Our ‘best tool’ for self-harm and suicidal teens

Parents seeking treatment for teens who self-harm or experience anxiety, depression, or suicidal thoughts face a wide range of treatment options and shortcuts: Cognitive Behavioral Therapy (CBT), Parent Management Training (PMT), Collaborative Assessment and Suicide Management (CAMS) and acceptance therapy and commitment (ACT) and others.

Each approach can benefit a specific subgroup of people. But for teens at high risk of self-harm and suicide, health experts and researchers are increasingly pointing to dialectical behavior therapy, or DBT, as an effective treatment.

“As of this moment, it’s probably the best tool we have,” said Michelle Burke, a child and adolescent psychiatrist at Stanford University.

in Study 2018 In the Journal of the American Medical Association, Dr. Burke and colleagues found that DBT led to more severe reductions in suicide attempts and self-harm among adolescents than more general treatment. A 2014 study by researchers in Norway I found a similar effectt, noting that the treatment also has a relatively low drop-out rate, and concluding that “it is indeed possible to engage, retain and treat adolescents” with DBT. The treatment has also been identified as an evidence-based primary treatment by the American Academy of Pediatrics. If anything, Dr. Burke said, DBT is “not available enough”.

Dialectical behavior therapy is a subset of cognitive behavioral therapy, which aims to reframe a person’s thoughts and behavior. DBT initially focuses on raw behavior and emotion, helping the individual to overcome moments of crisis and to understand what prompted the behavior in the first place.

DBT capacitor. The full version of the programme, which can take six months to a full year, consists of four components: Individual therapy for the adolescent; group therapy; Training teens and their parents to teach emotion regulation, and phone access to a therapist for help during crises.

The first step is to teach the patient to recognize the feelings in the body when a dangerous impulse appears, such as “a lump in the throat, a strained pulse, tense shoulders,” said Jill Rathos, a psychiatrist who practices on Long Island. In the 1990s, Dr. Rathus was part of a team that adapted the adult version of DBT for use by teens and their families.

Then patients learn to put these feelings into words. Dr. Rathos said it is critical that we “put language” into a physical and emotional experience. This engages parts of the brain, such as the prefrontal cortex, that help regulate emotions. In young adults, these brain regions are not fully developed and can easily become overwhelmed.

The next step is to learn how to lower a state of arousal using specific and often simple techniques: splashing the face with cold water, doing short but intense exercises, putting an ice pack on the eyes – “to guide body chemistry” in the language of the DBT

The intense nature of DBT reflects the difficulty of his challenge: regulating the emotions of adolescents who are so stressed that they struggle to think. At this age, Dr. Rathos said, the teen’s brain often isn’t developed enough to process the influx of incoming news and social information.

“The brain is overloaded, overwhelmed with high emotional excitement, you can’t learn anything new, you can’t process the information coming in, and therefore suggestions of what to do or try to bounce right off you,” Dr. Rathus said.

This is why teens appear to their parents unable to hear suggestions to curb their dangerous impulses, regardless of goodwill or empathy, noted Dr. Rathus. Some teens are unable to start DBT without medication, such as an antidepressant or anti-anxiety medication, to calm the brain enough for the treatment to take hold.

Medications are a source of tension among teen mental health experts, who note that medications can be prescribed too easily, or are prescribed in combinations with unknown side effects. But it can be vital as one tool for stabilizing your teen.

“The drug really helps take away the advantage,” said Dr. Burke of Stanford University. But there is no cure for suicidal behavior. The medication is for depression and anxiety, and the patient needs to learn other behavioral skills that the medication doesn’t teach you.”

Therapists trained in dialectical behavior therapy can be expensive and difficult to find, and they are often well-reserved.

Prices vary by state and provider, but doctors said it’s not uncommon for an hour of a one-on-one consultation to cost $150 to $200 or more, with group therapy about half that cost. Over a six-month period, treatment can cost up to $10,000 for a person paying out of pocket. But personal expenses can also vary widely depending on the type of insurance plan used, and whether the treatment is covered by Medicaid, the state insurance plan.

