A Pilot Intervention of Multifamily Dialectical Behavior Group Therapy in a Treatment-Seeking Adolescent Population

Abstract

This open pilot trial examined the feasibility of a 16-week multifamily dialectical behavior therapy (DBT) skills group adapted for a multifamily context as an addendum to treatment as usual. Psychopathology symptoms in both adolescents (N = 13) and caregivers (N = 16) were assessed pre- and posttreatment using multiple methods and reporters. There was a significant reduction in adolescent borderline and antisocial personality disorder symptoms as assessed by diagnostic interview, as well as a significant decrease in caregiver-reported adolescent internalizing and externalizing behaviors. However, adolescents did not self-report a significant decrease in symptoms. Results suggest that multifamily DBT skills group may be a feasible treatment in this population and speak to the importance of further research examining the implementation and dissemination of DBT with adolescents in a family context.

Keywords

adolescence dialectical behavior therapy personality disorders group treatment

Get full access to this article

View all access options for this article.

References

Achenbach

(1991). Manual for the youth self-report and 1991 profile. Burlington: Department of Psychiatry, University of Vermont.

Achenbach

T. M.

Edelbrock

(1983). Manual for the child behavior checklist and revised child behavior profile. Burlington: Department of Psychiatry, University of Vermont.

Achenbach

T. M.

Rescorla

L. A.

(2001). Manual for the ASEBA school-age forms and profiles. Burlington: University of Vermont, Research Center for Children, Youth, and Families.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text Rev.). Washington, DC: Author.

Angold

Costello

E. J.

Erkanli

(1999). Comorbidity. Journal of Child Psychology and Psychiatry, 40, 57–87.

Asarnow

J. R.

Tompson

M. C.

Berk

(2005). Adolescent depression: Family focused treatment strategies. In Pinsof

Lebow

(Eds.), Family psychology: The art of the science (pp. 425–449). New York, NY: Oxford University Press.

Brownell

K. D.

Kelman

J. H.

Stunkard

A. J.

(1983). Treatment of obese children with and without their mothers: Changes in weight and blood pressure. Pediatrics, 71, 515–523.

Carter

J. S.

Garber

(2011). Predictors of the first onset of a major depressive episode and changes in depressive symptoms across adolescence: Stress and negative cognitions. Journal of Abnormal Psychology, 120, 779–796.

Cohen

(1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum.

10.

Cohen

Chen

Crawford

T. N.

Brook

J. S.

Gordon

(2007). Personality disorders in early adolescence and the development of later substance use disorders in the general population. Drug and Alcohol Dependence, 88, 71–84.

11.

Derogatis

L. R.

(1983). SCL 90-R: Administration, scoring, and procedures manual. Towson, MD: Clinical Psychometric Research.

12.

Diamond

G. S.

Siqueland

(1995). Family therapy for depressed adolescents. Psychotherapy: Theory, Research, and Practice, 32, 77–90.

13.

Dixon

McFarlane

W. R.

Lefley

Lucksted

Cohen

Falloon

… Sondheimer

(2001). Evidence-based practices for services to families of people with psychiatric disabilities. Psychiatric Services, 52, 903–910.

14.

Feldman

Kazdin

A. E.

(1995). Parent management training for oppositional and conduct problem children. The Clinical Psychologist, 48, 3–5.

15.

Fogelson

D. L.

Nuechterlein

K. H.

Asarnow

R. F.

Payne

D. L.

Subotnik

K. L.

Giannini

C. A.

(1999). The factor structure of schizophrenia spectrum personality disorders: Signs and symptoms in relatives of psychotic patients from the UCLA Family Members Study. Psychiatry Research, 87, 137–146.

16.

Fruzzetti

A. E.

Santisteban

D. A.

Hoffman

P. D.

(2007). Dialectical behavior therapy with families. In Dimeff

L. A.

Koerner

(Eds.), Dialectical behavior therapy in clinical practice (pp. 222–244). New York, NY: Guilford Press.

