Meredith Pescatello and Dr. Tyler Pedersen, Counseling, Psychology, & Special Education
Brigham Young University (BYU) has over 30,000 students, and many of them face difficult personal and psychological challenges. These may include adjusting to school life after returning from a mission, coping with academic demands, finding balance between work and school, or dealing with difficult roommates and families. Although BYU and other universities provide counseling services to assist students, these services are stretched thin and many cannot meet the needs and demands of students (http://www.standard.net/State/2016/09/08/USU-studentgovernment- declares-mental-health-crisis). This project explores whether or not a peer-led intervention teaching skills from Dialectical Behavior Therapy (DBT) could effectively meet some students’ needs. DBT training is designed to enhance four major skills that may help students struggling to adjust to college life: mindfulness, interpersonal effectiveness, distress tolerance, and emotion regulation. While DBT and DBT-based groups are efficacious for a variety of clinical and sub-clinical problems in college students (Chugani & Landes, 2016) and there is literature demonstrating the efficacy of peer-mentored interventions (Viverito et al., 2013), there is currently very little literature about the efficacy of DBT-based groups led by peers. If DBT-based groups can be shown as helpful when peer-led, it may lead to new, more accessible and less expensive opportunities for counseling centers to effectively meet adjustment challenges and students’ needs. The goal of this project was to determine the efficacy of a peer-mentored DBT skills-based group for adjusting college students.
Over the last year, we have spent a considerable amount of time obtaining IRB approval. We first attempted to obtain IRB approval in February 2017. We had to make 5-6 revisions and did not receive IRB approval until September 2017. Most of the IRB concern regarded the safety of having undergrads leading the workshops, because they were considered therapy-like groups and may attract a clinical population.
While trying to obtain IRB approval, we developed and perfected a curriculum for the workshop. I (Meredith Pescatello) spent a lot of time receiving training in DBT from a faculty member with considerable DBT training (Dianne Nielsen) and was able to attend a training seminar on DBT in Ohio during March. We also spent a lot of time training another undergrad (Nathan Rhees) to co-lead the group with me.
The workshop we will run is once a week for two hours and lasts for four weeks. Each week we will teach one of the four DBT skills: mindfulness, interpersonal effectiveness, distress tolerance, and emotion regulation. Mindfulness skills help individuals learn how to ground themselves in the present moment. Interpersonal effectiveness skills teach individuals how to ask for what they need, deal with difficult roommates, and how to say no. Emotion regulation skills help individuals to learn how to modulate painful emotions and cope ahead for stressful life events. Distress tolerance skills teach individuals how to endure stressful situations. We plan on using a wait-list control model. We hope to have 10 individuals per group and replicate it several times. We are estimate having a sample size of about forty individuals by the end of winter 2018.
This fall, we began to recruit the first batch of students for the workshop. We anticipated starting the project in September/October 2017 and completing the groups around December. We planned on recruiting freshman who scored sub-clinically on the outcome measures. One of the other criterion was that individuals could not be seeking psychotherapy. Our rationale for using sub-clinical individuals was due to a safety concern about undergrads running the workshop. Our main recruitment strategy was through freshman housing. During recruitment, we discovered a problem. Over 90% of individuals interested in participating either scored clinically on one of the measures we used to assess distress or were currently seeking therapy. We persevered and continued to attempt recruitment, but we could not get enough participants who were sub-clinical. Tyler Pedersen and I began to reassess and we determined that if we kept the criteria as is (no clinical distress and no individuals seeking therapy), not only would we not get enough participation, but we may be missing an opportunity to help many struggling college students.
In November, we submitted a revised IRB. The main change was that we decided to recruit not only through freshman housing, but also through therapist referral at BYU Counseling and Psychological Services (CAPS). We decided to expand our criteria to allow for individuals who meet clinical criteria to participate in the group. We added additional safety measures, including having an on-call therapist at the disposal of the group members and the undergraduate group leaders. We contacted individuals who had been recruited during the early fall. We notified them of the changes and asked them if they would be willing to participate in a group during the winter semester. About 85% of individuals originally recruited said they would be interested in the group next semester. We received IRB approval on December 20, 2017. We plan on starting to recruit people for the new group during early January and running the first group in February.
During Winter semester 2018, we plan on running two rounds of the workshop. We will be recruiting about forty people. We will do a wait-list control model. Nathan Rhees and I (Meredith Pescatello) will co-lead the workshops. Individuals will be recruited through freshman housing and through therapist referral. All individuals (treatment group and wait-list control) will participate in the four-week workshop and be compensated $5 for every set of measures they complete. Following completion of the workshop individuals will take measures online. We will use Qualtrics to distribute the measures. We are hopeful that this workshop will decrease student distress and provide a more cost-effective way to teach DBT skills and coping skills in a group setting. Nathan and I (Meredith Pescatello) will present our findings during a BYU CAPS in-service meeting in Spring 2018. We also plan on presenting our findings at other academic conferences in fall 2018.
Chugani, C. D., & Landes, S. J. (2016). Dialectical behavior therapy in college counseling centers: Current trends and barriers to implementation. Journal Of College Student Psychotherapy, 30(3), 176-186. doi:10.1080/87568225.2016.1177429
Viverito, K. M., Cardin, S. A., Ann Johnson, L., & Owen, R. R. (2013). Lessons learned from two peer-led mutual support groups. International Journal Of Group Psychotherapy, 63(4), 593-600. doi:10.1521/ijgp.2013.63.4.593