To Adopt or Adapt: A Scoping Review of Dialectical Behaviour Therapy With Patients With Minoritised Identity Constructs

Abstract

Objective

Dialectical behaviour therapy (DBT) is an evidence-based psychological intervention (EBP) for reducing suicide behaviour. While DBT, like many EBPs, was developed and first evaluated in largely white samples in Western contexts, it is now broadly applied. This review assessed how DBT has been adopted or adapted when used with patient populations with minoritised identity constructs.

Methods

We conducted a PRISMA-guided scoping review of articles using DBT with a minoritised patient population. We used an implementation science framework, Framework for Reporting Adaptations and Modifications-Enhanced, to characterise adaptations to the content and context of DBT application. Through PubMed, Embase and PsycINFO, we identified 273 articles where the title or abstract mentioned DBT and described a minoritised adult patient population.

Principle Findings

We found 83.5% (228/273) articles reviewed reported adaptations to DBT content. Specifically, 66.3% (181/273), 44.6% (122/273) and 39.6% (108/273) of articles described reducing, expanding or changing DBT content, respectively. We found that 42.1% of articles (115/273) reported adaptations to the DBT context. Moreover, 57.5% of content adaptations and 65.3% of context adaptations did not specify a reason for adaptation.

Conclusions

This scoping review indicates that the majority of articles of studies using DBT with patients with minoritised identity constructs made adaptations to DBT, but few provided justification for these adaptations. We encourage clinicians and clinical administrators, researchers and policymakers to document adaptations and justifications thereof, and evaluate clinical and implementation outcomes.