UNC-CH School of Social Work Clinical Lecture Series 10/17/2016 DBT for Adolescents presented by Lorie Ritschel, PhD 1 DBT FOR ADOLESCENTS: WORKING WITH SUICIDAL, SELF-HARMING, AND EMOTIONALLY SENSITIVE YOUTH Lorie A. Ritschel, Ph.D. Assistant Professor, UNC Department of Psychiatry Trainer & Consultant, Behavioral Tech, LLC Private Practice, Durham DBT UNC Chapel Hill School of Social Work Clinical Lecture Series October 17, 2016 DISCLOSURES & NOTICES • I receive compensation for my work as a trainer with Behavioral Tech, LLC. • There are no specific conflicts to report vis à vis this training. I will share several books and resources with you – I do not receive compensation for any of those resources. OBJECTIVES • An overview of DBT • Empirical support • DBT as a transdiagnostic treatment for youth • Behavioral targeting • Specific adaptations and considerations for youth
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DBT for Adolescents presented by Lorie Ritschel, PhD 1 · ADOLESCENT DBT RCT FOLLOW UP •DBT-A>EUC on: •NSSI frequency •No differences on: •SI, hopelessness, depression, BPD
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UNC-CH School of Social Work Clinical Lecture Series 10/17/2016
DBT for Adolescents presented by Lorie Ritschel, PhD 1
DBT FOR ADOLESCENTS: WORKING WITH SUICIDAL, SELF-HARMING, AND EMOTIONALLY SENSITIVE YOUTH Lorie A. Ritschel, Ph.D.
Assistant Professor, UNC Department of Psychiatry
Trainer & Consultant, Behavioral Tech, LLC
Private Practice, Durham DBT
UNC Chapel Hill School of Social Work Clinical Lecture Series
October 17, 2016
DISCLOSURES & NOTICES
• I receive compensation for my work as a trainer with Behavioral Tech, LLC.
• There are no specific conflicts to report vis à vis this training. I will share several books and resources with you – I do not receive compensation for any of those resources.
OBJECTIVES
• An overview of DBT
• Empirical support
• DBT as a transdiagnostic treatment for youth
• Behavioral targeting
• Specific adaptations and considerations for youth
UNC-CH School of Social Work Clinical Lecture Series 10/17/2016
DBT for Adolescents presented by Lorie Ritschel, PhD 2
EVOLUTION OF THE TREATMENT
AN OVERVIEW OF DBT
GOAL OF TREATMENT:TEACH EMOTION REGULATION
Decrease emotional arousal
Re-orient attention
Inhibit mood-dependent action
Organize behavior in the service of effective (not mood-dependent) goals
UNC-CH School of Social Work Clinical Lecture Series 10/17/2016
DBT for Adolescents presented by Lorie Ritschel, PhD 3
Mode Frequency
Individual
TherapyWeekly
Group Therapy Weekly
Coaching Calls As needed
Consultation Team
Weekly
Standard DBT Treatment Modes
Ancillary: Other Medical Treatments (pharmacology)
PROBLEM AREAS AND SKILLS MODULES
Emotional
DysregulationSelf
Dysregulation
Interpersonal
Dysregulation
•Fluctuating or absent sense of self
•Feelings of emptiness
•Chaotic relationships
•Fear of being left alone or abandoned
•Slowed, confused, or paranoid thinking
•Self-harm or suicidal behaviors
•Impulsivity
Behavioral
Dysregulation
Cognitive
Dysregulation
•Rapidly shifting feelings and moods
•Problems with anger
PROBLEM AREAS AND SKILLS MODULES
Emotional
DysregulationSelf
Dysregulation
Interpersonal
Dysregulation
•Mindfulness •Interpersonal Effectiveness
•Middle Path•Distress Tolerance
Behavioral
Dysregulation
Cognitive
Dysregulation
•Emotion Regulation
UNC-CH School of Social Work Clinical Lecture Series 10/17/2016
DBT for Adolescents presented by Lorie Ritschel, PhD 4
ADOLESCENT GROUP SKILLS TRAINING
Orientation/
Mindfulness
Distress Tolerance
Orientation/
Mindfulness
Walking the Middle
Path
Orientation/
Mindfulness
Emotion Regulation
Orientation/
Mindfulness
Interpersonal Effectiveness
Entry Points
Length: 1.5 hours
Mindfulness 5 minutes
Homework Review 40 minutes
Break 10 minutes
Skills Training 30-40 minutes
Assign HW, Wind
Down5 minutes
DBT Multi-family Skills Training Group Format
Skills Acquisition
Help! I don’t know what to do!
Skills General-
ization
I can do a DEAR MAN with you, but can’t with my mom/boss/spouse!
Skills Strength-
ening
I know I need to do one of these skills, but I’m having trouble choosing
which one.
Relationship Repair
I’m sorry I walked out of our session today.
COACHING CALLS
UNC-CH School of Social Work Clinical Lecture Series 10/17/2016
DBT for Adolescents presented by Lorie Ritschel, PhD 5