Internet-Delivered Dialectical Behavior Therapy Skills Training for Suicidal and Heavy Drinkers

Abstract

Internet-Delivered Dialectical Behavior Therapy Skills Training for Suicidal and Heavy Drinkers Chelsey Rochelle Wilks A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy University of Washington 2018 Reading Committee: Marsha M. Linehan, Chair Mary Larimer Kevin King Program Authorized to Offer Degree: Clinical Psychology ©Copyright 2018 Chelsey Rochelle Wilks University of Washington Abstract Internet-Delivered Dialectical Behavior Therapy Skills Training for Suicidal and Heavy Drinkers Chelsey Rochelle Wilks Chair of the Supervisory Committee Professor Marsha M. Linehan Department of Psychology Alcohol use is considered to be a significant risk factor among those who die by suicide, especially among those who drink to regulate their emotions. Unfortunately, there is a dearth of treatment outcome research for individuals presenting with both suicide ideation and problem drinking. Moreover, treatments that target this population must be maximally effective and widely disseminable. The application of technology has been increasingly utilized as an efficacious and acceptable way to rapidly disseminate evidence-base treatment. However, these methods are used infrequently for individuals deemed too high risk for Internet-delivered treatment. Dialectical Behavior Therapy (DBT) skills training is an effective intervention for behaviors associated with emotion dysregulation including addictive and suicidal behaviors. DBT skills use has been identified as the active ingredient for treatment effectiveness; thus, a skills training intervention delivered via the Internet has the capacity to be a potent and efficient method of treatment delivery. This project sought to evaluate the usability, feasibility, acceptability, and preliminary efficacy of an Internet-delivered DBT skills training intervention compared to a waitlist control. Participants (N = 59) were randomized to receive the treatment immediately or after an 8-week waiting period. Primary outcomes were suicide ideation, alcohol use, and emotion dysregulation and secondary outcomes were reasons for living, alcohol related consequences, DBT skills use, and depression. Participants on average saw a significant reduction in all primary and secondary outcomes over the four-month study period. Individuals who were randomized to receive iDBT-ST first had faster reductions in suicide ideation and alcohol consumption. These preliminary results suggest that iDBT-ST may be a viable and accessible resource for high-risk and underserved populations.