17.

Gratz

K. L.

Tull

M. T.

Reynolds

E. K.

Bagge

C. L.

Latzman

R. D.

Daughters

S. B.

Lejuez

C. W.

(2009). Extending extant models of the pathogenesis of borderline personality disorder to childhood borderline personality symptoms: The roles of affective dysfunction, disinhibition, and self- and emotion-regulation deficits. Development and Psychopathology, 21, 1263–1291.

18.

Hafkenscheid

(1993). Psychometric evaluation of the Symptom Checklist (SCL-90) in psychiatric patients. Personality and Individual Differences, 14, 751–756.

19.

Hammen

Rudolph

Weisz

J. R.

Burge

Rao

(1999). The context of depression in clinic-referred youth: Neglected areas in treatment. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 64–71.

20.

Harley

Sprich

Safren

Jacobo

Fava

(2008). Adaptation of dialectical behavior therapy skills training group for treatment-resistant depression. The Journal of Nervous and Mental Disease, 196, 136–143.

21.

Holland

B. S.

Copenhaver

M. D.

(1988). Improved Bonferroni-type multiple testing procedures. Psychological Bulletin, 104, 145–149.

22.

Ivanova

M. Y.

Achenbach

T. M.

Rescorla

L. A.

Dumenci

Almqvist

Bilenberg

… Verhulst

F. C.

(2007). The generalizability of the youth self-report syndrome structure in 23 societies. Journal of Consulting and Clinical Psychology, 75, 729–738.

23.

Iverson

K. M.

Shenk

Fruzzetti

A. E.

(2009). Dialectical behavior therapy for women victims of domestic abuse: A pilot study. Professional Psychology: Research and Practice, 40, 242–248.

24.

Jacobson

N. S.

Truax

(1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 67, 332–339.

25.

James

A. C.

Taylor

Winmill

Alfoadari

(2008). A preliminary community study of dialectical behaviour therapy (DBT) with adolescent females demonstrating persistent, deliberate self-harm (DSH). Child and Adolescent Mental Health, 13, 148–152.

26.

Koons

C. R.

Robins

C. J.

Tweed

J. L.

Lynch

T. R.

Gonzalez

A. M.

Morse

J.Q.

… Bastian

L. A.

(2001). Efficacy of dialectical behavior therapy in women veterans with borderline personality disorder. Behavior Therapy, 32, 371–390.

27.

Lebow

J. L.

(2008). Couple and family therapy. In Lebow

J. L.

(Ed.), Twenty-first century psychotherapies: Contemporary approaches to theory and practice (pp. 307–346). Hoboken, NJ: John Wiley.

28.

Lebow

J. L.

Gurman

A. S.

(1995). Research assessing couple and family therapy. Annual Review of Psychology, 46, 27–57.

29.

Linehan

M. M.

(1993). Cognitive behavioral therapy of borderline personality disorder. New York, NY: Guilford Press.

30.

Linehan

M. M.

Armstrong

H. E.

Suarez

Allmon

Heard

H. L.

(1991). Cognitive-behavioral treatment of chronically suicidal borderline patients. Archives of General Psychiatry, 48, 1060–1064.

31.

Linehan

M. M.

Comtois

K. A.

Murray

A. M.

Brown

M. Z.

Gallop

R. J.

Heard

H. L.

… Lindenboim

(2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63, 757–766.

32.

Linehan

M. M.

Dimeff

L. A.

Reynolds

S. K.

Comtois

K. A.

Welch

S. S.

Heagerty

Kivlahan

D. R.

(2002). Dialectical behavior therapy versus comprehensive validation therapy plus 12-step for the treatment of opioid dependent women meeting criteria for borderline personality disorder. Drug and Alcohol Dependence, 67, 13–26.

33.

