Integration of DBT Skills and Parent Training for Parents With a History of Substance Use
Phase: NA
Conditions: Parenting, Substance Abuse Relapse, Emotional Regulation
Sponsor: University of Oregon

 
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Research Plan 
IMPORTANT: When completing this outline, please use the Research Plan Guidance for the content necessary to develop a 
comprehensive yet succinct Research Plan. Using the guidance to complete this outline will help facilitate timely IRB review. 
 
Study Title: Integration of DBT Skills and Parent Training for Parents with a History of Substance Use 
 
Protocol Number: STUDY00000041 
NCT#: NCT05287178 
Date of Document: 3/22/22 
 
Principal Investigator: 
Yoel Everett 
Faculty Advisor: 
Maureen Zalewski 
 
A. Introduction and Background 
Nearly 60% of adults who receive treatment for substance use disorders (SUDs) are parents (Niccols et 
al., 2012). Parental substance abuse is a risk factor for poor mental health outcomes in children, and this 
association is partly explained by more negative and ineffective parenting behaviors (Connors-Burrow et 
al., 2013, Miller et al., 1999).  Families with parents in recovery remain at high risk for these poorer 
outcomes, as even following treatment for SUD, these parents are vulnerable to relapse. Stress and 
emotion dysregulation are two important proximal risk factors implicated in relapse (Sinha et al., 2001; 
Kober, 2014), as SUD-related alterations in stress reactivity and emotion regulation deficits may lead to 
coping-oriented substance use (Fox et al., 2008). Parenting stress, a conceptually distinct type of stress 
related to the parenting role, is broadly associated with parent mental health, parenting behavior and 
child mental health outcomes (Holly et al., 2019). Parenting stress is particularly problematic for parents 
with a history of substance use, as stress responses triggered by stressful, negative interactions with 
children can increase craving for substance use which previously provided relief from negative emotions 
(Rutherford & Mayes, 2019). This is further complicated by the fact that children of parents with a history 
of substance use may be more likely to have emotional and behavioral difficulties that are associated 
with increased levels of parenting stress (Bailey et al., 2009; Barrosso et al., 2018). 
Parent training interventions, aimed at improving parenting behavior and children’s internalizing 
and externalizing problems, have been shown to reduce parenting stress (Colalillo & Johnston, 2016), 
and thus could benefit families in which a parent has a history of substance use by simultaneously 
improving parenting and child behavior while also contributing to relapse prevention (Neger & Prinz, 
2015). However, parent training programs are less effective for parents with SUD (Suchman et al., 2004). 
This is due in part to SUD-related deficits in emotion regulation, which in addition to representing a risk 
factor for maintenance of SUD, also hinder a parent’s ability to consistently set limits (i.e. parent 
management) or respond effectively when a child is emotional (i.e. parental emotion socialization) 
(Rutherford et al., 2015). Indeed, there is growing interest in integrated SUD treatments which address 
both parenting and emotion regulation (Neger & Prinz, 2015). 
 
DBT is an evidence-based intervention which focuses primarily on improving emotion regulation 
(Lynch et al., 2006) and has been found effective in treating substance abuse in severely emotionally 
dysregulated clinical populations (Linehan et al., 1999; Dimeff & Linehan, 2008). DBT Skills is a group-
based mode of DBT, which is an effective treatment on its own (Linehan et al., 2015). The content and 
format of DBT Skills lends itself well to integration with parent training, because of the shared behavioral 
approach and group-based, didactic modality. There is increasing interest in both the fields of DBT and 
parent training in integrating these two interventions in order to improve parental well-being and children’s 
outcomes (Zalewski et al., 2020). 

 
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B. Specific Aims/Study Objectives 
In an effort towards significantly reducing the intergenerational transmission of a wide range of 
mental disorders by intervening on parenting practices and clinically significant emotional dysregulation 
in parents and their preschool aged children, this proposal is to pilot test an integrated mental health and 
parenting intervention delivered via telehealth for 12 emotionally dysregulated parents with a history of 
substance use, in order to complete several foundational steps prior to conducting a larger scale 
randomized controlled trial. The proposed 20-week group therapy will integrate two evidence-based 
interventions: 1) Dialectical Behavior Therapy (DBT) Skills - targeting parental emotion dysregulation and 
substance use, and 2) Parent Training (PT) - targeting parenting behaviors linked to children’s mental 
health. The telehealth format will enhance the scalability of the intervention and reduce many of the 
common barriers to access that parents face when seeking treatment for themselves or their children. 
The Specific Aims are to: 
  
1. Determine feasibility, acceptability and implementation
. Feasibility of recruitment (number of 
participants meeting eligibility on the initial online screener and number meeting eligibility following 
intake), feasibility of measurement tools (time taken to complete online questionnaires, missing data from 
questionnaires) and feasibility of the intervention (number of sessions attended by parents) will all be 
assessed to determine overall feasibility of the intervention study. Acceptability will be evaluated using 
measures of client satisfaction and a qualitative exit interview with each parent post-intervention.  
Implementation will be assessed by examining the frequency with which clients use DBT and parenting 
skills and by tracking clients’ weekly skills use via a diary card. 
 
2. Evaluate pre -post and weekly changes in measures of parental emotion regulation, parenting 
stress, parenting quality and children’s mental health. Across all parents enrolled in DBT+PT, we will 
evaluate the rate and pattern of change in these interlinked domains which represent risk factors for 
relapse and further adverse outcomes. We anticipate pre-post changes (2 time points, approximately 20-
22 weeks apart) will be comparable to well-established change scores from the clinical trial literature 
base for DBT Skills and parent training interventions. Additionally, qualitative data from exit interviews 
with each parent will be analyzed using thematic analyses of responses to evaluate parents’ perceptions 
of changes in their own mental health, their parenting and their children’s behavior over the course of the 
intervention.  
Weekly repeated measures (20 time points) will allow us to model the rate and pattern of change 
from week to week. As the intervention is divided into 4 modules (see Procedures), change patterns will 
also be examined between modules. Data will be presented descriptively and we expect changes to 
unfold in a cascading order, with increased use of skills preceding reductions in parent emotion 
dysregulation, followed by improvements in parenting quality and subsequent improvements in child 
behavior.  
C. Methods, Materials and Analysis 
Setting. Clinical intakes, the weekly group DBT Skills+PT intervention sessions, and exit interviews will 
all be conducted via a HIPAA compliant teleconference platform (i.e. Zoom). The initial online screener, 
and pre-post and weekly assessments will be conducted via UO Qualtrics questionnaires.  
Study design. This study utilizes a mixed methods case study design with continuous assessment of 
quantitative measures. Figure 1 presents the study phases, along with what participating parents will 
complete in each phase, and the estimated time needed to complete each phase. 
 
