Dialectical Behavior Therapy in Adolescent Residential Treatment: Outcomes and Effectiveness

Dialectical Behavior Therapy (DBT), developed as outpatient treatment for adult women with self-harm spectrum behaviors (SHSB), has been effective in many adult settings, across various diagnoses. DBT was adapted for adolescents (DBT-A) and showed effectiveness in outpatient and hospital settings. Adolescents enter residential treatment with severe behavioral problems and emotional dysregulation; deficits that DBT-A addresses. A year-long treatment using DBT-A (n = 48, 46% male) in an adolescent residential setting with no exclusionary criteria regarding SHSB or diagnosis was examined using a pre–post design. Clinical functioning data was collected at admission and discharge, using Achenbach’s Youth Self Report (YSR), Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS), Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II), and DBT-A skills questionnaire. DBT-A demonstrated excellent clinical utility to reduce number of diagnoses from admission (M = 3.13) to discharge (M = 1.33, d = 1.435), and symptom severity, over and above gender and SHSB, independent of primary diagnosis. Regarding perceived utility of DBT-A modules, adolescents were significantly more likely to report using Distress Tolerance skills (71.7%) than other DBT-A skills and to report that all skills will work if used (67.8%) rather than reporting that a particular skill is ineffective.