Linehan

M. M.

Schmidt

III Dimeff

L. A.

Craft

J. C.

Kanter

Comtois

K. A.

(1999). Dialectical behavior therapy for patients with borderline personality disorder and drug-dependence. The American Journal of Addiction, 8, 279–292.

34.

Linehan

M. M.

Tutek

Heard

H. L.

Armstrong

H. E.

(1994). Interpersonal outcome of cognitive-behavioral treatment for chronically suicidal borderline patients. American Journal of Psychiatry, 51, 1771–1776.

35.

Loranger

A. W.

(1999). The international personality disorder examination. Lutz, FL: Psychological Assessment Resources.

36.

Loranger

A. W.

Sartorius

Andreoli

Berger

Buchheim

Channabasavanna

S. M.

… Regier

D. A.

(1994). The international personality disorder examination: The world health organization/alcohol, drug abuse, and mental health administration international pilot study of personality disorders. Archives of General Psychiatry, 51, 215–224.

37.

Lynch

T. R.

Cheavens

J. S.

Cukrowicz

K. C.

Thorp

S. R.

Bronner

Beyer

(2007). Treatment of older adults with co-morbid personality disorder and depression: A dialectical behavior therapy approach. International Journal of Geriatric Psychiatry, 22, 131–143.

38.

Lynch

T. R.

Morse

J. Q.

Mendelson

Robins

(2003). Dialectical behavior therapy for depressed older adults: A randomized pilot study. American Journal of Geriatric Psychiatry, 11, 33–45.

39.

Markon

K. E.

Krueger

R. F.

Watson

(2005). Delineating the structure of normal and abnormal personality: An integrative hierarchical approach. Journal of Personality and Social Psychology, 88, 139–157.

40.

Miller

A. L.

Glinski

Woodberry

K. A.

Mitchell

A. G.

Indik

(2002). Family therapy and dialectical behavior therapy with adolescents: Part I: Proposing a clinical synthesis. American Journal of Psychotherapy, 56, 568–584.

41.

Miller

A. L.

Rathus

J. H.

Linehan

M. M.

(2007). Dialectical behavior therapy with suicidal adolescents. New York, NY: Guilford Press.

42.

Neacsiu

A. D.

Rizvi

S. L.

Linehan

M. M.

(2010). Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder. Behavior Research and Therapy, 48, 832–839.

43.

Nelson-Gray

R. O.

Keane

S. P.

Hurst

R. M.

Mitchell

J. T.

Warburton

J. B.

Chok

J. T.

Cobb

A. R.

(2006). A modified DBT skills training program for oppositional defiant adolescents: Promising preliminary findings. Behaviour Research and Therapy, 44, 1811–1820.

44.

Nickell

A. D.

Waudby

C. J.

Trull

T. J.

(2002). Attachment, parental bonding and borderline personality disorder features in young adults. Journal of Personality Disorders, 16, 148–159.

45.

Rathus

J. H.

Miller

A. L.

(2002). Dialectical behavior therapy adapted for suicidal adolescents. Suicide and Life-Threatening Behaviors, 32, 146–157.

46.

Robins

C. J.

Chapman

A. L.

(2004). Dialectical behavior therapy: Current status, recent developments and future directions. Journal of Personality Disorders, 18, 73–89.

47.

Safer

D. L.

Telch

C. F.

Agras

W. S.

(2001). Dialectical behavior therapy for bulimia nervosa. American Journal of Psychiatry, 158, 632–634.

48.

Santisteban

D. A.

Muir

J. A.

Mena

M. P.

Mitrani

V. B.

(2003). Integrative borderline adolescent family therapy: Meeting the challenges of treating adolescents with borderline personality disorder. Psychotherapy: Therapy, Research, Practice, Training, 40, 251–264.

49.

Satin

La Greca

A. M.

Zigo

M. A.

Skyler

J. S.

(1989). Diabetes in adolescence: Effects of multi-family group therapy and parent simulation of diabetes. Journal of Pediatric Psychology, 14, 259–276.

