Enhancing member engagement in a Tier 3 personality disorder service during COVID-19: evaluation of a virtual group programme

Abstract Background: Drop-out rates from evidence-based interventions for people with a diagnosis of personality disorder (PD) are high. The COVID-19 pandemic has likely exacerbated barriers to engagement with the introduction of virtual working. Virtual therapy has a good evidence-base for Axis I disorders, but limited research for Axis II disorders. Aims: To investigate facilitators and barriers to engagement in a Tier 3 PD service virtual group programme. Method: A virtual group programme was developed in collaboration with service members, and analysed members’ attendance rates over a 5-month period pre- and post-COVID-19. Thematic analysis of semi-structured telephone interviews with 38 members is reported, describing their experience of the virtual group programme. Results: Attendance rates were significantly higher pre-COVID (72%) than post-COVID (50%). Thematic analysis highlighted key barriers to attendance were: practical issues, low motivation, challenges of working in a group online and feeling triggered at home. Main promoters of engagement were: feeling valued, continued sense of connection and maintaining focus on recovery. Discussion: The results suggest that the pandemic has exacerbated relational and practical barriers to engagement in a Tier 3 PD service. Ways of enhancing engagement are discussed, as well as preliminary recommendation for services offering virtual therapy to people with a diagnosis of PD.

摘要 背景：针对人格障碍（PD）患者的循证干预措施的辍学率很高。新冠疫情可能因虚拟工作的引入而加剧了参与障碍。虚拟疗法对轴Ⅰ障碍有良好的证据基础，但对轴Ⅱ障碍的研究有限。 目的：调查参与三级人格障碍服务虚拟团体项目的促进因素和障碍。 方法：与服务对象合作开发了一个虚拟团体项目，并分析了新冠疫情前后5个月期间成员的出勤率。报告了对38名成员进行的半结构化电话访谈的主题分析，描述了他们对虚拟团体项目的体验。 结果：新冠疫情前的出勤率（72%）显著高于疫情后（50%）。主题分析强调出勤的关键障碍包括：实际问题、动力不足、在线团体工作的挑战以及在家中被触发情绪。参与的主要促进因素包括：感到被重视、持续的联系感以及保持对康复的关注。 讨论：结果表明，疫情加剧了参与三级人格障碍服务的关系和实际障碍。讨论了提高参与度的方法，以及为向人格障碍患者提供虚拟疗法的服务提出的初步建议。