Date of Graduation

Summer 8-15-2021

Document Type


Degree Name

Doctor of Psychology


School of Nursing and Health Professions


Clinical Psychology (PsyD)

First Advisor

Brent Ferm, PhD

Second Advisor

William Collins, PsyD

Third Advisor

Valerie Jackson, PhD


This study explores the efficacy of delivering modified dialectical behavior therapy (m-DBT) to direct support staff who work with seriously mentally ill patients with neurocognitive deficits using remote web-based technology. The partnering facility for this study is a residential skilled-nursing facility that provides 24-hour care to individuals under conservatorship. Using a previously piloted m-DBT protocol, qualitative feedback was gathered from four participants with background training in psychology and varying experiences with DBT. All participants had direct knowledge of the treatment environment and experience working with the patient population. Gathered feedback was used to revise the m-DBT protocol to be used in future pilot studies for this specific patient population. An online m-DBT training program for direct service providers was developed based on the revised m-DBT protocol. Pre- and post-measures providing dichotomous responses were completed by participants assessing knowledge of DBT, ability to manage patients’ challenging behaviors, and assist patients with communication. Additionally, learning quizzes were completed between each module. Statistical analysis included a McNemar’s test to determine whether there were significant changes among participants before and after the online training. The results of the McNemar’s test suggest that there were no significant differences on responses from the pre- and post-survey among a small sample. These results suggest that direct support staff are able to learn concepts (i.e., coping skills) assist patients in using learned DBT skills outside of group. Future staff training in DBT might include more advanced content and live practice during m-DBT groups.