Since the COVID-19 pandemic, delivering psychotherapy via telehealth has become commonplace, including with dialectical behaviour therapy (DBT); however, there is minimal research examining the difference in engagement between in-person and telehealth DBT. A multi-component intervention, DBT addresses problems associated with emotion dysregulation across a range of diagnoses, including suicidal and self-harming behaviour. Comprehensive DBT includes weekly individual and group sessions, out-of-session skills coaching, and consultation team for therapists. The DBT-Linehan Board of Certification (LBC) certifies DBT programs that demonstrate fidelity to the evidence-based model.

This paper presents data drawn from LBC-certified DBT programs on the delivery of the treatment via telehealth. Primary aims were to determine differences in DBT attendance or non-completion: (1) associated with the transition to telehealth and (2) between clients attending solely in-person vs telehealth.

Data were analysed by cohort: (1) clients who started DBT in-person and transitioned to telehealth; (2) those who were seen solely in-person; and (3) those seen only via telehealth.

There was a lack of significant differences in missed sessions and treatment non-completion when comparing before and after the move to telehealth. Comparing solely in-person to telehealth, significant differences emerged with telehealth demonstrating fewer missed sessions as well as a lower rate of treatment non-completion. No differences were found when comparing adolescent and adult participants.

Implications for telehealth delivery of DBT are provided, along with reflections on the potential impact of client characteristics that can inform future research.

Patients with early cognitive impairment (ECI) face the prospect of progressive cognitive decline that impairs their ability to make decisions on financial and personal matters. Advance care planning (ACP) is a process that facilitates decision making on future care and often includes identifying a proxy decision maker. This prospective study explores factors related to completion or non-completion of ACP in patients with ECI.

Patients with ECI (n = 158, Mage = 76.2 ± 7.25 years) at a memory clinic received psycho-education and counseling on the importance of ACP and followed-up longitudinally for up to 12 months to ascertain if ACP had been completed. Univariate and logistic regression were used to analyze factors related to completion and non-completion of ACP.

Seventy-seven patients (48.7%) were initially willing to consider ACP after the counseling and psycho-educational session but only 17 (11.0%) eventually completed ACP. On logistic regression, patients who were single were 8.9 times more likely to complete ACP than those who were married (p = 0.007). Among those initially willing to consider ACP, factors impeding completion of ACP included patient (48.0%), process (31.0%), and family factors (21.0%).

As unmarried patients may not have immediate family members to depend on to make decisions, they may perceive ACP to be more important and relevant. Understanding the barriers to ACP completion can facilitate targeted interventions to improve the uptake of ACP.