Authors: (including presenting author): :
Wong HWS(1), Kwok WY(1), Leung THH(1), Lam CNL(1), Wong YPQ(1)
Affiliation: :
Clinical Psychology Department, Kwai Chung Hospital
Keyword 1: :
Dialectical Behaviour Therapy
Keyword 2: :
Borderline personality disorder
Keyword 3: :
Emotion dysregulation
Keyword 4: :
Routine outcome monitoring
Keyword 5: :
Outpatient psychiatry
Introduction: :
Borderline personality disorder (BPD) and related presentations, characterised by severe emotion dysregulation and recurrent crises, are associated with high use of emergency and inpatient services. With limited capacity for longer-term specialist therapies, services need scalable interventions that support self-management alongside treatment-as-usual (TAU). Dialectical Behaviour Therapy (DBT) is an evidence-based, skills-focused intervention that can be delivered in groups alongside treatment-as-usual (TAU). To our knowledge, this is the first Hospital Authority routine outcomes evaluation of a DBT skills programme, addressing a local evidence gap in implementation and clinical impact.
Objectives: :
To evaluate routine outcomes from DBT skills groups alongside TAU, focusing on change in emotion regulation difficulties and self-reported BPD symptom severity.
Methodology: :
This retrospective service evaluation combined routine outcome data from DBT skills groups at West Kowloon Psychiatric Centre from 2015 to 2025, including closed-cohort and open rolling-entry formats. Groups were led by DBT-trained clinical psychologists and held biweekly for 18 to 23 sessions (2–2.5 hours per session); included participants attended a median of 14 sessions (IQR 9–18). Outcomes were collected at baseline and after each of the four modules where available. Participants with BPD or complex emotion dysregulation with baseline and at least one follow-up were included (N = 43; 134 observations), relatively large for routine outcome monitoring given retention challenges in this population. Primary outcome was Difficulties in Emotion Regulation Scale (DERS), analysed using a linear mixed-effects model with planned baseline-to-final assessment contrast. Secondary outcome was Borderline Symptom List–23 (BSL-23), analysed from baseline to latest available follow-up due to sparse completion (n = 23).
Result & Outcome: :
DERS decreased over time (F(4, 93.2) = 7.40, p < .001), with differences from baseline significant from after the second module onwards and the largest reduction at completion. Model-estimated DERS reduced from 126 to 102 (mean change −24.1; 95% CI −34.3 to −13.9; p < .001; d = 1.12, baseline SD). Among participants with completion data (n=12), mean DERS decreased from 124 to 101. BSL-23 also decreased from 2.40 to 1.94 (n=23; mean change −0.47; p=0.032; d=0.48). Findings support modular DBT skills groups alongside TAU as a pragmatic, feasible outpatient model for clinically complex, high-need service users. The programme supports a shift from crisis-driven contact toward skills-based self-management, offering a shared, structured and empowering framework that can be applied across routine care pathways.
