Dialectical Behaviour Therapy Skills within an Indigenous Service in Aotearoa New Zealand

The focus of this study is collective and reciprocal learning regarding the relevance, and acceptability of DBT skills for Indigenous participants in New Zealand who have lived experience of family violence and suicidality. Accordingly, DBT skills are offered for evaluation by participants, rather than intervention to them. The plan is to offer six months of weekly 2-hour group sessions of dialectical behaviour therapy (DBT) skills training, however this format and process may change, based on feedback from the service, and from the participants. Typically the first hour of each group session involves mindfulness practice and review of homework assigned the week before. The homework involves practising skills taught the previous week, and completing an optional worksheet reflecting on the skills use. The second hour involves skills instruction, practice, homework assignment, and a closing mindfulness task. The content of these sessions will be an adaptation of the standard curriculum provided by Linehan (2015), modified for this context. The skills fall into the following 5 catagories: mindfulness, emotion regulation, distress tolerance, interpersonal skills and walking the middle path skills. Group sessions include up to 10 participants at a time, and two group facilitators. We will have three facilitators: a pakeha facilitator with expertise in DBT, and two Maori facilitators with expertise in family violence group facilitation, and in working from a te Ao Maori perspective (Maori worldview) with whanau who are traumatised and suicidal. Documentation within each session includes a record of participants who attended, and who completed homework; these will be used to monitor the extent to which the participants have tried out the skills on offer, in order to offer their informed opinion on the skills' relevance and applicability to their lives. At the conclusion of the skills group, focus group interviews (anticipated to last up to 2 hours) will be held with up to 10 participants within each session in order to obtain feedback regarding the applicability, utility and acceptability of the skills group sessions, and also the research process for participants. These interviews will be conducted by an independent researcher with direct experience of these issues. In addition, participants will be asked to complete post-group questionnaires on the acceptability of DBT skills, and a survey at the conclusion of the skills group sessions, advising on future research design. NB: This is considered to be an observational study as this most accurately reflects our intention and commitment to structure this research in a way that upholds the mana (dignity and authority) of the participants as partners and consultants with us in this investigation. We do not see them as patients or passive recipients of a treatment. Rather we see them as co-producers of a future treatment. This relates to a key issue that was discussed extensively with the ethics committee, who advised us to be very clear that DBT skills are *not* offered as an intervention in this context. Rather, the participants are serving as a community of lived-experience consultants first and foremost, as opposed to individuals receiving treatment. They are contributing their time and expertise primarily to comment on the acceptability of DBT skills training within Te Ao Maori - within the Maori worldview. This is a core perspective and philosophy underpinning this research.