burn-out by reducing after-hours phone coaching calls. PUBLIC HEALTH RELEVANCE: Dialectical Behavior Therapy (DBT) is an efficacious, comprehensive psychosocial treatment for individuals with Borderline Personality Disorder (BPD) and Substance Use Disorder (SUD). The primary goal of this project is to develop and test the feasibility of a DBT Field Coach, a program for a mobile technology device ("smart phone") designed specifically to enhance generalization of DBT skills among clients with BPD and SUD. The DBT Field Coach, by offering in-vivo skills coaching, may be a powerful tool for reducing urges to use substances and engage in other maladaptive behavior by directly teaching and coaching in alternative, adaptive coping behavior.