Evaluating telehealth Mother–Infant Dialectical Behaviour Therapy for mothers with borderline personality disorder

This study aims to evaluate the effectiveness of the telehealth Mother–Infant Dialectical Behaviour Therapy (tMIDBT) group programme for mothers with borderline personality disorder (BPD) and their infants under 2 years of age. The tMIDBT is an adaptation of the established Mother–Infant Dialectical Behaviour Therapy (MIDBT) programme developed at Helen Mayo House, Women’s and Children’s Health Network, Adelaide, South Australia (SA). The tMIDBT has been developed to increase access to specialised treatment for mothers who are unable to attend in-person groups because of geographical location, limited transport options or discomfort with in-person group participation. The tMIDBT retains the core therapeutic components of the in-person programme while adapting its delivery for telehealth. The study will include three study arms: tMIDBT, in-person MIDBT and a wait-list control. Participants will be allocated to one of these study arms according to service availability. Mothers who cannot attend in-person groups because of geographical location, transport difficulties or other practical barriers will be allocated to the tMIDBT group. Mothers offered a place in the in-person MIDBT programme will be allocated to the in-person MIDBT group. Mothers awaiting the next available telehealth or in-person MIDBT programme will be allocated to the wait-list group. In-person MIDBT programmes typically run once per year, while there will be two tMIDBT groups scheduled each year. The MIDBT is a structured, manualised intervention that teaches mothers with BPD DBT skills to manage the challenges of parenting while supporting their infant’s emotional regulation and socio-emotional development. The programme comprises four modules: mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness. These modules address managing difficult parenting thoughts and emotions, responding effectively to infant distress, supporting emotional regulation in both mothers and infants, and promoting healthy mother–infant relationships and social development. The tMIDBT programme will run for 24 weeks. During the programme, participants will have access to a secure online portal for MIDBT group-specific content that will include module handouts, skill-specific teaching videos and homework exercises. In addition, printed handouts, homework worksheets and items required to complete activities will be posted to participants before the commencement of each module. Each week, participants will be expected to watch pre-recorded skill-specific teaching videos (~60 minutes) and complete homework exercises (~60 minutes) before attending the online group session (~90 minutes). Each group will include a maximum of 12 mothers. Infants may be present during group sessions; however, their attendance is not required, and participants may choose to arrange alternative childcare. The group sessions will be delivered via Coviu, a secure telehealth platform approved by SA Health, and will include a review of homework, discussion and application of the weekly skills and a structured mother–infant activity. Participants will join group sessions from home or another agreed private setting using an internet-enabled device with video and audio capability. If needed, participants will be provided with a suitable device and/or mobile data to support participation. Homework will consist of reflections and activities that are primarily centred on the participant’s child. These activities encourage participants to practice and integrate DBT skills within their parenting role and in interactions with their child, supporting the application of skills and the parent–child relationship. Participants are asked to complete specific worksheets each week and practice daily Mindfulness techniques. At the next group session, participants share examples of their homework, enabling facilitators to assess participants’ understanding of the concepts, provide additional support where needed and reinforce learning. This process also allows participants to learn from one another through shared experiences and practical examples. Participants will also attend fortnightly 50-minute individual telehealth sessions (via Coviu) with a therapist to support engagement and implementation of the skills. Access to the online programme materials, including pre-recorded skill-specific teaching videos, will be monitored throughout the intervention. Attendance at group and individual sessions, programme completion and reasons for non-attendance or non-completion, where available, will be recorded. Participants will receive SMS and email reminders before each group and individual session. Participants who do not attend a scheduled session or who show reduced engagement with the online programme materials will be followed up by facilitators to identify and address barriers to participation. The tMIDBT programme will be facilitated by two therapists (a mental health social worker and a mental health nurse) based at Helen Mayo House who are trained and experienced in delivering the MIDBT programme. Facilitators will receive ongoing monthly 50-minute clinical supervision sessions throughout the study. In addition, they will have access to ad hoc supervision, as required, to support the management of clinical risk, adverse events and other issues arising during treatment.