Telehealth-Delivered Radically Open Dialectical Behavior Therapy for Adolescents (RO DBT-A): A Pilot Mixed-Methods Study

Objective: Disorders related to overcontrol frequently first appear during adolescence, are highly comorbid, and show limited treatment response, necessitating the adaptation of radically open dialectical behavior therapy (RO DBT; transdiagnostic treatment targeting overcontrol) for adolescents (RO DBT-A). This study tested the preliminary efficacy of telehealth-delivered RO DBT-A in a heterogeneous clinical sample of youths. Methods: The sample consisted of 20 female participants ages 13-21 with elevated overcontrol; most were White (75%) and non-Hispanic/Latino (80%). RO DBT-A was provided over 20 weeks via skills group and individual sessions (N =13 participants). Participants seeking other treatment or no treatment formed the control group (N =7). Outcomes included self -reported symptoms and overcontrol. Follow-up interviews were analyzed by using inductive, contextualist thematic analysis to examine participant perceptions and reasons for dropout. Results: The RO DBT-A group showed significant improvements in depression (t =-1.78, df =10, p =0.011) and quality of life (QOL; Wilcoxon W =75, p =0.021) compared with the control group. From baseline to posttreatment, youths receiving RO DBT-A demonstrated significant improvements in maladaptive overcontrol (t =2.76, df =12, p =0.043), anxiety (t =2.91, df =12, p =0.043), depression (Wilcoxon signed rank V =82.5, p =0.043), and QOL (t =-3.01, df =12, p =0.043). Qualitative analysis revealed themes related to treatment barriers, facilitators, and timing. Conclusions: The findings provide preliminary evidence supporting telehealth-delivered RO DBT-A in targeting overcontrol, decreasing symptomatology, and improving QOL in a heterogeneous clinical sample of youths. Qualitative followups highlighted that dropout was driven by barriers related to therapy (e.g., structure- and therapist -related issues) and the timing of RO DBT-A compared with other treatments.