Effectiveness of a modified dialectical behaviour therapy for adolescents within a stepped-care model
-
Sarosh Khalid-Khan
,
Ellen N. Jopling
Abstract
Objective:
Early intervention with evidence-based treatment is important to halt the progression from early manifestations of personality disorder traits to adult personality disorders. The purpose of this study is to evaluate dialectical behaviour therapy (DBT) modified for an adolescent population with borderline personality disorder (BPD), offered within a stepped-care model.
Methods:
Seven adolescents (M=1, F=6, Mage=16.86) diagnosed with either BPD or BPD traits participated in a modified 15-week DBT group. The group was offered within a stepped-care model, which required participants to have previously completed an 8-week distress-tolerance module. Pre/post scores on self-report measures of BPD symptomatology, including impulse control, emotional regulation and awareness, anxiety, depression, and substance use, were collected.
Results:
Participants showed a post-treatment decrease in anxiety symptoms (large effect size) and disruptive behaviours (medium effect size). There was also an increase in emotional symptoms (medium effect size) and hyperactivity/inattention (medium effect size).
Conclusion:
The modified DBT group shows promise in alleviating symptoms of anxiety and some of the disruptive behaviours associated with BPD. The increase in emotional symptoms may be due to the expressive nature of DBT, and may contribute to their eventual therapeutic processing in the next step of the program.
Acknowledgments
The authors would like to thank Margo Rivera (PhD) for her assistance with setting up the adolescent MPE group, and Linda Booij (PhD) for statistical support.
References
1. De Fruyt F, De Clercq B. Antecedents of personality disorder in childhood and adolescence: toward an integrative developmental model. Annu Rev Clin Psychol 2014;10:449–76.10.1146/annurev-clinpsy-032813-153634Search in Google Scholar PubMed
2. Fonagy P, Target M, Gergely G, Allen JG, Bateman AW. The developmental roots of borderline personality disorder in early attachment relationships: a theory and some evidence. Psychoanal Inq 2003;23:412–59.10.1080/07351692309349042Search in Google Scholar
3. Mervielde I, De Clercq B, De Fruyt F, Van Leeuwen K. Temperament, personality, and developmental psychopathology as childhood antecedents of personality disorders. J Pers Disord 2005;19:171–201.10.1521/pedi.19.2.171.62627Search in Google Scholar PubMed
4. Linehan MM, Wilks CR. The course and evolution of dialectical behavior therapy. Am J Psychother 2015;69:97–110.10.1176/appi.psychotherapy.2015.69.2.97Search in Google Scholar PubMed
5. Levy KN, Meehan KB, Kelly KM, Reynoso JS, Weber M, et al. Change in attachment patterns and reflective function in a randomized control trial of transference-focused psychotherapy for borderline personality disorder. J Consult Clin Psychol 2006;74:1027–40.10.1037/0022-006X.74.6.1027Search in Google Scholar PubMed
6. Miller AL, Rathus JH, Linehan MM, Wetzler S, Leigh E. Dialectical behavior therapy adapted for suicidal adolescents. Journal of Psychiatric Practice® 1997;3:78.10.1097/00131746-199703000-00002Search in Google Scholar
7. Rathus JH, Miller AL. Dialectical behavior therapy adapted for suicidal adolescents. Suicide Life Threat Behav 2002;32:146–57.10.1521/suli.32.2.146.24399Search in Google Scholar PubMed
8. Woodberry KA, Popenoe EJ. Implementing dialectical behavior therapy with adolescents and their families in a community outpatient clinic. Cogn Behav Pract 2008; 15:277–86.10.1016/j.cbpra.2007.08.004Search in Google Scholar
9. Fleischhaker C, Böhme R, Sixt B, Brück C, Schneider C, et al. Dialectical behavioral therapy for adolescents (DBT-A): a clinical trial for patients with suicidal and self-injurious behavior and borderline symptoms with a one-year follow-up. Child Adolesc Psychiatry Ment Health 2011;5:3.10.1186/1753-2000-5-3Search in Google Scholar PubMed PubMed Central
10. Cooney E, Davis K, Thompson P, Wharewera-Mika J, Stewart J. Feasibility of evaluating DBT for self-harming adolescents: a small randomised controlled trial. Auckland, New Zealand: Te Pou:1–46.Search in Google Scholar
