Time Modified DBT Skills Groups for Adolescents: A Rapid Review

Background and Purpose

Suicidal ideation and self-harm are growing concerns among adolescents. Nearly 20% of high school students have seriously thought about suicide and/or have a diagnosable mental health disorder. Dialectical behavioral therapy (DBT) is an established therapy known for its clinical utility for individuals experiencing suicidal behaviors/ideations, self-harm behaviors, and borderline personality disorder. Since its development, DBT has shown benefits for substance use, PTSD, depression, and eating disorders. DBT has also been modified to serve adolescents and their families/caregivers (DBT-A). Given the current needs among adolescents, DBT-A is a promising therapy for both adolescents and their families.

When provided to fidelity, DBT-A produces positive outcomes such as reducing suicidal ideation, self-harming behaviors, depression, and increasing emotional regulation. Outcomes related to time-modified DBT-A skill groups (e.g., less than 24-weeks) are still largely understudied. This review explores the impact on treatment outcomes when time modifications have been implemented

Methods

We employ a systematic searching approach utilizing a variety of academic databases (i.e., Medline and series of Ebsco databases). Peer-reviewed literature focused on abbreviated DBT and skills groups with youth populations published between January 2000 to July 2022 is included. Additional eligibility criteria included published in English and within the designated timeframe, used a youth sample under the age of 18, and involved an DBT-A group that had been abbreviated in length. Originally 203 studies were exported following the database search, 23 met inclusion criteria for the review.

Results

Of the 23 included studies, 21 utilized different samples with a total of 1,412 adolescent participants under age 18. Of this sample, 967 (68.48%) were identified as girls/female. Studies on average met for 13 weeks. Studies in inpatient settings used the shortest groups (e.g., 2 weeks) whereas outpatient settings met for average of 13 weeks. Many studies indicated promising clinical outcomes that included reductions in suicidal ideation, self-harm, and depression. This is consistent with previous DBT-A studies that implemented the 6-month standard length. Among those that included a comparison group, the DBT-A group was noted as yielding higher reductions in rates of depression and suicidal ideation. Three studies followed up with DBT-A participants and highlighted that skills learned during the DBT-A time modified skills group were retained 16-weeks to a year following completion.

Conclusion and Implications

The findings of this review indicate that DBT-A time modified skill groups yield positive outcomes for adolescents experiencing suicidal ideations and engaging in self-harm. This is an important finding as abbreviated time DBT-A groups can assist in the need for DBT services among youth and common barriers perspective recipients face (e.g., time restraints, attention/engagement). DBT-A with time modifications can open the door for more opportunities to reach adolescents who may not be able to qualify for standard DBT-A due to restrictions with insurance and/or financial concerns that come with long-term therapy. With respect to comprehensive DBT programs (i.e., DBT to fidelity), symptom presentation should be considered for each adolescent prior to enrollment into a modified DBT-A group.