Applying Technological Approaches to Clinical Supervision in Dialectical Behavior Therapy: A Randomized Feasibility Trial of the Bug-in-the-Eye (BITE) Model

• We examined the feasibility and acceptability of a novel technological approach to training in DBT.
• We highlighted methods of enhancing supervision of EBPs using observation and performance-based feedback.
• The implications for utilizing live supervision in the training of EBPs in training programs are discussed.

The growth of the evidence based practice (EBP) movement has created a need for efficient models of EBP training that provide timely feedback to trainees. This feasibility trial examined a technological approach to clinical supervision called bug-in-the-eye (BITE) among trainees learning Dialectical Behavior Therapy (DBT).Eight DBT trainees within a psychiatry residency program were randomized to receive either supervision-as-usual (SAU; n = 4) or BITE group supervision (n = 4) during a 1-year elective clinical rotation. A mixed method design was used to evaluate acceptability, feasibility, and preliminary effectiveness of BITE to improve DBT knowledge transfer and reduce burnout relative to SAU.Qualitative analyses indicate that BITE was feasible to implement and acceptable among trainees. Trainees assigned to the BITE condition had significantly better postsupervision scores on a DBT case formulation assignment compared to those receiving SAU. The BITE condition also showed a trend toward higher scores on an exam measuring knowledge of DBT skills and theory. There were no trends noted over time or between condition on pre-post reports of burnout or satisfaction with supervision.This study finds preliminary support for a supervision approach using BITE technology as a feasible and acceptable model of clinical supervision that is associated with differentially greater learning for DBT case conceptualization compared to traditional supervision. A key limitation of the study is the small sample size, which limits both statistical power and generalizability; however, findings suggest that technological methods of enhancing supervision may be implemented successfully in evidence-based behavioral therapies.