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DBT may benefit troubled youth in transition period: with its emphasis on mindfulness, dialectical behavioral therapy eases move into adult services.

SAN DIEGO -- Dialectical behavior therapy shows promise for emotionally troubled youths who are transitioning from state-run child services to state-run adult services, according to the results from a pilot study.

The finding marks the first time dialectical behavior therapy (DBT) has been applied to this segment of the population, Jaak Rakfeldt, Ph.D., reported during a poster session at the American Psychiatric Association's Institute on Psychiatric Services.

"This is a group of young people who have lived in multiple foster care placements, have been abandoned, neglected, abused, and traumatized," said Dr. Rakfeldt, a psychologist in the department of social work at Southern Connecticut State University, New Haven. "They end up with all sorts of developmental problems: cognitive deficits, emerging mental illness, substance abuse issues, and high-risk behaviors. At 18 years old, they're aging out of the department of youth services, so they're a very challenging group to work with."

For the study, 15 participants of a residential program for transitional youths in Connecticut underwent sessions with individual therapists, psychiatrists, and around-the-clock services from residential staff and case managers over a period of 17 months.

Seven of the 15 also received about 12 months of DBT, which blends cognitive-behavioral approaches with acceptance-based practices. The treatment was developed by Marsha M. Linehan, Ph.D., a psychologist who directs the Behavioral and Research & Therapy Clinics at the University of Washington, Seattle.

In an interview, Dr. Rakfeldt described the therapy as "highly structured, and it puts into the center of it mindfulness, which is almost like a Zen technique of emptying oneself and getting oneself emotionally balanced."

He had a hunch that component of DBT would help these youngsters, whose chief problems included emotional dys-regulation and acting out.

"If they get frustrated they punch somebody or they act out," he said. "If they can learn these skills of emotion regulation and distress tolerance, interpersonal effectiveness, and mindfulness, perhaps they can learn new coping mechanisms that are more appropriate to the world. That's the idea."

Quantitative measures for all study participants included the Modified Global Assessment of Functioning Scale and the Purposeful Productive Activity and Quality of Life Scale.

Over the 17-month period, those who received DBT showed improvements in global functioning, social relationships, and productive use of time or "intentionality" compared with their counterparts who did not receive DBT, but there were no differences between the two groups in terms of vocational functioning.

In the text of the poster, the investigators noted that the results for the qualitative analysis suggest that the members of the dialectical behavior therapy group "used the groups to work on specific interpersonal relationships, emotion regulation, and distress tolerance skills, as well as to get feedback and support from others in the group. The most important theme was that they felt they had a safe place to practice new behaviors."

Limitations of the study included the small sample size and its lack of random assignment to the DBT treatment group. Dr. Rakfeldt, also of Yale University, New Haven, estimated that future studies would need to be twice as large to draw strong inferences.


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Title Annotation:Dialectical behavior therapy
Author:Brunk, Doug
Publication:Clinical Psychiatry News
Geographic Code:1U9CA
Date:Dec 1, 2005
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