Research Lightning Round

CE Hours 1

About this course

This one hour CE "lightning round" session will provide an overview of recent research findings and innovative applications of DBT. Attendees will gain insights into the effectiveness of DBT in various populations and clinical presentations.

Feasibility and Acceptability of an Abbreviated DBT Skills Group in a Rural County Jail
Authors: Summarell, M. (presenter) & Moore, K.
BPD is highly over-represented in the criminal legal system (CLS; Mir et al., 2015). Dialectical behavior therapy (DBT) is an evidence-based approach for reducing BPD symptoms and related consequences (Linehan, 1993). Limited studies have examined DBT in CLS settings (Black et al., 2013; Nee & Farman, 2008; Whal, 2011), specifically in rural jail settings. The current study examined the feasibility and acceptability of an abbreviated DBT skills group delivered in a rural jail. Participants (N=24) were adults incarcerated in a rural jail who had elevated BPD symptoms. Participants engaged in an 8-session DBT group, which was implemented per an abbreviated manual previously implemented in an urban jail setting by our research team (Moore et al., 2018). Groups were led by two therapists trained in DBT within a designated classroom space in the jail. Three cohorts of incarcerated individuals (two male, one female) participated in the study. Feasibility was tracked via recruitment, attendance, and retention rates during the intervention. Additionally, participants were asked to complete anonymous feedback forms following each group session to measure acceptability. These forms captured their comfort with the group and its leader, how much they learned in the group, how useful the skills were, and how much they felt groups addressed problems with BPD symptoms. Open-ended questions were also included to capture suggestions for improvement. A total of 24 participants agreed to participate, and 5 completed all 8 sessions. Participants attended an average of 4.7 group sessions. There were high levels of non-adherence and drop-out, mostly attributed to logistical constraints of incarceration (e.g., jail policies and procedures). However, levels of acceptability were very high, with average scores ranging from 29.7-34.3 (possible range = 7-35) on feedback forms. Overall, results suggest that more psychoeducation and collaboration with jail officials is needed to improve feasibility of providing DBT skills groups in jail settings. In particular, policies that restrict incarcerated people with behavior problems from participating in groups challenge the implementation of DBT. The importance of this is underscored by high levels of acceptability, indicating clients in this setting find the group important and useful in managing psychological distress. Future research teams should explore specific strategies to improve the feasibility of implementing DBT skills groups in rural jails. The current study presents results for one aim of a larger study examining post-release outcomes of a DBT skills group. These findings are relatively brief, making them well-suited for a lightning talk.

Unpacking invalidating experiences: Daily emotional invalidation and minority stress as within-person predictors of borderline personality disorder
Authors: Ilagan, G. (presenter), Conway, C., Schirle, G., Gilbert, K., Lehman, E., & Rutter, L. A.
Dialectical behavior therapy’s (DBT) transactional model of emotion dysregulation proposes that invalidating experiences contribute to the development and maintenance of borderline personality disorder (BPD) symptoms. Most of the evidence to support this theory addresses the long-term effects of childhood invalidation experiences; relatively little is known about how invalidation relates to BPD symptoms in adulthood and at a within-person level. Moreover, recent theories have proposed that identity-related minority stressors may function as additional and extreme forms of invalidation for sexual/gender minoritized (SGM) and ethnic/racial minoritized (ERM) groups, who have been historically marginalized and underrepresented in the DBT literature. In a sample enriched for SGM and ERM identities, our study aimed to (1) examine within-person covariation in day-to-day perceived invalidation and BPD symptom severity and (2) explore minority stress as a form of invalidation – one that targets aspects of people’s minoritized identities. We recruited 170 community adults and 339 undergraduate students, oversampling from SGM and ERM groups, to complete daily surveys of invalidation, minority stress (expectations of rejection, internalized stigma), and BPD features over 2 weeks. Multilevel models examined within-person and between-person associations between daily stressors and SI. We observed that daily invalidation (r = .35) and, to a smaller extent, minority stress (rs = .22-.23) had meaningful within-person correlations with same-day BPD symptoms. Despite moderate between-person correlations (r range: .28 to .41) between invalidation and minority stress measures, they were more modestly associated on a within-person basis (r range: .09 to .11). In a multilevel multiple regression model, both invalidation and minority stress uniquely predicted daily PD symptoms, collectively accounting for approximately 20% of within-person outcome variation. These findings extend DBT’s invalidation model by showing that not only do daily invalidation experiences contribute to fluctuations in BPD symptoms, but that minority stress – conceptualized as identity-specific, extreme forms of invalidation – also plays a unique and additive role. For DBT clinicians, this suggests the importance of explicitly addressing minority stressors in therapy, particularly with clients from SGM and ERM backgrounds. Integrating culturally responsive strategies and helping clients build awareness of how invalidation operates both interpersonally and systemically may enhance the effectiveness of DBT for diverse populations.