 

 
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Figure 1. Flowchart of study procedures detailing the study phase, the measures completed by 
participants, and the estimated time required of participants. 
Study Phase  
Participant action  
Time Estimate  
Recruitment 
Parents respond to recruitment 
materials 
N/A 
 
Initial Online Screener 
Parent completes: 
DERS 
CAGE-AID 
 
DERS – 5 minutes 
CAGE-AID – 2 minutes 
 
Total: 7 minutes  
 
Clinical Intake 
Parent completes: 
Demographic questionnaire 
PHQ-9 
PPVT-V (Q-Global) 
SCID 5 diagnostic interview 
 
Demographics – 4 minutes 
PHQ-9 - 3 minutes 
PPVT-V – 20 minutes 
SCID 5– 180-300 minutes 
 
Total: 207-327 minutes  
  
Pre-intervention 
Parent completes: 
HAM-A 
PHQ-9 
ADCS (ADAPTED PACS) 
DERS 
DBT-WCCL 
WACB 
CBCL 
ERC 
PSI 
PSOC 
PS 
CCNES 
 
 
 
3 minutes 
3 minutes 
3 minutes 
5 minutes 
5 minutes 
3 minutes 
10 minutes 
5 minutes 
7 minutes 
5 minutes 
7 minutes 
8 minutes 
 
 
 
Total: 64 minutes  
        
 
Treatment Phase 
(20 assessment time points) 
20-weekly sessions of DBT 
Skills +PT 
Parent completes weekly 
measures: 
DERS 
DBT-WCCL 
ERC 
WACB 
PS 
CCNES 
Skill Use Diary Card 
 
 
 
 
Parent participates in weekly 
DBT Skills +PT sessions + 
individual check ins (10-15 min) 
when necessary as part of 
 
 
5 minutes 
5 minutes 
5 minutes 
3 minutes 
7 minutes 
8 minutes 
5 minutes 
 
Total for Weekly Assessment:
 
38 minutes  
 
2.5 hours/week 
 
 
 

 
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standard clinical case 
management 
Total: 190 minutes/week  
 
Post-intervention 
Parent completes: 
HAM-A 
PHQ-9 
ADCS (ADAPTED PACS) 
DERS 
DBT-WCCL 
WACB 
CBCL 
ERC 
PSI 
PSOC 
PS 
CCNES 
CSQ-8 
 
Qualitative exit interview 
(including SCID 5 diagnostic 
assessment of current 
substance use disorder) 
 
 
 
 
 
3 minutes 
3 minutes 
3 minutes 
5 minutes 
5 minutes 
3 minutes 
10 minutes 
5 minutes 
7 minutes 
5 minutes 
7 minutes 
8 minutes 
5 minutes 
 
60 minutes 
 
 
 
Total: 129 minutes  
 
Procedures  
Initial Online Screening. Parents responding to our recruitment materials (see section D: Recruitment 
Methods) will complete an online survey via UO Qualtrics to assess initial eligibility criteria. Parents will 
be asked to confirm that they are 18+ years of age, that they reside in Oregon, that they have at least 
partial custody of a preschool aged child (3-6 years old), that neither they nor their child has any known 
developmental disability, that they are proficient in English, and that they have the internet access 
needed to participate in an online remote telehealth intervention. We will also provide the scheduled 
weekly day and time of group therapy sessions so that parents can verify and confirm they will be able 
to participate. After confirming all of the above, parents will complete a self-report questionnaire 
evaluating parents’ emotion dysregulation and a screener for drug and alcohol problems. To participate 
in the study, parents must endorse a score of  >88 on the Difficulties with Emotion Regulation Scale 
(DERS) and meet a cutoff of 2 positive answers on an adapted version of the CAGE-AID screener for 
drug and alcohol problems, which asks about past (past 5 years) but not current (not in the past 12 
months) substance use. Parents who pass the initial online screening will be asked to provide their 
contact details so that a project coordinator can schedule a clinical intake with them. Parents who do 
not pass the initial online screening will be thanked for participating and informed that they do not 
match the eligibility requirements. See Appendix E. Online Screening Script. 
 
Clinical intake. Parents who meet screening criteria will be contacted and invited for the remotely 
conducted clinical intake (see Appendix F. Intake Scheduling Script). During intake scheduling, the 
project coordinator will ask for participating parents’ permission to be contacted via email, text and 
phone. The clinical intake will be conducted via a HIPAA compliant teleconference platform (Zoom), 
and a Zoom link will be emailed to the parent, using an encrypted email service (Hushmail). The 
purpose of the clinical intake is to: 1) formally determine eligibility and 2) characterize current parental 
mental health diagnoses. A trained intake clinician will consent parents to the intake process and ask 

 
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them to provide consent for the remainder of the study components (for details see section E. Informed 
Consent Process and Appendix A. Informed Consent Form). 
Following this, parents will complete a demographic questionnaire, the Peabody Picture 
Vocabulary Test-V (PPVT-V Q-Global), the Patient Health Questionnaire for Depression (9-items; PHQ-
9), and the Structured Clinical Interview for DSM-5 (SCID 5). Parents will be ineligible to participate if 
they meet for the exclusionary criteria detailed in section D. Research Population & Recruitment 
Methods: Participants.  
Pre-intervention Assessment. Parents who meet criteria for the study following the clinical intake will be 
asked to complete a broad battery of questionnaires (see Fig 1. Study Phase: “Pre-intervention”) to 
assess parent mental health symptoms, parenting stress, parenting quality and child mental health 
symptoms. The questionnaires will be completed online via UO Qualtrics and parents will receive an 
encrypted email (i.e. Hushmail) from the project coordinator with the UO Qualtrics link. 
DBT Skills +PT intervention. The study plans to recruit three groups of approximately 4-5 
parents/group. Parents will be recruited twice throughout the course of the year to facilitate running up 
to three groups (see section D. Research Population & Recruitment Methods for more details). Once a 
group of  parents has been recruited, participants will take part in 20 weekly DBT Skills +PT 
intervention sessions. The group sessions are conducted remotely over a HIPAA compliant version of 
Zoom and groups are led by Yoel Everett (PI) and  three other doctoral level student co-leaders who 
are supervised by Dr. Candice Mottweiler, a licensed clinical psychologist who is trained in both DBT 
and parent training. Dr. Christina Gamache Martin (Co-I) and Dr. Maureen Zalewski (Faculty Advisor) 
may also be consulted and provide supervision, when needed. 
Prior to the start of the first session, co-leaders will conduct 1 hour individual orientation 
sessions over Zoom with each participating parent, in order to orient them to the intervention, review 
intervention related portions of the consent form, and provide participating parents with an opportunity 
to ask questions in private if they wish. 
Before each weekly session, parents will receive an encrypted email from the project 
coordinator asking them to complete the 5 measures listed in Fig. 1: Study Phase: “Treatment Phase”, 
via a set of online UO Qualtrics questionnaires.  
The DBT Skills +PT group intervention is a novel integration of three evidence-based treatments 
(i.e. DBT Skills, Parent Management Training (PMT), and Emotion Coaching (EC)). Each DBT Skills 
+PT session will last up to 2.5 hours. The structure of each session typically includes a brief 
mindfulness practice, homework review to discuss use of skills previously learned, a 10-15 minute 
break, didactics to learn a new set of DBT and PT skills, and assignment of homework. The DBT Skills 
portion of each session follows the DBT Skills Training Manual Second Edition (Linehan, 2015a) and 
DBT Skills Training Handouts and Worksheets Second Edition (Linehan, 2015b). The DBT Skills 
portions cover the four modules of traditional DBT Skills, which each focus on specific goals related to 
emotion regulation: 
 
