Piloting a Dialectical Behavioral Therapy (DBT) Infused Skills Group in a Disciplinary Alternative Education Program (DAEP)

Antiracism Work in Schools: Using Dialectical Behavior Therapy Skills to Empower South Texas Educators

OBJECTIVE

Implicit biases within school systems contribute to racist school cultures and policies. Black and Hispanic students are more likely to be over-policed in schools and to be penalized, especially by White teachers. Dialectical behavior therapy (DBT) skills can be taught to educators to support antiracist efforts in schools.

METHOD

A virtual 2-day Train-the-Trainer antiracism workshop incorporating DBT skills was delivered to South Texas educators. DBT skills were integrated as life skills in antiracism situational role play, small group discussions, and meta-cognitive activities. Participants also received books on antiracism and an educators' toolkit to DBT and antiracism. Descriptive analysis described results from the workshop application, pre/post-workshop survey, and 6-month follow-up survey.

RESULTS

Twelve educators completed the workshop application, with 10 educators reporting no history of antiracism trainings at their schools. Nine educators attended the workshop. Workshop feedback was overwhelmingly positive. A pre/post-workshop survey demonstrated growth in both teaching and use of all measured DBT skills and antiracism attitudes. Confidence in teaching and using DBT skills and changes in antiracism attitudes were sustained 6 months later. Five educators reported leading an antiracism initiative in their schools since the attendance of the workshop.

CONCLUSION

A DBT-centered Train-the-Trainer antiracism workshop instilled confidence in educators to lead antiracism efforts, which resulted in the initiation of several initiatives in South Texas schools. Training educators, including teachers, counselors, and administrators, encouraged systemic antiracist change in school systems. The virtual training format may facilitate accessibility to educators who lack access to trainings; however, it may also add difficulty in building community among participants.

Implementation of a Brief Dialectical Behavioral Therapy (DBT) Skills Group in High Schools for At-Risk Youth: Protocol for a Mixed-Methods Study (Preprint)

Background

Adolescence is a developmental period marked by engagement in risk-taking behaviors, especially among impulsive or emotionally dysregulated youth. Thus, interventions that teach skills to reduce the risk of negative outcomes associated with emotional dysregulation are required. Social and emotional learning (SEL) programs have been developed to address both adolescent emotional dysregulation and risk-taking behaviors; however, current programs have mostly been implemented among younger youth and are used as a tier 1 universal intervention rather than a targeted tier 2 intervention for youth identified with emotional regulation difficulties.

Objective

This study aimed to address the need for SEL programming that can be delivered in schools, particularly for older youth who have difficulties with emotional or behavioral dysregulation, to reduce the risk of health-risk behaviors among this population.

Methods

Here, we outline the implementation of an SEL intervention titled Going 4 Goals, a 9-session adaptation of the Dialectical Behavioral Therapy for Adolescents (DBT-A) program delivered to at-risk high school students in a school setting. The primary objectives of the study are to test whether participating in the skills group intervention produces significant increases in the core DBT-A skills of mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness, while also producing significant decreases in substance use and risky behaviors. These primary outcomes are based on changes in participant scores between baseline and after the intervention and follow-ups at 1, 3, and 6 months compared with a control group of youth participating in the school’s health curriculum at the same time points. Qualitative interviews will also be conducted with intervention participants and school staff to examine acceptability and facilitators of and barriers to the intervention.

Results

A total of 171 participants across 13 groups had been enrolled in the intervention, with data collection ending December 2021. Data analysis will begin in the spring of 2022, with expected results to be published in the spring of 2023.

Conclusions

This paper describes the protocol of the 9-session school-based adaptation of the DBT-A intervention and discusses the strengths and limitations of the study and future directions.

International Registered Report Identifier (IRRID)

DERR1-10.2196/32490

Acceptance-based skill acquisition and cognitive reappraisal in a culturally responsive treatment for binge eating in adolescence

Emotional overeating, or eating in excess to soothe negative emotions, is a high-risk behavior for the future development of the binge-eating disorder (BED). The Emotional Overeating Intervention (EOI) is a culturally responsive, 10-week condensed dialectical behavior therapy (DBT) skills group intervention for adolescents endorsing emotional-overeating and binge-eating behaviors. The present study served as a secondary analysis of the intervention data, with the aim of using quantitative measures and qualitative interviews to examine intervention acceptability and DBT skill acquisition. Data were analyzed using descriptive statistics for quantitative surveys and qualitative content analysis for interviews. Among the 15 adolescents (M_age = 15.40 years; 73.3% identifying as female; 100% identifying as Black) who participated in the EOI pilot trial, most identified learning acceptance-based DBT skills, particularly radical acceptance, as both highly acceptable and the most useful aspect of treatment. Participants reported increases in distress tolerance appraisal and emotion regulation cognitive reappraisal scale scores from baseline to post-intervention. Accordingly, acceptance-based DBT skills may be associated with change-based cognitive strategies, which may contribute to improvements in emerging BED pathology. Findings serve as an initial step in informing preventative models of scalable interventions for subthreshold BED among adolescents, by identifying variables that warrant investigation as potential mechanisms of change.

Pilot Study

A significant proportion of youth engage in health risk behaviors, which are of concern, as they are associated with adverse health consequences across development. Two factors associated with engagement in such behaviors are emotion dysregulation and impulsivity. Dialectical behavioral therapy (DBT) is an effective intervention that enhances emotion regulation skills to reduce problem behaviors among adolescent populations; however, limited research has been conducted implementing the program within school settings. The current study was a 9-week DBT skills group conducted among 80 middle school youth, with pre-posttest data among 53 students. Findings indicated feasibility to implement the program in schools and preliminary evidence of efficacy in decreasing youth's likelihood to engage in risky, particularly among youth high on an emotion-based impulsivity trait. Brief DBT skills group may be an effective program to be utilized by school nurses and health-care teams to reduce health risk behaviors among school-aged youth.

Dialectical behavior therapy for nonsuicidal self-injury and depression among adolescents: preliminary meta-analytic evidence

BACKGROUND

Dialectical behavior therapy (DBT) has proven effective in reducing symptoms and behaviors related to Borderline Personality Disorder. More recently, it has been modified and applied to adolescents struggling with regulating their emotions and who may engage in impulsive, self-destructive behaviors, including nonsuicidal self-injury (NSSI). However, there is limited research evidence regarding the effectiveness of DBT for reducing NSSI behavior and depression among adolescents. Given the high suicide risk associated with NSSI and its association with depression, this is clearly an important focus of clinical and research attention.

METHOD

This meta-analysis sought to offer preliminary evidence regarding the effectiveness of DBT to treat NSSI and depression in adolescents. Twelve published studies were included; all 12 reported pre- and post-treatment measures of depression and six of these studies reported pre- and post-treatment measures of NSSI.

RESULTS

The weighted mean effect size for NSSI was large (g = 0.81, 95% CI = 0.59-1.03); the weighted mean effect size for depression was small (g = 0.36, 95% CI = 0.30-0.42).

CONCLUSIONS

Intervention effects for both outcomes were positive, suggesting decreased NSSI and improvement in depressive symptoms for adolescents following a course of DBT. However, given considerable limitations in the research base available for meta-analysis, these findings are preliminary and tentative. Limitations in the current knowledge base and suggestions for future research are discussed.