NHS mental health services continue to experience high demand and limited capacity, contributing to long waiting times and poorer outcomes for service users. Dialectical behaviour therapy (DBT) skills groups are an established intervention for emotion dysregulation, yet little is known about whether group size influences treatment outcomes. This comparative service evaluation examined whether larger DBT skills training groups (20 participants), delivered as a standalone intervention, produced outcomes and retention comparable to standard–sized groups (12 participants), to provide preliminary evidence regarding the feasibility of increasing service capacity. Routinely collected data were analysed for 206 adults who attended standalone DBT skills training groups, delivered in cohorts of either 12 participants (n = 103) or 20 participants (n = 103). Emotion regulation difficulties were assessed pre– and post–intervention using the Difficulties in Emotion Regulation Scale (DERS–18). Drop-out rates were used as an indicator of retention. Independent samples t-tests indicated no significant differences in treatment outcomes between smaller and larger groups (p =.300, d = 0.15). Drop-out rates were comparable across formats (36% vs 43%). Larger DBT skills–training groups produced comparable outcomes and retention to the service’s standard–sized groups. These findings offer preliminary feasibility signals that increasing group size may help expand access, although controlled research is required before wider implementation.

Key learning aims

1. (1) To evaluate the feasibility of delivering DBT skills‑training in larger groups within routine NHS practice by examining whether increasing group size affects clinical outcomes.

2. (2) To compare retention across 12- and 20-person DBT skills-training formats by comparing engagement and discontinuation rates as part of a comparative service evaluation.

Transgender and gender diverse (TGD) young people face elevated risk of emotion dysregulation, depression, anxiety, and self-harm and suicide, likely due to chronic invalidation leading to emotion dysregulation. Dialectical Behaviour Therapy (DBT) is an effective intervention for these difficulties, but has not been fully optimised for TGD-specific experiences. TGD-specific charities may be viewed as safer and more accessible than NHS services, though they may lack resources for evidence-based interventions. This study aimed to optimise DBT skills training for TGD young people (DBT-TGD+) and assess the feasibility and acceptability of delivering this intervention within a TGD charity. Early indicators of effectiveness were also examined. An open pilot trial, with a case series design and qualitative methods, was conducted. TGD young people (aged 16–25 years) with self-reported emotion regulation difficulties attended a 16-week DBT skills training group co-facilitated by a psychologist and two TGD charity youth workers. Quantitative and qualitative data assessed feasibility, acceptability, mental health (emotion dysregulation, depression, anxiety), and TGD-specific outcomes. Reliable change and clinically significant change were calculated where norms existed. Qualitative data underwent reflexive thematic analysis. Twelve participants were recruited, with 75% retention and 80% average attendance. Participants and facilitators rated the intervention as feasible and acceptable. Qualitative findings highlighted perceived benefits. Reliable and clinically significant change ranged from 25% to 75% across mental health outcomes, with additional positive trends in some TGD-specific measures. DBT-TGD+ was feasible and acceptable to deliver in a TGD charity setting. Findings inform future intervention refinement and research.

Background: Patients diagnosed with a personality disorder (PD) are often stigmatized by the healthcare staff who treat them. Aims: This study aimed to compare the impact on front-line staff of a self-management Acceptance and Commitment Therapy-based training intervention (ACTr) with a knowledge- and skills-based Dialectical Behaviour Training intervention (DBTr). Method: A service-based randomized controlled trial was conducted comparing the effects of 2-day ACTr (N = 53) and DBTr (N = 47) staff workshops over 6 months. Primary outcome measures were staff attitudes towards patients and staff-patient relationships. Results: For both interventions, staff attitudes, therapeutic relationship, and social distancing all improved pre- to postintervention, and these changes were maintained at 6-month follow-up. Conclusions: Although offering different resources to staff, both ACTr and DBTr were associated with an improved disposition towards PD patients. Future research could evaluate a combined approach, both for staff working with PD patients and those working with other stigmatized groups.

Implementing change in organizational systems is challenging, and implementing a new psychotherapeutic approach is no different. A literature exists on issues in implementation across a wide range of domains (technological, healthcare, justice). However, little of it is utilized in endeavours to implement innovations in psychological treatments. This paper draws on the implementation literature and on the experiences of the British Isles DBT Training Team (BIDBT) in implementing Dialectical Behaviour Therapy (DBT) in mental healthcare systems in the UK over the last 13 years. This paper describes principles and strategies of ‘organizational pre-treatment’ as a necessary prerequisite to implementation.

NICE Clinical Guideline no. 78 recently identified Dialectical Behaviour Therapy (DBT) as an appropriate treatment approach for the effective treatment of suicidal behaviours in the context of borderline personality disorder. Uniquely among the cognitive behavioural therapies DBT is a team-based treatment. This paper focuses on the task of selecting and training a team before considering issues in the training and supervision of therapists learning this approach.