Outpatient Dialectical Behavior Therapy for Adolescents: Treatment Outcomes and Comparison of Treatment Effects in Two Skills Training Group Formats Open Access

Abstract

The current study is a pilot trial evaluating dialectical behavior therapy for adolescents (DBT-A) and comparing two formats of group skills training: parallel adolescent and parent groups (DBT-A/P), and multifamily group (DBT-A/MF). DBT-A was developed utilizing multifamily groups (Miller, Rathus, & Linehan, 2007; Miller, Rathus, Linehan, Wetzler, & Leigh, 1997), and the only RCT of DBT-A to date utilized that skills training format (Mehlum et al., 2014). There are no published outcome studies of DBT-A utilizing a parallel group format, and no studies comparing parallel and multifamily groups. Participants were 37 adolescents who participated in six months of outpatient DBT-A/MF or DBT-A/P, including individual DBT and skills training group. Adolescents were assessed on a number of self-report and interview-assessed variables before treatment, and again at six months after the start of DBT. Self-report variables were depression, borderline personality disorder (BPD), and emotion dysregulation symptoms, and DBT skills use. Interview-assessed behaviors were non-suicidal self-injury frequency and severity, and frequency of suicide attempts and psychiatric hospitalizations. Adolescents in both DBT-A/MF and DBT-A/P demonstrated significant improvements in self-reported symptoms of depression, BPD, and emotion dysregulation. Adolescents in DBT-A/MF did not significantly outperform adolescents in DBT-A/P on attendance or completion rates or any self-report or behavioral variable. Low treatment dropout rates suggest that both DBT-A/MF and DBT-A/P were well accepted by patients. These findings help establish the feasibility and acceptability of different DBT-A skills training group formats. A larger randomized trial is needed for further evaluation of DBT-A and comparison of skills training formats.

Table of Contents

Introduction 1

Self-Harm, Suicide, and BPD 2

Theories of Development of BPD and Mechanisms of Therapeutic Change in DBT 5

Empirical Support for DBT in Adults 8

Adaptations of DBT for Adolescent Populations 10

Empirical Support for DBT in Adolescents 13

Aims and Hypotheses of Current Study 15

Method 16

Inclusion and Exclusion Criteria 16

Participants 17

Measures 17

Procedure 20

Data Analysis 22

Results 24

Sample Characteristics 24

Implementation and Effectiveness of DBT-A in Total Sample 25

Comparison of Implementation and Effectiveness of DBT-A/MF and DBT-A/P 27

Discussion 29

Limitations 37

Conclusions and Future Directions 39

References 41

Tables 57

About this Dissertation

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School	Laney Graduate School
Department	Psychology
Degree	PhD
Submission	Dissertation
Language	English
Research Field	Psychology, Clinical
Keyword	emotion dysregulation dialectical behavior therapy adolescents
Committee Chair / Thesis Advisor	Craighead, W Edward, Emory University
Committee Members	Rodman, Hillary R, Emory University Gillespie, Charles, Emory University Westen, Drew, Emory University Ramirez, Cynthia, Emory University

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