Predictors of Therapeutic Alliance Trajectories in DBT for BPD
Authors: Chen, S. (presenter) & Chapman, A.
Therapeutic alliance plays a critical role in psychotherapy outcomes, particularly in the treatment of Borderline Personality Disorder (BPD), a condition marked by pervasive interpersonal difficulties. Recent research has underscored the importance of examining the therapeutic alliance longitudinally in the context of Dialectical Behavior Therapy (DBT) for BPD (Guimond et al., 2022; Bedics et al., 2015). However, little is known about the client and treatment factors that shape alliance trajectories in DBT. This study examined whether client characteristics (e.g., treatment expectancy) and treatment-related variables (e.g., DBT treatment duration) predicted the course of therapeutic alliance over time. Data were drawn from a previously published randomized controlled trial (McMain et al., 2022), which included 240 individuals diagnosed with BPD and presenting with suicidality and/or self-injurious behaviors. Participants were randomly assigned to receive either 6 months (DBT-6) or 12 months (DBT-12) of DBT. Clients reported treatment expectancy prior to start of therapy, while both clients and therapists completed the Working Alliance Inventory (WAI) at weeks 1, 2, 3, and 4, and at 3 and 6 months. Growth curve modeling was used to analyze trajectories of WAI total scores and the task, bond, and goal subscales. Results indicate that early client-rated alliance (first four sessions) was best modeled with a linear trajectory, whereas later alliance (1, 3, and 6 months) followed a quadratic pattern. Higher client treatment expectancy predicted stronger baseline client-rated alliance across WAI subscales but did not influence the rate of change of alliance trajectories. Compared to DBT-6, clients in the DBT-12 condition showed a more positive early trajectory in WAI Goal, though no significant group differences emerged in client-rated early alliance trajectories for other subscales or the total score. Notably, the acceleration rate of the WAI Task trajectory differed significantly between conditions during the later phase of treatment. Analyses of therapist-rated alliance are ongoing and will be completed by the end of summer. Clinically, the findings highlight the importance of fostering treatment expectancy and a strong early alliance while also attending to the evolving nature of the therapeutic relationship over time, which may follow a non-linear trajectory and vary depending on treatment duration.

