Effectiveness of Delivering Dialectical Behavioral Therapy Techniques by Email in Patients With Borderline Personality Disorder: Nonrandomized Controlled Trial

BACKGROUND: Borderline personality disorder is a debilitating and prevalent mental health disorder, with often inaccessible treatment options. Electronically delivered dialectical behavioral therapy could be an efficacious and more accessible intervention. OBJECTIVE: We aimed to evaluate the efficacy of electronic delivery of dialectical behavioral therapy in the treatment of individuals with symptoms of borderline personality disorder. METHODS: Study participants diagnosed with borderline personality disorder were offered either an email-based or in-person group format dialectical behavioral therapy skill-building program. During each session, participants were provided with both the material and feedback regarding their previous week’s homework. Electronically delivered dialectical behavioral therapy protocol and content were designed to mirror in-person content. Participants were assessed using the Self-Assessment Questionnaire (SAQ) and Difficulties in Emotion Regulation Scale (DERS). RESULTS: There were significant increases in SAQ scores from pre- to posttreatment in the electronic delivery group (F(1,92)=69.32, P<.001) and in-person group (F(1,92)=60.97, P<.001). There were no significant differences observed between the groups at pre- and posttreatment for SAQ scores (F(1,92)=.05, P=.83). There were significant decreases in DERS scores observed between pre- and posttreatment in the electronic delivery group (F(1,91)=30.15, P<.001) and the in-person group (F(1,91)=58.18, P<.001). There were no significant differences observed between the groups for DERS scores pre- and posttreatment (F(1,91)=.24, P=.63). There was no significant difference in treatment efficacy observed between the 2 treatment arms (P<.001). CONCLUSIONS: Despite the proven efficacy of in-person dialectical behavioral therapy in the treatment of borderline personality disorder, there are barriers to receiving this treatment. With the prevalence of internet access continuing to rise globally, delivering dialectical behavioral therapy with email may provide a more accessible alternative to treatment for individuals with borderline personality disorder without sacrificing the quality of care. TRIAL REGISTRATION: ClinicalTrials.gov NCT04493580; https://clinicaltrials.gov/ct2/show/NCT04493580