1) Mindfulness Skills help clients increase control over their attention and notice present emotions 
and thoughts. These skills are taught for 2 weeks at the start of the other three modules. 
2) Emotion Regulation Skills teach skills to understand and label emotions, decrease the 
frequency of unwanted emotion, and decrease emotional vulnerability. 
3) Distress Tolerance Skills teach clients how to deal with the most intense emotions in which they 
have urges to self-destruct. One set of distress tolerance skills is specifically focused on 
managing difficulties with addiction. 
4) Interpersonal Effectiveness Skills help clients apply ER skills within interpersonal contexts, 
which are often highly emotionally evocative for individuals with elevated emotion dysregulation. 
 
Parent training portions (both PMT and EC components) follow the Parenting Hyperactive 
Preschoolers Clinician Guide (Harvey, Herbert & Stowe, 2015) which was selected because it is an 
evidence-based parent training program that integrates PMT and EC (Herbert et al., 2013). Parent 
management training (PMT) portions of the intervention cover: how to use praise effectively, how to 

 
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increase positive interactions and use parental attention to reward positive behavior, how to set up a 
reward system, how to use effective commands, how to use consequences to discourage negative 
behavior, and how to teach children problem solving. Emotion coaching (EC) portions of the 
intervention cover: psychoeducation on children’s emotional development, how to teach children to 
identify and label emotions, how to validate children’s emotions, handling children’s negative emotions, 
fostering children’s positive emotions and how parents can model emotion regulation and expression to 
their children.  
 
 
Post-intervention Assessment. Following the 20-week intervention, parents will be asked to complete 
the set of measures listed in Fig. 1: Study Phase: “Post-intervention” via online Qualtrics 
questionnaires. In addition, they will participate in an exit interview (approximately 1 hour), conducted 
over Zoom by a trained staff member who was not one of the DBT Skills +PT co-leaders. During the 
exit interview,  
parents will be assessed for any current (since the clinical intake) substance use disorder using the 
SCID 5. Additionally, parents will be asked to share their thoughts and experiences from participating in 
the DBT Skills +PT group intervention. 
 
Materials. All measures are well-validated, and have been used with clinical samples, in samples with 
racial and ethnic diversity, and in intervention studies which demonstrate change. Figure 1 provides a 
summary of the data collection schedule and measures, which are briefly outlined below in the order in 
which they appear in Figure 1. This broad battery of assessments is necessary to achieve the study 
aims, which include evaluating changes in three related domains (parent symptoms, parenting 
behaviors, and child symptoms), and comparing these changes to the clinical trial literature bases for 
DBT, PMT and EC (which have often utilized different measures to assess treatment-induced 
changes). All self and parent-report measures are included in this submission (see Appendices H-T). 
 
A. The Difficulties with Emotion Regulation Scale (DERS; Gratz & Roemer, 2004) is a 36-item self-
report measure used to assess adult emotion dysregulation. Items are rated on a scale of 1 to 5, 
with higher scores indicating higher levels of dysregulation. The measure is comprised of six 
subscales: lack of emotional awareness, lack of emotional clarity, limited emotion regulation 
strategies, difficulties with impulse control, difficulties engaging in goal-directed behavior, and 
nonacceptance of emotional responses. 
B. CAGE-Adapted to Include Drugs (CAGE-AID; Brown & Rounds, 1995) is a 4-item screener for 
alcohol and drug use. Items are scored 0 for “no” and 1 for “yes” responses. Higher scores are an 
indication of greater alcohol and drug problems. A total score of 2 or greater is considered clinically 
significant. The original measure focuses on lifetime use. For the purposes of this study, 
participants will be asked to answer for the time period in the past 5 years, but not in the past year. 
C. Demographic questionnaire. Standard questions for assessing parent age, child age, parent 
gender, child gender, parent marital/relationship status, educational background, sexual orientation, 
number of people in household, number of children, race, ethnicity, socioeconomic status, and 
religious affiliation.  
D. The Patient Health Questionnaire - depression module (PHQ-9; Kroenke, Spitzer, & Williams, 2001) 
is a 9-item self-report questionnaire in which participants rate how often depressive symptoms have 
bothered them in the past 2 weeks on a scale of 0 (Not at all) to 3 (Nearly every day). Scores are 
summed for a total score ranging from 0 to 27 with higher scores indicating higher levels of 
depressed mood. 
E. The Peabody Picture Vocabulary Test (PPVT-V Q-Global; Dunn & Dunn, 2007) form A is a forced-
choice format test of receptive vocabulary that provides an estimate of verbal cognitive ability of 
English-speaking adults and children. Participants are shown a page containing four drawings (in 
color) laid out in a 2-by-2 grid. Participants are then asked to point to the picture that corresponds to 
a word said by the experimenter. The task consists of 228 numbered items which are grouped into 
19 sets of 12 items each and items increase in difficulty across the task. Items are administered 

