Academic journal article Journal of Counseling and Development : JCD

Preliminary Evidence for the Effectiveness of Dialectical Behavior Therapy for Adolescents

Academic journal article Journal of Counseling and Development : JCD

Preliminary Evidence for the Effectiveness of Dialectical Behavior Therapy for Adolescents

Article excerpt

Up to 50% of adolescents in the United States have struggled with a mental illness at some point in their lives, and among these adolescents, 32% struggle with an anxiety disorder and 14% struggle with a mood disorder of some kind (Merikangas et al., 2010). Furthermore, up to 40% of adolescents have been diagnosed with more than one disorder. For those who do not receive adequate treatment, the consequences of the mental illnesses can be extremely deleterious and last into adulthood. Adolescents who do not receive adequate care struggle academically and behaviorally, are more likely to have difficulty with employment, and are more likely to engage in illegal activities later in life compared with adolescents who receive mental health treatment (Essau, Lewinsohn, Olaya, & Seeley, 2014; Suido, Thalji, & Ferron, 2011; Zara & Farrington, 2013). Researchers report that up to half of adolescents in the United States have engaged in self-injury at some point in their lives (Craigen, Healey, Walley, Byrd, & Schuster, 2010). In addition, suicide is the second leading cause of death for adolescents, and up to 30% of adolescents who struggle with depression also have endorsed thoughts of suicide (Avenevoli, Swendsen, He, Burstein, & Merikangas, 2015; Heron, 2016). In light of these statistics, counselors are charged with developing evidence-based treatments that can address these disorders and the life-threatening behaviors that accompany them.

Dialectical behavior therapy for adolescents (DBT-A; Miller, Rathus, & Linehan, 2007) was adapted from traditional dialectical behavior therapy (DBT; Linehan, 2015) to facilitate the treatment of adolescents who struggle with the pervasive emotion dysregulation that is related to many mental health disorders. Miller et al. (2007) based DBT-A on Linehan's (2015) biosocial model, which posits that pervasive emotion dysregulation is the consequence of two interacting factors: (a) an individual's biological predisposition for emotional sensitivity and (b) interactions within an invalidating environment. DBT-A is a multimodal treatment based on this biosocial model that was designed to specifically address symptoms of emotion dysregulation and help clients develop new skills to effectively regulate emotions. Counselors also help adolescents achieve treatment goals by engaging them in a dialectical relationship characterized by the synthesis of an accepting relational position that concurrently promotes change. DBT-A includes all of the modes of treatment that are included in traditional DBT: weekly individual therapy sessions, weekly psychoeducational skills groups, intersession phone coaching, and a therapist consultation group. Counselors use behavioral interventions with adolescents to determine how new positive coping behaviors can be reinforced while eliminating old, harmful behaviors.

As in traditional DBT, adolescents are expected to complete homework weekly and track skills use daily (Miller et al., 2007). However, DBT-A also includes a few adaptations. In addition to mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation, there is an added skills module--walking the middle path. Researchers developed this module to specifically address the parent-child relationship and included validation, behaviorism, and a more focused approach to teaching dialectics (Rathus & Miller, 2015). Family sessions are included as needed, and parents are often included in skills training. Finally, the time frame of treatment was shortened to accommodate the needs of adolescents (Miller et al., 2007).

Preliminary research on DBT-A is promising, and studies have shown statistically significant results for reducing anxiety (Ritschel, Lim, & Stewart, 2015), depression (Nelson-Gray et al., 2006; Perepletchikova et al., 2011; Rathus & Miller, 2002), self-injury (James, Taylor, Winmill, & Alfoadari, 2008; James, Winmill, Anderson, & Alfoadari, 2011; Woodberry & Popenoe, 2008), and suicide risk (Fleischhaker et al. …

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