CanSOLVE 2.0 Theme 3.1 Mind the Gap - Dialectical Behavioural Therapy (DBT) Skills Training Program Pilot

BACKGROUND:Mental health "Mental health" refers to the state of one's psychological and emotionalwell‐being. It's about one's feelings and thoughts, whether they are experiencingpositive emotions, such as happiness and contentment, or facing challenges like stress,sadness, or anxiety. This is not the same as mental illness, but poor mental health canlead to physical and mental illness.People with chronic kidney disease face a significant burden on their mental health andalthough recognized as a serious issue, an approach to addressing mental health care forpeople with kidney disease and kidney failure is lacking. New models are needed to meetthe mental health needs of people with kidney disease in Canada.In earlier stages of the Mind the Gap project, we identified that the top 5 challenges tomental health in people receiving hemodialysis were: 1. Loss of control 2. Lack of acceptance and/or adjustment to the situation 3. Lack of trust and/or confidence in the healthcare system and providers 4. Dialysis‐related symptoms 5. Feeling overwhelmedPossible solutions identified to the above mental health challenges includedcounselling/therapy and peer support. Dialectical Behavioural Therapy (DBT) is a form ofcounselling that focuses on learning ways to change unhelpful thoughts and behaviours andteaches skills for interpersonal relationships. Group DBT could help address most of thepriority challenges to mental health listed above and provides an opportunity for peersupport.DIALECTICAL BEHAVIOURAL THERAPY (DBT) Skills Training:Based on data gathered through the Mind the Gap surveys and the Priority SettingWorkshop, we have identified the top 5 challenges to mental well‐being in facility‐basedhemodialysis as: loss of control, lack of acceptance and/or adjustment to the situation,lack of trust and confidence in the healthcare system and providers, dialysis‐relatedsymptoms, and feeling overwhelmed. After discussions with various stakeholders, wereached consensus that implementation of a Dialectical Behavioural Therapy (DBT) skillstraining program, which targets 4 key concepts: mindfulness, distress tolerance,emotional regulation, and interpersonal effectiveness, has potential to address most ofthese five challenges. DBT skills training has been used in many different settings(treatment of borderline personality disorder, substance abuse, improving self‐esteem inadolescents, improving corporate culture) and populations, but to our knowledge has notbeen studied in the hemodialysis population.We will pilot two 13‐week group DBT skills training program sessions in Manitoba thatwill be led by a licensed clinical psychologist who is trained and certified in deliveryof DBT. Additional staff (e.g. Licensed Kidney Health Manitoba Social Workers andOccupational Therapists) will co‐facilitate the group. An initial DBT skills traininggroup will meet in person at SOGH weekly for 13 weeks. Following completion of andincorporating feedback from the first session, we will consider implementing a secondvirtual 13‐week DBT group session.STUDY PROCEDURES:Both in‐person and virtual DBT group participants will complete 8 short questionnairesregarding their mental health before the program starts at 6 weeks into the program, andafter the DBT program ends (12 weeks). These questionnaires ask questions about yourwellbeing, distress tolerance, anxiety, ability to cope, resilience, sleep, pain, angerand will take approximately 20‐30 minutes to complete at each study assessment timepoint. Participants will also complete an end of study questionnaire (10‐15 minutes tocomplete) to gather their perspectives on their experience in the DBT program. Bothin‐person and virtual DBT group participants will be provided with weekly sessionreminders and the relevant program materials by the research coordinator. This willinclude electronic or hardcopies of worksheets and handouts accompanying each week'scontent and videos that will be delivered by mail/email/drop off in HD unit as per yourpreference. The group leader or co‐leader may also check in with all participantsthroughout the 13‐week program periodically in an individual meeting.The total time commitment (in sessions and home assignments) for this DBT program studywill be approximately 36‐39 hours:Questionnaires will take approximately 1.5‐2 hours in total over the 3 study assessmenttime points (pre‐, 6‐week, 12‐week, post‐intervention).The DBT program content will be 25 hours of commitment (around 2 hours/week +orientation).Home assignments and program material will take the additional 9‐12 hours over the12‐week program.