Computer-Based Training in DBT Validation Strategies

DESCRIPTION (provided by applicant): Dissemination of evidence-based therapies remains a high priority at NIDA. A number of barriers limit accessibility to evidence-based therapies in routine clinical settings. Substance use disorders (SUDs) co-occurring with borderline personality disorder (BPD) pose serious and complex public health problems. Dialectical Behavior Therapy for Substance Abusers (DBT-SUD) is a comprehensive psychosocial treatment, efficacious for substance-dependent individuals with BPD. In Phase I, we developed and evaluated an innovative computer-based training (CBT) prototype highlighting DBT-SUD Validation strategies for drug treatment providers using an iterative process of prototype development. Validation strategies are among the core treatment strategies used in DBT-SUD. We tested the prototype's efficacy in a randomized controlled trial (RCT) comparing the DBT-SUD CBT (n = 12) to a control CBT (n = 12) in a sample of treatment providers from routine drug treatment settings. Results demonstrated that the DBT-SUD CBT was efficacious at producing knowledge gains, recall of course strategies, increased self-efficacy in treating drug-addicted BPD patients, and use of skills in therapeutic settings in subsequent weeks. We propose to significantly expand this course content and its evaluation in Phase II. We will again use an iterative process of development, relying on extensive end-user testing and feedback from a panel of scientific advisors and DBT-SUD experts. Upon completion, we will begin a RCT (n = 120) to compare the CBT (n = 40) to other 'standard' training methods, specifically instructor-led training (n = 40) and text (n = 40). In addition to the outcome variables assessed in Phase I, we will include a performance-based test assessing clinical application of skills for Phase II. In the clinical application test, subjects will take part in a role-play scenario where they will act as DBT-SUD therapist, and a research assistant will act as a fictional 'client'. These role-plays will be video-taped and coded for adherence.