Staff perspectives on implementing dialectical behavior therapy skills groups in the Veterans Health Administration.

Abstract

Reducing veteran suicide is a high priority for the Veterans Health Administration (VHA). While dialectical behavior therapy skills groups (DBT-SG) may be as effective as comprehensive DBT in reducing suicide attempt, barriers and facilitators to this innovation in VHA are not well known. In preparation for a hybrid Type 1 effectiveness-implementation trial, we conducted individual semistructured qualitative interviews with 35 VHA staff (therapists, suicide prevention coordinators, local and national leaders) and identified themes using rapid qualitative analysis (Hamilton, 2013). Five themes emerged: (a) While leadership noted wanting innovative suicide prevention, (b) knowledge of DBT varied widely across respondents. (c) Implementation challenges, especially after COVID-19, included staff shortage and burnout. (d) DBT-SG may require adaptation to fit the diversity of the veteran population, including Indigenous, homeless, and urban veterans, and (e) virtual DBT-SG options hold promise for expanding reach and access and must be implemented with appropriate risk management. Enthusiasm for DBT-SG was high, and implementation challenges in a stressed health care system were noted. DBT-SG, especially delivered virtually, holds promise for VHA and will need to be implemented with attention to staffing, provider needs, and veteran diversity. (PsycInfo Database Record (c) 2025 APA, all rights reserved).