The Comprehensive Adaptive Multisite Prevention of University student Suicide (CAMPUS) Trial: Primary Outcomes
Authors: Rizvi, S. (presenter), Compton, S., Seeley, J., Blalock, K., Kassing, F., Sinclair, J., Oshin, L., Gallop, R., Snyderman, T., Crumlish, J., Jobes, D., Stadelman, S., Sapin, F., Krall, H., Davies, K., Steele, D., Goldston, D., & Pistorello, J.
We would like the opportunity to present the primary outcome results from the CAMPUS Trial to the ISITDBT community. To our knowledge, this is the largest trial conducted on students presenting to university counseling centers (UCCs) with high suicide risk. As rates of suicidal ideation increase among students, university counseling centers are faced with limited resources to meet the growing and complex needs of suicidal students. The purpose of this study was to develop and evaluate 4 adaptive treatment strategies (ATSs) for students at risk for suicide treated in university counseling centers. In a sequential multiple assignment randomized trial (SMART) across four sites, 227 diverse university students ages 18-25 years (Mage = 20; 56% white; 63% female) with moderate to high risk for suicide were first randomized (Stage 1) to either 4-6 weeks of a suicide focused treatment (CAMS) or treatment as usual (TAU). Insufficient responders to Stage 1 treatment were then re-randomized to one of two Stage 2 treatments for an additional 1-8 weeks of CAMS or an adapted form of Dialectical Behavior Therapy (CC-DBT). Primary outcomes were treatment response (CGI-I≤2) and total scores on the Scale for Suicide Ideation (SSI). Overall, all participants demonstrated significant improvement in suicide risk over the course of the trial, with an average response rate of 61.0% and a 7.57 (SE=0.32) reduction in SSI total scores across all ATSs at the end of acute treatment. Overall comparisons found significant differences in response rates (p<.04) and symptoms (p<.01) with more improvement in students who started with TAU and then switched to CAMS (ATS-3). The difference in the estimated mean SSI scores between the most effective ATS (TAU-CAMS) and the other three ATSs was 1.68 (95%CI=0.43,2.94) and a difference in response rates of 13.0% (95%CI=2.6%,23.4%). Results suggest that university students at risk for suicide can be safely and effectively treated in counseling centers. Implications for the implementation of suicide-specific treatments, like CAMS and DBT, into UCCs will be discussed.

Examining Payment Choices for DBT Clinicians
Authors: Oshin, L. (presenter), Wang, I., Mathew, D., Ogunnaya, Z., Rizvi, S., Deleta, T.
Despite the vast array of evidence demonstrating the effectiveness and efficacy of Dialectical Behavior Therapy for borderline personality disorder, suicide and self-harm behavior, and chronic emotion dysregulation (DeCou et al., 2019; Rizvi et al., 2024), DBT has gained a reputation of being a treatment that is difficult to access. Comprehensive DBT involves more components than traditional individual outpatient therapy, requires extensive training, and can be difficult to cover using insurance (Koons et al., 2013; Sloan et al., 2023). Minimal options for payment, such as insurance or sliding scale fees, can be a barrier to access, particularly among individuals with low socioeconomic status or who are marginalized in other ways. Additionally, there is evidence that mode of payment can be an indicator of effectiveness of DBT (James et al., 2015). Despite evidence that DBT might be a uniquely difficult treatment to cover using insurance, there is little research to demonstrate how DBT clinicians approach billing and payment. The current study sought to explore factors related to billing among DBT clinicians. Data were collected using an online questionnaire that was distributed among two listservs of DBT clinicians (n = 277). Clinicians reported on their demographic information, their clinical practice, how they handle billing, and provided qualitative data on their perspectives of billing for DBT. Participants were mostly psychologists (36.8%) and social workers (35.3%) and had been licensed for M = 13.00 (SD = 8.40) years. Many clinicians accept multiple options for clients to pay for services. The most common was private pay (85.2%), followed by private insurance (49.5%), and Medicaid/Medicare (30.3%). Clinicians reported that an average of 61.8% of their clients used private pay, 52.2% used private insurance, and 36.5% used Medicaid/Medicare. Clinicians who had been licensed longer were more likely to accept Medicaid/Medicare (t(255) = -2.07, p = .02) or a health management organization (HMO) (t(255) = -2.82, p = .003). Finally, clinicians’ qualitative responses indicated that they find it uniquely difficult to accept insurance for DBT because they cannot get all components of the intervention covered, making it difficult to balance their desire to make DBT accessible to those who need it with their desire to have their compensation correspond to their work. This presentation will present more information regarding the clinicians, their practices, and will combine qualitative and quantitative data to explore barriers to expanding payment options for DBT.

Learning Objectives

State the prevalence rate of BPD in legal settings.
Recite 2 reasons DBT is appropriate for legal settings.
State the advantages of daily diary study designs and within-person analyses
Explain the theory that minority stress functions as an extreme form of invalidation
Describe the role of therapeutic alliance in DBT for clients with BPD
Explain how treatment expectancy may influence alliance trajectories
Identify differences in alliance trajectories between shorter term (6 months) and longer term (12 months) of DBT treatment
Identify primary outcomes of this trial and implications for UCCs.
Itemize 3 common barriers to receiving DBT care.
Explain the most common ways that clinicians seek payment for their services.
Critique the current payment options, particularly in how they fail DBT clinicians.

