53 Adolescent Dialectical Behaviour Therapy: Levels of Care

Abstract

Abstract Introduction/Background A growing body of research supports the efficacy of Dialectical Behavioural Therapy (DBT) for adolescents with various mental health diagnoses, but a traditional DBT program uses intensive resources (weekly individual and group therapy). To see whether a less intensive program could benefit certain participants, a complementary program called “DBT Lite” was designed and implemented at a large acute care Children’s Hospital. The group format (youth and parents together), therapeutic principals and coping skills taught were the same (based on “DBT Skills Manual for Adolescents”, Miller & Rathus, 2014), but DBT Lite involved only group therapy, and was offered over a shorter time frame (12 weeks vs. 19 weeks). Objectives The purpose of this study was to compare the effectiveness of “DBT Full” and “DBT Lite” on improving emotion regulation and family functioning/parental stress and decreasing emergency department (ED) visits and hospitalizations among adolescents age 13-17 with mental health diagnoses. Participants were not randomized; the treatment was selected according to severity of illness. We hypothesized that both treatment programs would show benefits but that “Full DBT” would result in greater improvements than “DBT Lite” due to its more comprehensive treatment model. Design/Methods Data was collected prospectively pre- and post-treatment from youth and parents participating in both programs over a 3-year period. The primary outcome measures were the DERS (Difficulties in Emotion Regulation Scale), the FACES-IV (Family Adaptability and Cohesion Scale, 4th Ed), and the PSS (Parental Stress Scale). Results were analyzed using paired-sample t-tests. We also examined ED and hospital admission data 6 months prior to starting the group and 6 months following completion of the group. Results In “Full DBT”, emotion regulation improved in both youth (n=9) and parents (n=12) post-treatment (DERS total score: youth p=0.02; parents p=0.01). Parents reported significant improvements on measures of parental stress (PSS p=0.002), and family functioning (FACES-IV family communication p=0.000, satisfaction p=0.008, and overall family functioning p=0.002). However, these improvements were not significant in youth measures. In “DBT Lite”, youth (n=16) and parents (n=17) did not report significant improvements in emotion regulation or family functioning, but did report decreases in parental stress (PSS p=0.005). Both groups resulted in measurable differences in acute care use: the percentage of patients with ED presentations 6 months pre- vs. 6 months post-group decreased from 70% to 27% for “Lite”, and 81% to 50% for “Full”. The percentage of patients requiring hospital admission decreased from 13% to 10% for “Lite”, and 56% to 28% for “Full”. Conclusion These results suggest that although “DBT Lite” may not have the same family functioning and emotion regulation benefits as its full-service counterpart, it can still reduce parental stress and decrease use of acute care resources. This study confirms the patient and family benefits of a full DBT program, but also has important implications for centres with limited mental health resources, given that “Full DBT” requires 38 clinician hours per patient to deliver, versus 12 hours for “DBT Lite”.