Background: Preventing veteran suicide requires addressing mechanisms driving suicidal behavior, such as emotion dysregulation. Dialectical Behavior Therapy Skills Groups (DBT-SG) are well established for reducing emotion dysregulation, improving coping skills, and in some studies, reducing suicide attempt, but will require implementation support to deliver DBT-SG and to test its effectiveness within the Veterans Health Administration (VHA).
Methods: We conducted a mixed-method developmental formative evaluation of DBT-SG at four VHA medical centers, guided by the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, as part of a hybrid effectiveness-implementation trial (Clinical trials ID, NCT05000749).
Results: Quantitative Organizational Reasons for Change Assessment data (n = 30 VHA staff) and qualitative data (n = 35 VHA staff) were merged, compared, and triangulated. Quantitative and qualitative data largely converged, showing favorable views of evidence supporting DBT-SG and strong enthusiasm for its potential to reduce veteran suicide attempt. Staff noted DBT-SG's broad applicability to veterans. Staff were less optimistic about the inner context supporting DBT-SG implementation, commenting on how limited staffing could be a barrier despite leadership wanting to support suicide prevention.
Conclusions: Implementation barriers to DBT-SG at VHA include limited staffing, despite staff enthusiasm. The next phase of this project will evaluate DBT-SG effectiveness in a randomized controlled trial.
Clinical trials registration: https://clinicaltrials.gov/study/NCT05000749, identifier NCT05000749.
Keywords: Dialectical Behavior Therapy; Veterans Health Administration; emotion dysregulation; i-PARIHS; implementation; mixed methods; psychotherapy; suicide prevention.
This work is authored by Suzanne E. Decker, Aimee Kroll-Desrosiers, Kristin Mattocks, Frances M. Aunon, Elizabeth Galliford, Neal Doran, Scarlett Baird, Jennifer K. Rielage, Josephine Ridley, Jenny Bannister, Thorayya S. Giovannelli, Sara J. Landes, Marianne Goodman, Lorrie Walker, Eric DeRycke, Chris Shriver, Ethan Spana, Mark Honsberger, Hannah Brown, Stacey Demirelli, Elena Shest and Steve Martino on behalf of the U.S. Government and as regards Dr. Decker, Dr. Kroll-Desrosiers, Dr. Mattocks, Dr. Aunon, Ms. Galliford, Dr. Doran, Dr. Baird, Dr. Rielage, Dr. Ridley, Dr. Bannister, Dr. Giovannelli, Dr. Landes, Dr. Goodman, Ms. Walker, Mr. DeRycke, Mr. Shriver, Mr. Spana, Mr. Honsberger, Ms. Brown, Ms. Demirelli, Ms. Shest and Dr. Martino and the U.S. Government, is not subject to copyright protection in the United States. Foreign and other copyrights may apply.