 
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until the participant commits 8 or more errors in a given set. Standardized scores on this measure 
range from 20-160. The Q-Global administration is a web-based version to administer the test. 
F. Structured Clinical Interview for DSM-5 (SCID-5; First, Spitzer, Gibbon & Williams, 2015). The 
SCID-5 will be used as the diagnostic measure during the intake to assess parents’ potential mental 
health disorders, including substance use disorders. Substance use disorder modules will assess 
for current (past 12 months) and past (past 5 years) of the following DSM 5 defined disorders: 
alcohol, cannabis, hallucinogenic, inhalant, opioid, sedative/hypnotic/anxiolytic, and stimulant. 
G. The Hamilton Anxiety Scale (HAM-A; Hamilton, 1969) is a 14-item self-report measure that 
assesses physical symptoms of anxiety. Subjects rate the severity of symptoms ranging from 0 (Not 
present) to 4 (Very Severe). Scores are summed for a total score ranging from 0 to 56, with higher 
scores indicating higher levels of anxiety. 
H. The Aggregated Drug Craving Scale (ADCS; Costello et al., 2020) is an adaptation of the Penn 
Alcohol Craving Scale (PACS; Flannery et al., 1999) aimed at measuring a broad range of 
substance craving. The measure includes five items that assesses intensity, frequency, and 
duration of craving along with ability to resist substance use if it was available, and it asks 
responders to give an average craving rating for the past week. The response ranges from 0 to 6 
for each item and higher scores indicate greater cravings. 
I. 
The DBT Ways of Coping Checklist (DBT-WCCL; Neacsiu et al., 2010) is a 38-item self-report 
questionnaire which measures the frequency of DBT Skills use. 
J. The Weekly Assessment of Child Behavior (WACB, Forte et al., 2012) is a brief 9-item parent-report 
measure in which parents rate (on a Likert scale of 1-7) how often their child engages in positive 
behaviors on a weekly basis. The measure is based on the positive opposites of behaviors 
measured by the Eyberg Child Behavior Inventory (ECBI) and yields two scales: Intensity and 
Need-to-Change. The measure has demonstrated strong convergent validity with other established 
measures of child behavior problems. 
K. The Child Behavior Checklist (CBCL; Achenbach & Rescorla, 2000) is a 99-item parent-report 
ratings scale for children’s problem behaviors which provide subscales for both internalizing (e.g. 
anxious, sad) and externalizing (e.g. hyperactive, aggressive) behaviors. Higher scores indicate 
greater problem behaviors and symptoms of psychopathology. 
L. The Emotion Regulation Checklist (ERC; Shields & Cicchetti, 1997) is a 24-item parent-report 
measure in which parents rate (on a Likert scale of 1-4) how characteristic of their child are 
statements which focus on mood lability, lack of flexibility, dysregulated negative emotion, empathy, 
emotional self-awareness and positive response to others. The measure produces two subscales 
(lability/negativity and emotion regulation) and a composite of the two. 
M. The Parenting Stress Index Short-Form (PSI-4 SF; Abidin, 1995) is a 36-item parent report 
measure of parental stress (rated on a five point Likert scale), and includes three subscales: 
Parental Distress, Parent–Child Dysfunctional Interaction, and Difficult Child. Normative scores 
have been established and raw scores are converted to T-scores and percentiles for interpretation. 
N. The Parenting Sense of Competence Scale (PSOC; Johnston & Mash, 1989) is a 17-item measure 
of parental self-efficacy (rated on a six-point Likert scale). There are two subscales: satisfaction with 
parenting and self-efficacy in the parenting role. Lower scores indicate less parental self-efficacy. 
O. The Parenting Scale (PS; Arnold et al., 1993) is a 30-item self-report questionnaire, in which 
parents are asked to describe (on a Likert scale of 1-7) how they respond to a variety of child 
misbehaviors. It yields three subscales: laxness, over-reactivity and hostile parenting. 
P. The Coping with Children's Negative Emotions Scale (CCNES; Fabes, Eisenberg & Bernzweig, 
1990) assesses parental self-report of emotion socialization practices. Parents are presented with 
12 vignettes describing scenarios in which their children exhibit distress. Parents rate (on a Likert 
scale of 1-7) the likelihood they would engage in 6 potential parental responses to these situations, 
with each corresponding to 6 subscales: distress reactions, punitive reactions, minimization, 
expressive encouragement, emotion-focused reactions and problem-focused reactions. The first 
three can then be summed into an Invalidating/Unsupportive composite and the latter three can be 
summed into a Validating/Supportive composite. 
 

 
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Q. Skill Use Diary Card. A diary card developed for this study will be used to assess parents’ weekly 
use of specific DBT and parenting skills, both as a study measure of treatment dosage and for 
treatment purposes. Parents are asked to circle days of the week in which they used each skill. 
Additionally, they are asked if DBT Skills were used in a parenting or a non-parenting context. Diary 
cards also include an additional question that assesses for suicidal thoughts over the past week. 
R. The Client Satisfaction Questionnaire (CSQ-8; Attkisson & Zwick, 1982) will be used to assess 
acceptability of the intervention. It is a brief 8-item self-report measure in which clients are asked to 
rate (on a Likert scale of 1-4) their satisfaction with the intervention. 
S. Qualitative Exit Interview. A semi-structured exit interview will be used to evaluate parents’ 
satisfaction with the intervention, challenges they experienced completing the intervention, their use 
of DBT/Parent training skills, and suggestions they have for improving the intervention delivery. 
Interviews will be video recorded so that representative quotes and themes can be identified. 
 
Analyses  
We will conduct multiple analyses to evaluate how, when, why, and to what extent the DBT Skills +PT 
intervention was effective in changing parents’ mental health and/or parents’ parenting quality and/or 
children’s mental health and behavior. All data will be de-identified and all findings from our analyses 
will be reported anonymously. 
 
Aim 1. Determine feasibility, acceptability and implementation. Three types of feasibility will be 
examined. Feasibility of recruitment will be assessed by examining the number of participants meeting 
eligibility on the initial online screener and the number of participants meeting eligibility following the 
clinical intake. Feasibility of measurement tools will be assessed by calculating the average time taken 
by participants to complete the online Qualtrics questionnaires, and the average percentage of missing 
data from the online questionnaires. Feasibility of the intervention will be evaluated by calculating the 
average number of sessions attended by parents. 
Acceptability will be examined by averaging the total scores obtained from the Client 
Satisfaction Questionnaire (CSQ-8). In addition, using qualitative thematic analyses, we will report on 
data collected during the exit interview, identifying overall themes about the intervention that emerge 
from parents’ comments. 
We will examine implementation by calculating the average daily number of DBT and parenting 
skills parents report using each week on their diary card (averaged across parents) and comparing 
these to skill use reported in other published research (ex. 7-8 DBT skills per week; Gamache Martin et 
al., 2017). We will primarily report data for Aim 1 at an aggregated group level. We may also include 
de-identified information at the individual level in the form of quotes from parents’ exit interviews. 
Aim 2. Evaluate pre-post and weekly changes. We will examine pre-post changes for the primary 
outcomes of DBT Skill use (DBT-WCCL), parental emotion dysregulation (DERS), parenting stress 
(PSI) and parenting quality (PS, CCNES). Pre-post change scores will also be calculated for the 
secondary outcomes of child internalizing and externalizing behaviors (CBCL), child emotion regulation 
(ERC), parent mental health symptoms (HAM-A, PHQ-9, ADCS). Pre-post change scores will be 
compared to the clinical trial literature base for DBT and parent training interventions which often use 
the same measures and for which expected change scores are established. Additionally, based on 
post-intervention reports during the SCID 5 diagnostic interview, the percentage of parents reporting 
sustained recovery (vs relapse) from substance use disorder will be calculated and reported.  
We will examine change across time based on data available in the weekly assessment 
measures of parents’ DBT and parenting skill use (DBT-WCCL, Skill Use Diary Card), parents’ emotion 
dysregulation (DERS), parenting quality (PS), and children’s symptoms and behaviors (ERC and 
WACB). Consistent with common practice in case study designs (Kazdin, 2003; Kazdin, 2019; Rizvi & 
Nock, 2008), we will primarily use visual inspection (i.e. evaluating graphical displays of participants’ 
weekly scores) to examine the data collected during Weeks 1-20 of the DBT Skills +PT intervention. 
We will use the same procedures to examine changes in data collected at the four time points 
representing the start of each DBT module. We will inspect several aspects of these data, such as 