11. James AC, Taylor A, Winmill L, Alfoadari K. A preliminary community study of dialectical behaviour therapy (DBT) with adolescent females demonstrating persistent, deliberate self-harm (DSH). Child Adolesc Ment Health 2008;13:148–52.10.1111/j.1475-3588.2007.00470.xSearch in Google Scholar PubMed
12. Mehlum L, Tørmoen AJ, Ramberg M, Haga E, Diep LM, et al. Dialectical behavior therapy for adolescents with repeated suicidal and self-harming behavior: a randomized trial. J Am Acad Child Adolesc Psychiat 2014;53:1082–91.10.1016/j.jaac.2014.07.003Search in Google Scholar PubMed
13. Courtney DB, Flament MF. Adapted dialectical behavior therapy for adolescents with self-injurious thoughts and behaviors. J Nerv Ment Dis 2015;203:537–44.10.1097/NMD.0000000000000324Search in Google Scholar PubMed
14. Flannery-Schroeder EC, Kendall PC. Group and individual cognitive-behavioral treatments for youth with anxiety disorders: a randomized clinical trial. Cognit Ther Res 2000;24:251–78.10.1023/A:1005500219286Search in Google Scholar
15. Strauss CC, Forehand R, Smith K, Frame CL. The association between social withdrawal and internalizing problems of children. J Abnorm Child Psychol 1986;14:525–35.10.1007/BF01260521Search in Google Scholar PubMed
16. Johnson JG, Smailes EM, Cohen P, Brown J, Bernstein DP. Associations between four types of childhood neglect and personality disorder symptoms during adolescence and early adulthood: findings of a community-based longitudinal study. J Pers Disord 2000;14:171–87.10.1521/pedi.2000.14.2.171Search in Google Scholar PubMed
17. Brodsky BS, Cloitre M, Dulit RA. Relationship of dissociation to self-mutilation and childhood abuse in borderline personality disorder. Am J Psychiat 1995;152:1788.10.1176/ajp.152.12.1788Search in Google Scholar PubMed
18. Farber BA, Lippert RA, Nevas DB. The therapist as attachment figure. Psychotherapy: Theory, Research, Practice, Training 1995;32:204.10.1037/0033-3204.32.2.204Search in Google Scholar
19. Parish M, Eagle MN. Attachment to the therapist. Psychoanal Psychol 2003;20:271.10.1037/0736-9735.20.2.271Search in Google Scholar
20. Beck JS. Beck youth inventories. Psychological Corporation Harcourt Brace, 2001.Search in Google Scholar
21. Goodman R. Strengths and difficulties questionnaire. PsycTESTS Dataset, 2011.10.1037/t00540-000Search in Google Scholar
22. Patrick D, Edwards, T. Youth Quality of Life Instrument – Short Form (YQOL-SF) Measurement Instrument Database for the Social Sciences [Internet]. Midss.org. 2002 [cited 25 August 2015]. Available from: http://www.midss.org/content/youth-quality-life-instrument-short-form-yqol-sf.Search in Google Scholar
23. Maruish ME, editor. The use of psychological testing for treatment planning and outcomes assessment: Volume 1: General considerations. NY, USA: Routledge, 2004.Search in Google Scholar
24. Kovacs M. Children’s depression inventory (CDI). Toronto: Multi-Health Systems Inc., 2004.Search in Google Scholar
25. Groves S, Backer HS, van den Bosch W, Miller A. Dialectical behaviour therapy with adolescents. Child Adolesc Ment Health 2012;17:65–75.10.1111/j.1475-3588.2011.00611.xSearch in Google Scholar PubMed
26. Block-Lerner J, Adair C, Plumb JC, Rhatigan DL, Orsillo SM. The case for mindfulness-based approaches in the cultivation of empathy: does nonjudgmental, present-moment awareness increase capacity for perspective-taking and empathic concern?. J Marital Fam Ther 2007;33:501–16.10.1111/j.1752-0606.2007.00034.xSearch in Google Scholar PubMed
27. Doering S, Hörz S, Rentrop M, Fischer-Kern M, Schuster P, et al. Transference-focused psychotherapy v. treatment by community psychotherapists for borderline personality disorder: randomised controlled trial. Br J Psychiat 2010;196:389–95.10.1192/bjp.bp.109.070177Search in Google Scholar PubMed
28. Sharp C, Bleiberg E. Borderline personality disorder in children and adolescents. Lewis child and adolescent psychiatry: comprehensive textbook. Philadelphia, PA, USA: Wolters Kluwer, 2007:680–91.Search in Google Scholar
29. Linehan MM. Skills training manual for treating borderline personality disorder. Guildford: Guilford Press, 1993.Search in Google Scholar
©2018 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Editorial
- Sibling abuse: a Cadmean victory for societal indifference!
