Skills-homework completion and phone coaching as predictors of therapeutic change and outcomes in completers of a DBT intensive outpatient programme.

ABSTRACT

OBJECTIVES: Dialectical behaviour therapy (DBT) emphasizes generalization of skills to the patient's real-world context as a primary mechanism of change in treatment. To promote generalization, DBT includes weekly skills-focused homework assignments and as-needed phone coaching. Despite this central function of generalization in DBT, research on these treatment components is limited. The current study addresses this research gap by assessing the association of homework and phone coaching to DBT treatment outcomes. DESIGN: A longitudinal study design explored the extent to which (a) completion of skills homework and (b) frequency of phone coaching were associated with therapeutic changes and treatment outcomes in a DBT intensive outpatient programme (DBT-IOP). METHOD: Medical records and diary cards of 56 patients who had completed a four-month treatment cycle of DBT-IOP were reviewed and coded for proportion of skills homework completed, frequency of phone coaching calls, and reported urges for and engagement in suicide, non-suicidal self-injury, illicit or non-prescribed substance use, and alcohol use behaviours. RESULTS: Completion of skills homework and frequency of phone coaching were significantly associated with (a) reduced urges for suicide, non-suicidal self-injury, illicit or non-prescribed substance use, and alcohol use from the beginning to end of treatment and (b) a lower likelihood of engaging in any of these behaviours during the final month of treatment. CONCLUSIONS: Results suggest that within a DBT programme modified for an intensive outpatient setting, skills homework and phone coaching may enhance therapeutic change and outcomes in target behaviours. These generalization methods appear to be important ingredients of DBT effectiveness. PRACTITIONER POINTS In dialectical behaviour therapy (DBT), therapeutic skills homework and phone coaching are specifically designed to promote generalization of skills from the therapeutic context to the patient's real-world contexts. In a DBT intensive outpatient programme, patient engagement with therapeutic homework and phone coaching were associated with favourable therapeutic change and outcomes in target urges and behaviours. Clinicians may consider a patient's lack of homework completion and/or phone coaching to be early warning signs of poor therapeutic progress within dialectical behaviour therapy.