 
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changes in the trajectories of each measure, to determine the direction and extent of change in the 
measured symptoms and behaviors from week to week, and the timing of when those changes 
occurred. We will also characterize the order in which changes unfold over time (e.g. increased DBT 
skill use precedes improvement in parent emotion regulation, which precedes improvements in 
parenting quality measures, which precedes improvements in child behavior measures).These visual 
inspection analyses will be conducted at both the individual level and at an aggregated group level. 
We will employ a number of standard methods of statistical analysis of single-case experimental 
design (SCED) data to further examine, quantify and corroborate results of visual inspection. 
Consistent with previous SCED studies, we will calculate Tau-U effect sizes (Parker et al., 2011; 
Vannest & Ninci, 2015; Brossart et al., 2018), linear regressions (Ramaiya et al., 2018) and perform 
hierarchical linear modeling which can be used to aggregate single-case results (Van den Noortgate & 
Onghena, 2007; Ugille et al., 2012). These analyses will provide preliminary information on the rate and 
order of change for the different targeted symptoms and behaviors, and enable us to report on the 
degree to which DBT Skills +PT changed parent-reported symptoms and behaviors at the level of 
individual parents as well as at the group level, aggregating data across all participating parents. 
D. Research Population & Recruitment Methods 
Participants. We intend to recruit and conduct intakes with approximately 18 parents, enroll up to 15 
eligible parents in DBT+PT, so as to reach our target of 12 parents who complete at least 4 sessions. 
This attrition rate is based on our lab’s prior experience providing DBT Skills to a parent population. 
Participating parents will be split into three DBT Skills +PT groups that are run at different times over 
the course of the year. Recruitment efforts  will take place twice over the course of the year to facilitate 
this.  
To participate, parents must be 18+ years of age and reside in Oregon, have at least partial 
custody of a 3-6 year old child, neither parent nor child may have any known developmental disability, 
and the parent must be proficient in English, as our laboratory is unable to conduct the clinical intake, 
assessments, and DBT Skills +PT intervention with non-English speaking participants. Parents must 
also have internet access to facilitate participating in the remote telehealth DBT Skills +PT intervention.  
Additionally, eligible parents must endorse elevated emotion dysregulation (a score of >88 on the 
DERS, equivalent to +.5 SD above a normative score; Ritschel, Tone, Schoemann, & Lim, 2015) and 
endorse 2 or more items on the CAGE-AID screener for past (past 5 years), but not current (not in the 
past 12 months), substance use. 
Only one eligible parent can participate in the study. In the case of two parents who wish to 
participate and both meet inclusion criteria, the family will decide which parent is most likely to complete 
all assessments and intervention sessions and that parent will be the research participant. If a 
participating parent has more than one preschool aged child (age 3-6), we will ask parents to decide 
which child is the target child for whom they will report during assessments. Parents will be excluded if 
they have a current (past 12 months) substance use disorder, if they do not have a past (past 5 years) 
substance use disorder, if they or their child have a known developmental disability or if during the 
clinical intake parents are determined to have a low IQ score (IQ<70) on the PPVT-IV, are psychotic as 
determined by the SCID 5, actively manic or psychotic as determined by clinical observation, are 
actively suicidal with an active plan as determined by the SCID 5 and/or PHQ-9, or are determined by 
clinical judgement to be at high risk of violence towards others. Additionally, if clinical judgement 
suggests a parent requires a higher level or different form of care, we may exclude them from 
participating or request that they secure an individual therapy provider in order to participate in the 
study. 
 
Recruitment. Participants will be recruited through a number of recruitment strategies: 
 
1. Team Duckling (https://teamduckling.uoregon.edu/) developmental database, which is 
maintained by the UO Psychology Department. Parents of children aged 3-6 will be initially 
contacted through email using a standard email script (see Appendix B. Recruitment Email). 

 
10
 
2. Craigslist postings to recruit participants (see Appendix C. Craigslist Posting). 
 
3. Social media posts. We may use social media posts/advertisements targeting parents within the 
state of Oregon (including but not limited to Facebook; for an example, see (Appendix D. 
Facebook Posting).  
 
4. Contacting parents who have participated in previous studies within Dr. Zalewski’s START Lab 
or other research labs, and who have indicated they are interested in being contacted to 
participate in future studies (see Appendix B. Recruitment Email). 
 
5. Referrals from various mental health clinics (including, but not limited to the University of 
Oregon Psychology Clinic, HEDCO Clinic (College of Education), and the University of Oregon 
Counseling Center (University of Oregon Health Services), the Child and Family Center 
(Prevention Science Institute at UO), Portland DBT Insitute, Willamette Family, Serenity Lane, 
Parenting Now, Vista Counseling, Strong Integrated Behavioral Health. We will provide such 
clinics with an online virtual flyer with information about the study and a link to our online 
Qualtrics screener, which they can then provide to clients (see Appendix EE. DBT+PT 
Recruitment Flier). 
 
 
6. Direct mailings. With the assistance of local agencies (i.e. Department of Human 
Services, Head Start of Lane County) through which our lab has recruited for previous 
studies, we will directly mail letters describing our study to the agencies mailing list of 
families that have children ages 3-6. A recruitment letter (see Appendix FF. Mailing 
Recruitment) will be provided to the agencies who have agreed to mail the letters on our 
behalf as to maintain privacy of their clientele. This is a template of what will be stated in 
the letter. It will be modified slightly (ex. specify agency name) to fit with the population 
the agency serves. 
 
All recruitment materials will briefly discuss the details of the study and invite parents to complete an 
initial online screening survey to see if they are eligible to participate. 
 
Parents who pass the initial online screening (see Appendix E. Online Screening Script) will be 
contacted by a trained research staff member to schedule the diagnostic clinical intake. Parents who do 
not pass the initial online screening will be thanked for participating and informed that they do not 
match the eligibility requirements. All parents who complete the online screening will be provided with a 
list of community mental health resources (see Appendix BB. Community Resources). 
 
Compensation/Reimbursement.  Participating families who are eligible for the full study can be 
compensated up to $360 for their participation in the study. Payments will be made after participants 
complete each phase of the study and are broken down as follows: $60 after the intake, $30 after the 
pre-intervention assessment, $10 after each weekly measure they complete during the 20 weeks of 
treatment, $30 after the post-intervention assessment, and $40 after the exit interview. 
Compensation will be provided via check payments which will be mailed to participants or via 
reloadable debit cards that will be provided to them. Potential costs to the participants include childcare 
expenses during the clinical intake, the assessments, intervention sessions and the qualitative exit 
interview. 
 