Only two states–Minnesota and Missouri–provide broad support for DBT, according to Anthony DuBose, head of training at Behavioral Tech, an organization that trains DBT therapists. He cited another reason for the relative paucity of DBT counseling: some therapists fear that the treatment is too intense and may exceed the time available to them. “We need to convince mental health providers that they can do this,” he said.

The initial costs can be worth it in the long run: Several studies compiled by researchers at University of Washington She suggests that DBT interventions, while initially costly, can reduce the need for frequent and costly emergency room visits. According to the university’s Center for Behavioral Technology, DBT is cost-effective, and “accumulating evidence indicates that DBT reduces the cost of treatment.”

Skinny versions of DBT exist, experts said, and may also work for teens with self-harm and suicidal tendencies. But these experts caution that many of these emerging differences have not been studied with the same rigor as the full treatment.

Anecdotally, teens who’ve had some DBT or CBT training appear to be better equipped to deal with feelings of distress and suicidal tendencies, according to Dr. Stephanie Kinbeck, a pediatric emergency room physician at Cincinnati Children’s who has researched therapeutic approaches to suicidal impulses.

Dr. Kennebec said she has seen the value of training firsthand in cases where teens have come to the emergency room out of their intense emotions. Dr. Kienbeck said adolescents who did not receive treatment and did not have training to return to it often needed to stay in the emergency room longer, until they were put on a treatment program. She added that she felt more comfortable sending a child home if he had some sense of how to deal with difficult emotional situations.

“Those patients who already have some CBT or DBT have the ability to identify what their feelings are, tell me how you might translate their emotions into what they’re going to do next,” Dr. Kennebec said. “This is invaluable.”

There are many therapeutic models that help address various emotional issues including anxiety, depression, and trauma. When acute behavioral risks, such as self-harm and suicide, are a concern, the American Foundation for Suicide Prevention Recommend a number of options After DBT, including CAMS, which has been shown in studies To be effective in reducing suicidal thoughts, and Cognitive behavioral therapy for suicide prevention, or CBT-SPwhich has been shown in studies To be effective in preventing further suicide attempts in adults with at least one previous attempt.

In DBT, the teen is not the only one learning. Parents are trained to validate their teen’s feelings, as irrational as these feelings may seem.

“The mistake parents make, even well-meaning and loving parents, is to minimize feelings,” said Dr. Rathos. Telling a distraught teen “just go for a walk, or focus on schoolwork, is like telling him to climb Mount Everest.”

She said the teen can’t hear words, and quickly “learns not to trust” strong feelings or emotions. Parents take group classes where they are instructed to understand what teens are going through and teach them specific ways to address distress.

Valerie, a Silicon Valley executive, described her family’s experience with DBT (requesting that her last name not be used to protect their privacy). Halfway through 2021, Valerie’s 12-year-old daughter is increasingly growing; As a solid student, she started acting in school, suffered seemingly uncontrollable meltdowns and became obsessed with her looks and weight.

The girl started a DBT, and Valerie took the parent’s instructions, which taught her more effective ways to respond to her daughter, for example, by first checking the girl’s painful feelings rather than immediately suggesting a solution.

If her daughter is afraid of dealing with a difficult subject or a teacher at school, Valerie tries to paraphrase the fear: “I’d say, ‘Okay, you’re going to have this bad experience. So, before that, get some good sleep, eat some good snacks, arrange to meet a friend afterwards, and bring a little gummy bear to class. “

“It’s like filling your tank before going on a long trip,” Valerie added. She said the concepts she had begun to adopt in her own life when she studied “anxiety thoughts,” such as, “Will I be alone after I sell my business?”

She said her daughter is getting better. “It helped her get rid of feeling hopeless or getting attached to things,” Valerie said. “It reduces the catastrophe of things” and “no longer goes into rabbit holes that you can’t get out of.”

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