Dialectical Behavior Therapy Skills on College Campuses Scoping Review: State of the Evidence

Background and Purpose: College campuses are facing an unprecedented demand for mental health services due to rising suicide, depression, anxiety, and ADHD. The need for mental health treatment exceeds the capacity of counseling centers. Dialectical Behavior Therapy (DBT) includes skills training is an effective stand-alone evidence-based treatment which improves depression, anxiety, ADHD, eating disorders, emotion regulation, and coping. Although DBT skills have been used on college campuses from universal interventions in the form of a college course, to abbreviated skills training groups, and comprehensive DBT programs, no comprehensive review exists. This scoping review explores the effectiveness of DBT skills-based interventions on college campuses, identifying barriers and facilitators for future research, using data from a large study across education levels.

Methods: The databases PubMed, Scopus, Web of Science, APA PsycINFO (via EBSCOhost), and ASSIA (via ProQuest) were searched for English-language articles on DBT skills interventions in school-based settings. Authors also searched reference lists, contacted DBT developers, and hand-searched Discover Psychology and Google Scholar. The search included quantitative, qualitative, mixed methods designs, as well as and case studies. Search results were imported into EndNote, duplicates removed, and then into Covidence for systematic review screening. Nine reviewers independently screened titles and abstracts, with three reviewers screening full-text articles. Two reviewers extracted data. The primary investigator resolved discrepancies at each stage. This study examined a subset of articles that examined the effectiveness of DBT skills implemented in college or university settings, including and implementation barriers and facilitators.

Results: The search identified 10,386 abstracts, with 166 meeting the criteria for DBT skills interventions in school settings. After full-text review, 78 studies remained, 30 of which were conducted in higher education. Results indicated DBT skills effectiveness at multiple tiers of support in college settings. This included a universal credit-bearing college course available to all students (N=3), showing improved coping, life satisfaction, and emotion regulation, and distress tolerance. DBT skills groups (N=18) demonstrating outcomes including reduced depression, anxiety, and stress, and improved emotional well-being, functioning, interpersonal skills, coping, and problem solving. Comprehensive DBT (N=4) also showed reduced suicidality, non-suicidal self-injury, depression, and anxiety and improved social adjustment, emotion regulation and distress tolerance for high-risk populations. Implementation barriers and facilitators, as well as qualitative feedback from stakeholders are summarized.

Conclusions and Implications: DBT skills when used on college campuses have the potential to address a variety of mental health problems and promote overall wellness and resilience for all students. Abbreviated DBT skills interventions have shown the most success and uptake on college campuses in order to meet competing demands and time constraints of students. Future research should explore effective methods for wide-spread implementation of DBT skills at multiple tiers of support on college campuses and with vulnerable populations in under-resourced settings.