Attrition. Efforts to minimize attrition include provision of incentives (which calculated across time spent 
on assessments are estimated to be in excess of $20/hour for those participating in the full study). 
Furthermore, the case study design, which does not necessitate inferential statistical analyses, ensures 
that our research aims can still be accomplished despite participant attrition. 

 
11
E. Informed Consent Process 
A single informed consent form (see Appendix A. Informed Consent Form) will cover all phases of the 
study (clinical intake, pre-intervention assessment, intervention, and post-intervention assessment). 
Prior to the clinical intake, a copy of the Informed Consent Form will be emailed to participants. At the 
start of the clinical intake, a trained research staff member will give each parent an overview of the 
study in its entirety and review confidentiality practices, potential risks, and any benefits. Participants 
will also be informed that as this is an intervention development project, the intervention group co-
leaders are involved in the research and will have access to assessment data. Limits to confidentiality 
will be covered (as in the case of abuse of vulnerable populations, harm to self or others), as will the 
steps that will be taken if this information is revealed. Because the clinical intake and the assessments 
will specifically ask about suicidality, parents will be told in detail what procedures will occur if they are 
judged to be a risk to themselves or others (see Appendix X. Critical Risk Protocol). Parents will be 
invited to ask questions and will then provide consent via electronic signature on the Informed Consent 
Form and email it back to the staff member conducting the clinical intake. 
 
At the start of the post-intervention qualitative interview, the trained research staff member 
conducting the interview will briefly cover the purpose of the exit interview and review the relevant 
portion of the consent form with the parent. Parents will be asked to verbally reaffirm their consent to 
participate. We will clearly track that the parent’s consent to participate in the study was collected at the 
clinical intake and at the post-intervention exit interview (see Appendix Z. Documentation of Informed 
Consent). 
A copy of the informed consent form will be posted on a Federal website (e.g. clinicaltrials.gov) 
after the study is closed to recruitment and no later than 60 days after the last study visit by any 
subject.  
 
Research roles for consent procedures. All research staff members involved in collecting informed 
consent will be highly trained. Specifically, through the first two years of a clinical graduate student’s 
studies, they take courses on assessment procedures, psychopathology and development, and begin 
working as individual and group therapists in the local psychology clinic under a licensed psychologist’s 
supervision. This training includes exposure to a clinical population directly, and specialized training in 
assessing risk.  
F. Provisions for Participant Privacy and Data Confidentiality 
Methods of data collection from participating parents will occur through UO Qualtrics and a 
HIPAA compliant version of Zoom. Zoom will be used for clinical intakes, the intervention 
sessions and the final exit interview. OneDrive will be the primary cloud storage method for 
identifiable or highly sensitive data. OneDrive includes security controls and encryption of 
data 
that 
satisfy 
the 
requirements 
of 
the 
HIPAA 
Security 
Rule 
(https://www.hipaajournal.com/onedrive-hipaa-compliant/). 
 
Upon entering the study, the parent will be assigned a unique, random ID number, which will be used to 
label each parent’s data throughout the study phases (i.e. intake, pre-intervention assessment, 
intervention, post-intervention assessment). Participants will be explicitly directed not to provide any 
identifying information, including their name or their child’s name when completing Qualtrics 
questionnaires, and instead will be directed to provide only their unique ID number. A master list linking 
the ID number to identifiable information (i.e. parent and child’s real names, contact information) will be 
stored separately from all other data, on a password-protected server, only to be accessed by key 
study personnel. 
 
Questionnaire data will be collected via the Qualtrics system and will be accessible on the Qualtrics 
website. Qualtrics assigns a random code to each participant. Once the data are downloaded, the 
Qualtrics codes will be replaced with the family’s unique ID number. Data will be downloaded 

 
12
temporarily and moved to be stored on OneDrive, accessible only by the research team. Copies of the 
data will be immediately deleted from local computers after being added to OneDrive. 
 
Video recordings from the clinical intake, intervention sessions and final exit interview will initially be 
stored on secure servers of the University of Oregon and later transferred to secure, online cloud 
storage (OneDrive) with extra security features to encrypt and protect the data. All video recordings will 
be accessible only by the research team. Video recordings will be labeled with a random code number 
and not participant’s names or other identifying information. Video recordings will be stored on 
OneDrive for 3 years after publication of the data, at which time they will be destroyed. Video 
recordings of the clinical intake and intervention sessions may be used for the purpose of internal 
review when consultation about a diagnosis or treatment is needed, to enhance therapist skill, further 
refine the development of the intervention, and train other future therapists. Research assistants will be 
trained to qualitatively code the exit interviews. All research assistants will complete human subjects 
training and will therefore be bound to confidentiality rules. 
 
Clinical records which are a standard part of maintaining a client file such as session notes, 
emergency contacts, and release of information forms (see Appendix Y. Release of 
Information Authorization Form) are not considered study data and will also be stored on 
OneDrive, but kept separate from study data. No person who is not part of the research 
team will have access to this identifiable data. 
 
Emails to enrolled participants (e.g. Zoom links, Qualtrics questionnaire links) will be sent 
via an encrypted email service (Hushmail). Phone communication with the research team 
may be conducted using Google Voice. Text messages sent to participants will not include 
identifying participant information unless first volunteered by the individual (e.g. a first 
name). Participant names will not be saved in a contact list connected to the Google Voice 
account. Their unique phone number will be used to search for the message thread. All 
messages will be permanently deleted from the device upon fulfillment of the intended 
purpose. 
 
Sharing data. This research study is part of a larger set of related studies being conducted by the 
Center on Parenting and Opioids (CPO), a National Center co-located at UO’s Prevention Science 
Institute (PSI), UO’s Center for Translational Neuroscience (CTN) and Oregon Health and Sciences 
University (OHSU). The research at CPO is funded by an award from the National Institute on Drug 
Abuse (NIDA).  De-identified data collected as part of the current study will be shared to the CPO Data 
Repository (CPO-DR). This repository stores data from many CPO-affiliated studies and is maintained 
by CPO staff. This expectation for data sharing is in accordance with guidelines from national funding 
agencies (e.g., see NIH Data Sharing Policy here: 
http://grants.nih.gov/grants/policy/data_sharing/index.htm). 
 
We will not share any personally identifiable information about the participants in our study to the CPO-
DR. We will securely transfer data as in accordance with CPO policies and procedures. The CPO-
DR is designed to store encrypted, password-protected data behind firewalls. Data in the CPO-DR will 
be preserved indefinitely. Because we will not share identified data to the CPO-DR, data from 
participants in our study cannot be directly linked to data collected by other CPO research. In other 
words, no CPO researchers will be able to know if someone who participated in our study also 
participated in another CPO-affiliated study. Instead, data from our study may be combined with data 
from other CPO studies. Many of the studies that are part of the CPO have agreed to administer the 
same set of questionnaires, so that we can combine the responses across multiple studies. Increasing 
the sample size in this manner will make us more licensed to generalize the findings. Other 
researchers outside of the research team and the CPO research teams can request access to the data 
in CPO-DR. Only researchers who have agreed to protect the confidentiality of participants and the 
privacy of the data will be authorized to access the CPO-DR. CPO staff will be responsible for 
determining which researchers have access to the data.  