50.

Sexton

T. L.

Alexander

J. F.

(2002). Functional family therapy for at-risk adolescents and their families. In Patterson

(Ed.), Comprehensive handbook of psychotherapy: Cognitive-behavioral approaches (pp. 117–140). Hoboken, NJ: John Wiley.

51.

Shiner

R. L.

(2009). The development of personality disorders: Perspectives from normal personality development in childhood and adolescence. Development and Psychopathology, 21, 715–734.

52.

Skodol

A. E.

Siever

L. J.

Livesley

W. J.

Gunderson

J. G.

Pfohl

Widiger

T. A.

(2002). The borderline personality diagnosis II: Biology, genetics, and clinical course. Biological Psychiatry, 51, 951–963.

53.

Soler

Pascual

J. C.

Tiana

Cebría

Barrachina

Campins

… Pérez

(2009). Dialectical behavior therapy skills training compared to standard group therapy in borderline personality disorder: A 3-month randomized controlled clinical trial. Behaviour Research and Therapy, 47, 353–358.

54.

Stanton

M. D.

Shadish

W. R.

(1997). Outcome, attrition, and family-couples treatment for drug abuse: A meta-analysis and review of the controlled, comparative studies. Psychological Bulletin, 122, 170–191.

55.

Stepp

S. D.

Epler

A. J.

Jahng

Trull

T. J.

(2008). The effect of dialectical behavior therapy skills use on borderline personality disorder features. Journal of Personality Disorders, 22, 549–563.

56.

Telch

C. F.

Agras

W. S.

Linehan

M. M.

(2000). Group dialectical behavior therapy for binge-eating disorder: A preliminary, uncontrolled trial. Behavior Therapy, 31, 569–582.

57.

Telch

C. F.

Agras

W. S.

Linehan

M. M.

(2001). Dialectical behavior therapy for binge eating disorder. Journal of Consulting and Clinical Psychology, 69, 1061–1065.

58.

Trupin

E. W.

Stewart

D. G.

Beach

Boesky

(2002). Effectiveness of a dialectical behaviour therapy program for incarcerated female juvenile offenders. Child and Adolescent Mental Health, 7, 121–127.

59.

van den Bosch

L. M. C.

Koeter

M. W. J.

Stijnen

Verheul

van den Brink

(2005). Sustained efficacy of dialectical behavior therapy for borderline personality disorder. Behaviour Research and Therapy, 43, 1231–1241.

60.

Verheul

van den Bosch

L. M. C.

Koeter

M. W. J.

de Ridder

M. A. J.

Stijnen

van den Brink

(2003). Dialectical behaviour therapy for women with borderline personality disorder: 12-Month, randomized clinical trial in the Netherlands. British Journal of Psychiatry, 182, 135–140.

61.

Weisz

J. R.

Jensen-Doss

Hawley

K. M.

(2006). Evidence-based youth psychotherapies versus usual clinical care: A meta-analysis of direct comparisons. American Psychologist, 61, 671–689.

62.

White

C. N.

Gunderson

J. G.

Zanarini

M. C.

Hudson

J. I.

(2003). Family studies of borderline personality disorder: A review. Harvard Review of Psychiatry, 11, 8–19.

63.

Wise

E. A.

(2004). Methods for analyzing psychotherapy outcomes: A review of clinical significance, reliable change, and recommendations for future directions. Journal of Personality Assessment, 82, 50–59.

64.

Woodberry

K. A.

Miller

A. L.

Glinski

Indik

Mitchell

A. G.

(2002). Family therapy and dialectical behavior therapy with adolescents: Part II: A theoretical review. American Journal of Psychotherapy, 56, 585–602.

65.

Woodberry

K. A.

Popenoe

E. J.

(2008). Implementing dialectical behavior therapy with adolescents and their families in a community outpatient clinic. Cognitive and Behavioral Practice, 15, 277–286.