Learning Levels

All Levels

Target Audience

This educational activity is intended for behavioral health professionals, including Psychologists, Social Workers, Counselors, MFT's, Psychiatrists, and nurses.

Course Instructor(s)

Madison D. Summarell, M.A.

Madison Summarell, M.A. is a pre-doctoral psychology intern at the Charleston Area Medical Center (CAMC) and a doctoral candidate in Clinical Psychology at East Tennessee State University (ETSU). She conducts research in the Crime, Addiction, and Re-Entry (CARE) Lab under the mentorship of Dr. Kelly E. Moore at ETSU and at CAMC under the supervision of Dr. Patrick Kerr. Madison’s research focuses on understanding the mechanisms linking borderline personality disorder (BPD) to legal system involvement, including the roles of substance use and emotion dysregulation. She is particularly interested in the implementation of evidence-based interventions—such as dialectical behavior therapy (DBT)—within legal and correctional settings.
Gabrielle Ilagan

Gabrielle (she/her) is a fifth-year Ph.D. student in the Clinical Psychology program. Her research interests broadly include treatment accessibility and short- and long-term changes in personality disorder symptoms, including suicide, nonsuicidal self-injury, and emotion dysregulation, especially in minoritized populations. Prior to joining the Bronx Personality Lab, Gabrielle worked at McLean Hospital's Gunderson Personality Disorders Institute. She earned her bachelor's degree in psychology and history with a concentration in global studies from Williams College.
Spencer Chen, MA

Graduate Student

Spencer Chen (she/her/hers) is a clinical psychology PhD student at the Personality and Emotion Research Lab at Simon Fraser University. She is passionate about research on borderline personality disorder, DBT, suicide, and emotion regulation.
Shireen L. Rizvi, PhD, ABPP

Shireen L. Rizvi, PhD, ABPP, is Professor of Psychiatry and Behavioral Sciences at Montefiore Einstein Medical Center in New York, where she serves as Director of Psychology Training and Director of DBT Services and Research. Dr. Rizvi received her doctorate under the mentorship of Marsha M. Linehan. She has received extensive grant funding and published dozens of research papers. Dr. Rizvi is board certified in cognitive and behavioral therapies and DBT. Her mission is to get DBT tools to as many people as possible. Her website is www.shireenrizvi.com.
Linda Oshin

Linda Oshin is an Assistant Professor at the Rutgers University Graduate School of Applied and Professional Psychology. She earned her Ph.D. in clinical psychology from the University of Connecticut. She completed her predoctoral internship at the Yale Department of Psychiatry and her postdoctoral fellowship at GSAPP. Her program of research focuses on the social context of depression, emotion dysregulation, and suicidality among adolescents and young adults of color. Specifically, she studies ethnic-racial identity, family racial socialization, cultural values, and treatment engagement. Her research goal is to make mental health treatment more effective and accessible to youth of color.

