Admittedly, it’s a little peculiar that I’m writing a blog on DBT for youth, given that I’ve always been somewhat afraid of adolescents! I think I was probably afraid of them even when I was an adolescent. It’s probably the emotional ups and downs and unpredictability of their behaviour, the confusing social dynamics, and so forth that wig me out. I also think that I probably seem like some kind of stiff, out-of-it middle-aged guy to the young folks. Now, I have one son who is firmly planted in adolescence, and another emerging adolescent. I see and interact with these creatures every day, and I’m sad to say that I’m probably more afraid of them now than I used to be! That said, I often work with and sometimes teach youth in my martial arts classes, and in that context, I have found them to be focused, respectful, and interested in learning and improving. We treat adolescents at the DBT Centre, and I’ve been inspired and amazed at what they’re capable of. Youth have incredible strengths that are often overlooked or overshadowed by some of the mental health problems that they struggle with. But, I digress…
My plan was to spend some time talking about what we know about DBT for youth. Back in 2002, Drs. Jill Rathus and Alec Miller published findings from a very interesting study comparing DBT for adolescence (DBT-A) to supportive psychodynamic therapy. The findings were promising: DBT-A clients had fewer psychiatric hospitalizations and a lower dropout rate than the clients who received the other treatment. Rathus and Miller had worked diligently for years to find a way to make DBT workable for adolescents, and some of the changes they made to the treatment included the length of group skills training and the addition of particular types of skills that are especially relevant to families. For example, adolescent groups tend to be about 90 minutes, compared to the 2 1/2 hours that Marsha Linehan started off with for adult DBT skills groups. DBT-A also includes skills aimed at helping families understand how they might be rewarding or reinforcing the exact behaviours that they don’t want to see, such as a parent inadvertently making it easier for their youth to stay in bed all day by bringing them food or providing extra support when they stay in bed but not when they get up. Other additions included education on dialectical theory, which in DBT, basically means that the most effective approach with anyone is to balance acceptance of who they are with efforts to help them change and move toward important goals. Further, DBT-A often involves group skills training with the parents/caregivers in attendance, so that the youth and their family are learning the same skills at the same time. When DBT-A first came out, it was met with great enthusiasm, despite the fact that only one study had been published. Now, this approach has been examined in rigorous trials both in the United States and in Europe, and the findings have strongly supported the effectiveness of DBT for adolescents (see McCauley et al., 2018; Mehlum et al., 2014; 2016).
I think that one important feature of the DBT-A is that it is a comprehensive approach. DBT-A typically includes weekly individual therapy, multi-family skills training classes, and the availability of the therapist between session for phone coaching calls to help the client learn how to use skills in difficult situations. As with standard DBT, DBT-A also includes a consultation team of therapists who meet weekly to maintain and improve their skills and motivation.
Recently, our local CBC radio station discussed the mental health treatment of youth, and a recent, large review of effective approaches to reducing risk. One of the conclusions of this review was that multi-component treatment programs are likely to be most effective clinically and more cost-effective for youth. DBT and other similar approaches fall squarely within this domain of comprehensive, multicomponent treatment packages. For more information on the review, please see the following link: https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/Global-Review-Identifies-Successful-Mental-Health-Interventions-for-Teens.aspx.
~ Alexander L.Chapman, Ph.D., R.Psych.