title: Teaching Dialectical Behavior Therapy to Psychiatry Residents: The Columbia Psychiatry Residency DBT Curriculum.
abstract: OBJECTIVE
  Dialectical behavior therapy (DBT) is an evidence-based psychosocial treatment with efficacy in reducing self-harm behaviors in borderline personality disorder (BPD). This study describes and evaluates a clinical curriculum to teach DBT to psychiatry residents, developed at a large urban university hospital. The curriculum objectives are to (1) have psychiatry residents achieve basic understanding of DBT theory and clinical skill, (2) increase residents' ability and confidence in treating self-harm behaviors (both suicidal behavior and non-suicidal self-injury), and (3) enhance residents' willingness to treat individuals with BPD.
  
  
  METHODS
  In addition to a 6-week didactic course on DBT offered to all residents (n = 62), 25 elected to enroll in a year-long DBT clinical training curriculum over the course of a 5-year period. The DBT clinical training consisted of 15 h of additional didactics, ongoing conduct of individual therapy and group DBT skills training, videotaping of individual therapy sessions, and weekly supervision meetings utilizing videotape to provide feedback. Residents participating in the clinical training program videotaped baseline and later sessions, which were rated for DBT adherence. All 62 graduates of the program were surveyed regarding the impact of the training on their practice of psychiatry.
  
  
  RESULTS
  Upon graduation, a high percentage (87 % in the curriculum and 70 % in the didactic course only) reported incorporating DBT into their psychiatry practice, as well as willingness and confidence in treating BPD and self-harm behaviors. Residents participating in the clinical training demonstrated significant improvement in their ability to utilize DBT interventions, particularly in structuring sessions, problem assessment, problem solving, and using validation and dialectical strategies.
  
  
  CONCLUSIONS
  This DBT curriculum was effective in preparing psychiatrists-in-training to incorporate evidence-based practices for effective treatment of BPD and self-harm behaviors and can serve as a model for teaching DBT during psychiatry residency training. Limitations include a small sample size and lack of baseline survey measurement of attitudes for pre- and post-curriculum comparison.
authors.affiliation: Columbia University College of Physicians and Surgeons, New York, NY, USA. Brodsky@nyspi.columbia.edu.
authors.forename: Beth S
authors.initials: BS
authors.lastname: Brodsky
authors.affiliation: Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Cabaniss
authors.affiliation: Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Arbuckle
authors.affiliation: Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Oquendo
authors.affiliation: Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Stanley
mesh_terms: D000046:Academic Medical Centers; D001521:Behavior Therapy / Q000193:education*; D001883:Borderline Personality Disorder / Q000628:therapy; D003479:Curriculum; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D009518:New York; D011570:Psychiatry / Q000193:education*; D000092864:Suicide Prevention
keywords: Psychotherapy; Residents; Supervision