References

Smith, M., Kromash, R., Siebert, S., Punceles Y., & Moore, K. E. (2022). Borderline Personality Disorder among Justice-Involved Populations. In C. Garofalo & J. J. Sijtsema (Eds.), Clinical Forensic Psychology – Introductory Perspectives on Offending. Palgrave Macmillian.
Eaton-Stull, Y., Streidl, C., Hays, D., Bauer, M., & Rigel, S. (2024). Animal-Assisted Dialectical Behavior Therapy Skills Groups for Those who are Incarcerated: A Pre-Post-test Study. Research on Social Work Practice, 10497315241240708. https://doi.org/10.1177/10497315241240708
Verona, E., McDonald, J. B., Fournier, L. F., Brown, M. E., & Carsten, E. E. (2024). Adapting a dialectical behavior therapy skills group within a jail setting: implementation challenges and considerations. Cognitive and Behavioral Practice. https://doi.org/10.1016/j.cbpra.2024.05.001
Scanlon, F., & Morgan, R. D. (2025). Mental health services in jail: Identifying and quantifying barriers to implementation. Psychological Services. Advance online publication. https://doi.org/10.1037/ser0000945
Ciesinski, N. K., Sorgi-Wilson, K. M., Cheung, J. C., Chen, E. Y., & McCloskey, M. S. (2022). The effect of dialectical behavior therapy on anger and aggressive behavior: A systematic review with meta-analysis. Behaviour research and therapy, 154, 104122. https://doi.org/10.1016/j.brat.2022.104122
Valentine, S. E., Smith, A. M., & Stewart, K. (2020). A review of the empirical evidence for DBT skills training as a stand-alone intervention. The handbook of dialectical behavior therapy, 325-358. https://doi.org/10.1016/B978-0-12-816384-9.00015-4
Moore, K. E., Folk, J. B., Boren, E. A., Tangney, J. P., Fischer, S., & Schrader, S. W. (2018). Pilot study of a brief dialectical behavior therapy skills group for jail inmates. Psychological services, 15(1), 98. https://doi.org/10.1037/ser0000105
Tomlinson, M. F. (2018). A Theoretical and Empirical Review of Dialectical Behavior Therapy Within Forensic Psychiatric and Correctional Settings Worldwide. International Journal of Forensic Mental Health, 17(1), 72–95. https://doi.org/10.1080/14999013.2017.1416003
Cardona, N. D., Madigan, R. J., & Sauer-Zavala, S. (2022). How minority stress becomes traumatic invalidation: An emotion-focused conceptualization of minority stress in sexual and gender minority people. Clinical Psychology: Science and Practice, 29(2), 185–195. https://doi.org/10.1037/cps0000054
Vijay, A., Fruzzetti, A., & Fruzzetti, A. E. (2023). Racism is an extreme invalidating social environment. 57th Annual Convention of the Association for Behavioral and Cognitive Therapies, Seattle, WA. Available online at https://elearning.abct.org/products/recorded-mini-workshop-15-racism-as-an-extreme-invaliding-environment-2023-convention-recording#tab-product_tab_overview
Hernandez Mozo, E., Siegel, J. A., Jones, I. J., Rivera, D. B., & Blashill, A. J. (2025). The association between minority stressors, intraminority stressors, and borderline personality disorder symptomatology among sexual minority men. Personality Disorders: Theory, Research, and Treatment, 16(2), 193–197. https://doi.org/10.1037/per0000705
Greville-Harris, M., Hempel, R., Karl, A., Dieppe, P., & Lynch, T. R. (2016). The Power of Invalidating Communication: Receiving Invalidating Feedback Predicts Threat-Related Emotional, Physiological, and Social Responses. Journal of Social and Clinical Psychology, 35(6), 471–493. https://doi.org/10.1521/jscp.2016.35.6.471
Denning, D. M., Newlands, R. T., Gonzales, A., & Benuto, L. T. (2022). Borderline Personality Disorder Symptoms in a Community Sample of Sexually and Gender Diverse Adults. Journal of Personality Disorders, 36(6), 701–716. https://doi.org/10.1521/pedi.2022.36.6.701
Feinstein, B. A., Dyar, C., Poon, J. A., Goodman, F. R., & Davila, J. (2022). The Affective Consequences of Minority Stress Among Bisexual, Pansexual, and Queer (Bi+) Adults: A Daily Diary Study. Behavior Therapy, 53(4), 571–584. https://doi.org/10.1016/j.beth.2022.01.013