 
13
   
It is possible that data in the CPO-DR could be accidentally shared with an unauthorized person who 
may attempt to learn participants’ identities. We will not share any personally identifiable information 
from our study to the CPO-DR. So, the risk is small of someone learning the identity of any of our 
study’s participants by accessing CPO-DR data.    
  
We will ask participants to consent to sharing their de-identified data to the CPO-DR in the Informed 
Consent Form (see Appendix A. Informed Consent Form). Participants who prefer not to share their de-
identified data to the CPO-DR may opt not to participate in the study.  
 
Certificate of Confidentiality. To help us protect the privacy of participants, a Certificate of 
Confidentiality (CoC) from the National Institutes of Health (NIH) was automatically issued as part 
of the CPO’s NIDA P50 grant. This CoC will cover the current research. The research team can use 
the CoC to legally refuse to disclose information that may identify participants in any federal, state, or 
local civil, criminal, administrative, legislative, or other proceedings (e.g., if there is a court subpoena). 
The researchers would use the Certificate to resist any demands for information that would identify 
participants. The Certificate of Confidentiality would not be used to prevent disclosure to state or local 
authorities of child abuse and neglect, or harm to self or others. It will also not be used to prevent an 
audit by the UO IRB or federal funders.  
G. Potential Research Risks or Discomforts to Participants 
Clinical intake risks. While the clinical intake will invite parents to share potentially painful life events, 
the intake will be similar to what would be experienced in any clinical or psychological treatment setting. 
There could be a risk in that parents may meet criteria for mental disorders, which could be upsetting to 
them. Additionally, if the parent is actively suicidal, the intake clinician will conduct a suicide risk 
assessment using the Linehan Risk Assessment and Management Protocol (See Appendix W. 
LRAMP). Following the diagnostic interview, the intake clinician will inform parents about any diagnoses 
made and will provide referrals upon request. If the parent IQ scores are lower than 70 on the PPVT-IV 
(i.e. the parent is ineligible), the intake clinician will provide the parent with the results and the intake 
will be ended prior to completion of the SCID-5 (see Appendix AA. Clinical Intake Debriefing Script). 
Intake clinicians are well-trained and supervised (by Dr. Mottweiler) research staff members with 
experience in assessment and provision of clinical feedback to individuals from clinical populations. 
Intake clinicians will also provide referrals if needed and participants will be provided the PI’s contact 
information should they have additional questions about their experience during intake. Parents will be 
informed of the risk of experiencing upsetting emotions during the informed consent process. 
 
Assessment risks. Answering questionnaires about their mental health, their child’s behavior and their 
own parenting may bring up negative emotions, but the level of distress expected is minimal. Parents 
will be informed of these risks during the informed consent process and reminded that their participation 
is voluntary.  
 
DBT Skills +PT intervention risks. Parents in the DBT Skills +PT group will potentially encounter risks 
by virtue of being in a weekly intervention. By applying DBT and parenting skills in their everyday lives, 
and by being asked to share about these experiences, parents may experience painful emotions. 
However, it is our estimation that the negative emotions experienced would be similar to parents 
engaging in other forms of psychological treatments and in fact, is likely to be very beneficial. Risks of 
psychotherapy are explicitly discussed in the informed consent form. 
 
Telehealth-related risks. There are some specific risks associated with telehealth services. First, 
although it is HIPAA compliant, it is not possible to completely guarantee the security of the Zoom 
software. As with any technology, there is a chance of a security breach that would affect participants’ 
privacy of personal and/or medical information. Second, as parents will be completing sessions in their 
own home, it is not possible to guarantee the same level of privacy as in a clinic. Third, it is possible 

 
14
that parents’ confidentiality may be breached if other members of the therapy group are not in a 
confidential setting. Fourth, it is more difficult for therapists to respond immediately to an emergency 
situation, should that occur during a session. 
We will mitigate these risks by providing instruction to group members on how best to create a 
private and secure space for themselves and other group members (e.g. use of a secure internet 
connection, use of headphones during session, conducting sessions in a private room, instructing 
participants not to record or photograph sessions). To mitigate the risks of emergency situations, 
participants will be asked to provide their location at the start of each session and therapists will 
maintain emergency contacts for each group member. Based on best practices for assessing and 
treating suicidal individuals via telehealth, Appendix X. Critical Risk Protocol includes guidelines for 
such cases which will inform our procedures. All telehealth related risks will be covered in the consent 
form (see Appendix A. Informed Consent Form). 
 
Unimproved or worsening of symptoms. Continued or worsening of symptoms is always a risk, even for 
those engaged in treatment. While these risks are not specific to the proposed study intervention, it is 
important for the study team and parents to be aware of the potential adverse events associated with 
emotion dysregulation and mental disorders. 
 
Confidentiality. The potential for breach of confidentiality exists with the clinical intake, assessment, and 
DBT +PT intervention digital files and for clinical records. Furthermore, as will be reviewed for all 
parents at the intake, confidentiality may be broken if child abuse or neglect, or intention to harm self or 
other is disclosed by the parent. As the intervention will involve parents sharing and discussing different 
parenting situations, it is possible participants may disclose information regarding child abuse or 
domestic violence. In such cases, the co-leaders will follow-up with parents to clarify the risk and 
current safety of their children and determine whether mandated reporting is warranted. The PI and 
clinical supervisor will report this information to child protection services, a primary health care provider, 
or emergency services, depending on the specifics of the disclosure. Procedures for responding to 
such critical incidents are detailed in Appendix X. Critical Risk Protocol. 
 
Data Safety Monitoring Plan. The funding agency required a Data Safety Monitoring Plan for this 
research (see Appendix CC. Data Safety Monitoring Plan). There was no funder requirement for an 
established Data and Safety Monitoring Board/Committee (DSMB/C) as noted in the DSMP. 
H. Potential Benefits of the Research 
Parents who participate in the DBT +PT intervention will receive an evidence-based treatment that has 
been found effective in treating substance abuse in emotionally dysregulated populations, and which is 
scarcely available (or not adherently provided) in Eugene (i.e. DBT Skills), as well as evidence-based 
parent training for children’s emotional and behavior problems. They may experience improvements in 
their mental health and parenting skills, however there may be no direct benefit of participating in the 
intervention. 
Beyond that, participation in this research will contribute to scientific understanding of the effectiveness 
and feasibility of integrating these treatments. Our study will facilitate future research and the 
development of new clinical interventions that will ultimately benefit other parents and families. 
I. Investigator Experience 
Investigator Qualification. Yoel Everett, M.A.: Yoel Everett (PI) is a graduate student researcher in the 
UO START Lab, and is a 4th year student in the clinical psychology doctoral program at the University 
of Oregon. He received his Bachelor’s of Arts in Psychology from Tel Aviv University in 2015, a 
Master’s of Arts from the University of Oregon in 2019 and has been involved in research on emotion 
and emotion regulation for the past 6 years. He also spent one year working in a parent training 
program for parents of severely disruptive children, and co-authored the English version of a parent 
training program manual. He is now in his third year of clinical training at the UO Psychology clinic and 

 
15
in external practicum sites in Eugene, where he has assessed and treated individuals with a variety of 
psychological symptoms in both in-person and telehealth settings. He currently leads a DBT+ Parent 
Training group as part of an IRB-approved case study with 3 parents. He will be responsible for all 
aspects of the project, including integrating and manualizing DBT and Parent Training materials, 
development of recruitment materials, conducting clinical intakes, co-leading the DBT +PT intervention, 
data analysis, and authorship of resultant manuscripts. 
 