- Original Articles
- Effectiveness of a modified dialectical behaviour therapy for adolescents within a stepped-care model
- The parental role in adolescent screen related sedentary behavior
- Parental support for human papilloma virus vaccination by adolescents in Ibadan North Local Government Area, Ibadan, Nigeria
- Evaluation of social anxiety, self-esteem, life quality in adolescents with acne vulgaris
- A retrospective chart review: adolescents with borderline personality disorder, borderline personality traits, and controls
- Orofacial pain and quality of life in early adolescents in India
- Immune status of representative infectious diseases among Japanese female university students
- Using photovoice in adolescent health research: a case-study of the Well-being of Adolescents in Vulnerable Environments (WAVE) Study in Ibadan, Nigeria
- Utilisation of maternal health services by adolescent mothers in Kenya: analysis of the demographic health survey 2008–2009
- Parents as partners in adolescent HIV prevention in Eastern and Southern Africa: an evaluation of the current United Nations’ approach
- Eating habits and presence of cardiovascular risks in children
- Ignorance could hurt: an assessment of fertility awareness, childbirth intentions and parenting attitudes among university students
- Influenza vaccination challenges in an at-risk student population: considerations for health services
- Case Report
- From oliguria to urinary incontinence: a case of Munchausen’s syndrome in an adolescent boy
- Short Communications
- Both high and low testosterone levels may play a role in suicidal behavior in adolescent, young, middle-age, and older men: a hypothesis
- Obesity and facial dysmorphism in an adolescent patient with a 16p11.2 microdeletion
Articles in the same Issue
- Editorial
- Sibling abuse: a Cadmean victory for societal indifference!
- Original Articles
- Effectiveness of a modified dialectical behaviour therapy for adolescents within a stepped-care model
- The parental role in adolescent screen related sedentary behavior
- Parental support for human papilloma virus vaccination by adolescents in Ibadan North Local Government Area, Ibadan, Nigeria
- Evaluation of social anxiety, self-esteem, life quality in adolescents with acne vulgaris
- A retrospective chart review: adolescents with borderline personality disorder, borderline personality traits, and controls
- Orofacial pain and quality of life in early adolescents in India
- Immune status of representative infectious diseases among Japanese female university students
- Using photovoice in adolescent health research: a case-study of the Well-being of Adolescents in Vulnerable Environments (WAVE) Study in Ibadan, Nigeria
- Utilisation of maternal health services by adolescent mothers in Kenya: analysis of the demographic health survey 2008–2009
- Parents as partners in adolescent HIV prevention in Eastern and Southern Africa: an evaluation of the current United Nations’ approach
- Eating habits and presence of cardiovascular risks in children
- Ignorance could hurt: an assessment of fertility awareness, childbirth intentions and parenting attitudes among university students
- Influenza vaccination challenges in an at-risk student population: considerations for health services
- Case Report
- From oliguria to urinary incontinence: a case of Munchausen’s syndrome in an adolescent boy
- Short Communications
- Both high and low testosterone levels may play a role in suicidal behavior in adolescent, young, middle-age, and older men: a hypothesis
- Obesity and facial dysmorphism in an adolescent patient with a 16p11.2 microdeletion