Haft, S. L., O’Grady, S. M., Shaller, E. A. L., & Liu, N. H. (2022). Cultural adaptations of dialectical behavior therapy: A systematic review. Journal of Consulting and Clinical Psychology, 90(10), 787–801. https://doi.org/10.1037/ccp0000730
Guimond, T. H., Varma, S., Wnuk, S. M., & McMain, S. F. (2021). A longitudinal approach to evaluating therapist and client contributions to alliance on outcomes in borderline personality disorder. Personality Disorders Theory Research and Treatment, 13(6), 583–596. https://doi.org/10.1037/per0000526
Bedics, J. D., Atkins, D. C., Harned, M. S., & Linehan, M. M. (2015). The therapeutic alliance as a predictor of outcome in dialectical behavior therapy versus nonbehavioral psychotherapy by experts for borderline personality disorder. Psychotherapy, 52(1), 67–77. https://doi.org/10.1037/a0038457
McMain, S. F., Chapman, A. L., Kuo, J. R., Dixon-Gordon, K. L., Guimond, T. H., Labrish, C., Isaranuwatchai, W., & Streiner, D. L. (2022). The Effectiveness of 6 versus 12 Months of Dialectical Behavior Therapy for Borderline Personality Disorder: A Noninferiority Randomized Clinical Trial. Psychotherapy and Psychosomatics, 91(6), 382–397. https://doi.org/10.1159/000525102
Kassing, F., Seeley, J. R., Rizvi, S. L., Compton, S. N., Sinclair, J., Oshin, L. A., ... & Pistorello, J. (2024). Assessing the implementation of suicide-focused treatments delivered in hybrid telemental health format in a real-world setting. Psychotherapy Research, 1-15. https://doi.org/10.1080/10503307.2024.2415104
Blalock, K., Pistorello, J., Rizvi, S. L., Seeley, J. R., Kassing, F., Sinclair, J., ... & Compton, S. N. (2025). The Comprehensive Adaptive Multisite Prevention of University Student Suicide Trial: Protocol for a Randomized Controlled Trial. JMIR Research Protocols, 14(1), e68441. doi:10.2196/68441
Jobes, D. A., & Rizvi, S. L. (2024). The use of CAMS and DBT to effectively treat patients who are suicidal. Frontiers in Psychiatry, 15, 1354430. https://doi.org/10.3389/fpsyt.2024.1354430
DeCou, C. R., Comtois, K. A., & Landes, S. J. (2019). Dialectical behavior therapy is effective for the treatment of suicidal behavior: A meta-analysis. Behavior Therapy, 50(1), 60–72. https://doi.org/10.1016/j.beth.2018.03.009
Harned, M. S., Schmidt, S. C., Korslund, K. E., & Gaglia, A. (2024). Therapist adherence to dialectical behavior therapy in routine practice: Common challenges and recommendations for improvement. Journal of Contemporary Psychotherapy, 54(2), 87–98. https://doi.org/10.1007/s10879-023-09601-x
James, S., Freeman, K. R., Mayo, D., Riggs, M. L., Morgan, J. P., Schaepper, M. A., & Montgomery, S. B. (2015). Does insurance matter? Implementing Dialectical Behavior Therapy with two groups of youth engaged in deliberate self-harm. Administration and Policy in Mental Health and Mental Health Services Research, 42(4), 449–461. https://doi.org/10.1007/s10488-014-0588-7
Rizvi, S. L., Bitran, A. M., Oshin, L. A., Yin, Q., & Ruork, A. K. (2024). The state of the science: Dialectical Behavior Therapy. Behavior Therapy, 55(6), 1233–1248. https://doi.org/10.1016/j.beth.2024.02.006
Sloan, C. A., Zelkowitz, R. L., Brooks, T. L., & Cohen, J. M. (2023). A call to increase cultural responsiveness and accessibility of Dialectical Behavior Therapy: Commentary on Jakubovic and Drabick (2023). Clinical Psychology: Science and Practice, 30(3), 268–271. https://doi.org/10.1037/cps0000165

CE Process Info

Content

Research Lightning Round

1 parts
- Research Lightning Round

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Research Lightning Round

About this course

Learning Objectives

Learning Levels

Target Audience

Course Instructor(s)

References

CE Process Info

Content

American Psychological Association (APA)

Joint Accreditation (JA)

New York State Education Department's State Board for Social Work (NYSEDSW)

New York Education Department for Licensed Mental Health Counselors (NYSEDLMHC)

New York State Education Department's State Board for Psychology (NYSEDPSY)

New York State Education Department's State Board for Marriage and Family Therapy (NYSEDMFT)

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