Christina Gamache Martin, PhD.: Christina Gamache Martin, Ph.D. (Co-I) is a research associate in the 
Department of Psychology at the University of Oregon. She is a licensed clinical psychologist in Oregon 
and is currently a clinical interventionist for Dialectical Behavior Therapy (DBT) on a NIMH funded 
randomized control trial (PI Dr. Zalewski). She has supervised clinical psychology graduate students in 
the DBT practicum in the Psychology Department at the University of Oregon. Her program of research 
centers around the development of psychopathology within the broader context of parental 
psychopathology and emotional distress, and it seeks to clarify potential clinical challenges 
encountered when both parents and their children present with psychopathology or other stressors 
such as trauma, with the ultimate goal of bridging the current gap between developmental and adult 
psychopathology through basic science research and the development of interventions to better meet 
the needs of families where both children and parents are at risk. 
 
Candice Mottweiler, PhD.: Candice Mottweiler is a postdoc in the Department of Psychology at the 
University of Oregon (UO). She received her PhD in Clinical Psychology from the University of 
Oregon in 2017 following a one-year internship at the University of Kansas School of Medicine. Her 
clinical specialties include working with children and families, using behavioral and cognitive 
behavioral techniques; as well as providing dialectal behavioral therapy (DBT) to adults struggling 
with emotion regulation. Dr. Mottweiler has led DBT groups for parents at the University of Oregon 
since 2018.  She also works as a therapist (since 2017) at Options Counseling and Family 
Services, providing individual therapy to children, adolescents, and adults as well as leading an 
adult DBT group. In addition, she has provided clinical supervision for graduate students and 
interns leading/co-leading DBT groups at UO and Options since 2019. She has worked in varying 
roles on several research projects since 2006, generally focused on child development and/or 
parenting. Her responsibilities on this project will include providing direct supervision for DBT group 
leaders during a scheduled weekly meeting as well as between scheduled meetings to address 
clinical challenges and/or emergencies as needed. 
 
Maureen Zalewski, PhD.: Dr. Maureen Zalewski (Faculty Advisor) has a doctorate in clinical psychology 
and is a licensed psychologist in the state of Oregon. She currently trains and supervises clinical 
doctoral students in the provision of DBT to clients of the UO Psychology clinic. Dr. Zalewski is formally 
trained in Dialectical Behavior Therapy, a treatment designed for women with Borderline Personality 
Disorder, by the treatment developer, Dr. Marsha Linehan. She has treated many individuals with BPD 
and emotion dysregulation and conducted suicide risk assessments. As a researcher, Dr. Zalewski has 
been involved in intervention development efforts of extending DBT for mothers. Dr. Zalewski has first 
authored and co-authored publications on parents with BPD and BPD symptoms such as severe 
emotion dysregulation, and on the effects of parental emotion dysregulation on child development. 
 
Roles and Research Duties. The principal investigator (Everett) and faculty advisor (Zalewski) will be 
involved in all aspects of this research. The co-Investigator (Martin) will help in the development and 
refinement of intervention session plans and will be highly involved in preparing resultant manuscripts 
from this study. The clinical supervisor (Mottweiler) will provide supervision for all intervention co-
leaders by reviewing video recordings of sessions and meeting with co-leaders regularly to provide 
clinical feedback. The project coordinator will be involved in the development of recruitment materials, 
recruitment efforts, scheduling, data collection, data storage and following of procedures for this 
protocol. Yoel Everett (PI) will train all research assistants who may be involved in qualitative coding of 
the exit interviews. In addition, Yoel Everett and the additional co-leaders will be responsible for 

 
16
conducting clinical intakes and co-leading the DBT+PT intervention. A trained clinical psychology 
graduate student will be responsible for conducting the exit interviews. 
 
Training and Oversight. Yoel Everett (PI), the other group co-leaders and Dr. Mottweiler, will participate 
in weekly consultation meetings. These consultation team meetings are designed to assist co-leaders 
in adhering to the DBT treatment model and the Parent Training manual. All research personnel 
involved in recruitment, screening, intakes, assessments and the intervention will complete the 
Collaborative Institutional Training Initiative’s (CITI) Protection of Human Research Subjects program 
for Social-Behavioral-Educational Researchers as well as the Good Clinical Practices training to ensure 
ethical and professional conduct of the research. Study personnel will complete and have up-to-date 
CITI training certificates on file with the Project Coordinator. Additionally, each member of the study 
team will be trained by the PI to follow the approved research protocol. 
 
 

 
17
Appendices submitted with this application
 
A. Informed Consent Form 
B. Recruitment Email 
C. Craigslist Posting 
D. Facebook Posting 
E. Online Screening Script 
F. Intake Scheduling Script 
G. Difficulties with Emotion Regulation Scale (DERS) 
H. CAGE-AID Screener 
I. 
Demographic Questionnaire 
J. Patient Health Questionnaire 9 (PHQ-9) 
K. Hamilton Anxiety Rating Scale (HAM-A) 
L. The Aggregated Drug Craving Scale (ADCS) 
M. DBT Ways of Coping Checklist (DBT-WCCL) 
N. Weekly Assessment of Child Behavior (WACB) 
O. Emotion Regulation Checklist (ERC) 
P. Parenting Stress Index (PSI) 
Q. Parenting Sense of Competence Scale (PSOC) 
R. Parenting Scale (PS) 
S. Coping with Children's Negative Emotions Scale (CCNES) 
T. DBT/Parenting Skill Use Diary Card 
U. Client Satisfaction Questionnaire (CSQ-8) Sample Text 
V. Sample Exit Interview Questions  
W. Linehan Risk Assessment and Management Protocol (LRAMP) 
X. Critical Risk Protocol 
Y. Release of Information Authorization Form 
Z. Documentation of Informed Consent 
AA. Clinical Intake Debriefing Script 
BB. Community Resources 
CC. Data Safety Monitoring Plan 
DD. Child Behavior Checklist (CBCL) 
EE. DBT+PT Recruitment Flyer 
FF. Mailing Recruitment