DBT increases anxiety, depression and family conflict

[Anonymous]

From the actual study:

“The largest randomised controlled trial conducted to date amongst adolescents receiving outpatient treatment for severe emotion dysregulation (i.e. suicidal behaviour, nonsuicidal self-injury, and deliberate self-harm) (see McCauley et al., 2018) found that those receiving DBT relative to supportive individual and group psychotherapy were significantly less likely to engage in suicidal behaviour and non-suicidal self-injury immediately post-treatment.”

This study was teaching DBT “based” skills and was not a comprehensive DBT program. It was also presented to subjects who were not necessarily emotionally dysregulated. And there was no family component which IME, is one of the most important aspects of DBT.

DBT is certainly not for everyone, but I don’t think this study disproves it’s effectiveness.

[Anonymous]

Anonymous wrote:From the actual study:

“The largest randomised controlled trial conducted to date amongst adolescents receiving outpatient treatment for severe emotion dysregulation (i.e. suicidal behaviour, nonsuicidal self-injury, and deliberate self-harm) (see McCauley et al., 2018) found that those receiving DBT relative to supportive individual and group psychotherapy were significantly less likely to engage in suicidal behaviour and non-suicidal self-injury immediately post-treatment.”

This study was teaching DBT “based” skills and was not a comprehensive DBT program. It was also presented to subjects who were not necessarily emotionally dysregulated. And there was no family component which IME, is one of the most important aspects of DBT.

DBT is certainly not for everyone, but I don’t think this study disproves it’s effectiveness.

I read the article, not the study. What the article was saying is that the universal DBT-like school program was bad and harmful and should not be used. Actual DBT for an individual or family was not a part of the study and is not something that schools do, as far as I know.

[Anonymous]

Wow I’m glad someone posted this although I disagree with OP’s spin - DBT is the evidence based treatment for suicidalality/self harm. This study shows however that a partial DBT program delivered to mentally healthy kids can cause iatrogenic harm. Curious what mechanism people think is happening?

[Anonymous]

Anonymous wrote:

Anonymous wrote:I also agree that there is too much emphasis on trying to bring mental health awareness into all aspects of a young person's life. It's one thing to encourage being aware of what you're thinking/feeling and knowing support resources available to you, and another to have specific modalities applied to everyone and encouraging pathologies to be casually thrown around. It's more harmful than helpful, I'd say.

This reminds me of the critique of the now-discredited three-cueing method of teaching reading - that is is the way poor readers read and by teaching it, we are teaching children to use coping strategies of poor readers rather than teaching them to be good readers. By teaching coping methods for emotional dysregulation, are we teaching emotional dysregulation?

Huh, that is a very interesting take. The preface to the article refers to the idea that healthy emotional regulation involves a context-specific menu of different techniques. I do feel like some of the techniques I’ve been taught, especially mindfulness, can make things worse if deployed at the wrong time. Eg a mindful approach can magnify anxiety at a time when ignoring or distracting might work better. I am in therapy with a great therapist who can help me tease this stuff out, but that’s very different from just dictating to a class of adolescents who may not have the 1:1 support to discuss what is working.

[Anonymous]

Anonymous wrote:This study was about the application of DBT universally via the schools, not about DBT in the clinical setting. Two different things. Probably associated with whether the parental unit in these school based programs was involved the way clinical adolescent programs are structured.

I cannot imagine for a minute that any school personnel would be able to deliver DBT effectively to students - neither counselors, nor teachers, nor school psychologists.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I also agree that there is too much emphasis on trying to bring mental health awareness into all aspects of a young person's life. It's one thing to encourage being aware of what you're thinking/feeling and knowing support resources available to you, and another to have specific modalities applied to everyone and encouraging pathologies to be casually thrown around. It's more harmful than helpful, I'd say.

This reminds me of the critique of the now-discredited three-cueing method of teaching reading - that is is the way poor readers read and by teaching it, we are teaching children to use coping strategies of poor readers rather than teaching them to be good readers. By teaching coping methods for emotional dysregulation, are we teaching emotional dysregulation?

Huh, that is a very interesting take. The preface to the article refers to the idea that healthy emotional regulation involves a context-specific menu of different techniques. I do feel like some of the techniques I’ve been taught, especially mindfulness, can make things worse if deployed at the wrong time. Eg a mindful approach can magnify anxiety at a time when ignoring or distracting might work better. I am in therapy with a great therapist who can help me tease this stuff out, but that’s very different from just dictating to a class of adolescents who may not have the 1:1 support to discuss what is working.

NP and agree, that's an interesting perspective. I had a similar experience with meditation during a period of very high stress and depression -- clearing my mind of all thoughts just left the depression sitting there and, uh, I did not enjoy sitting with it. Meanwhile mindfulness DID work for depression and I still use some of the techniques now.

Also as someone who has done a lot of therapy and "self work" or whatever, and has spent time around a lot of people in a similar situation, I can absolutely see how an intensive focus on identifying and processing emotion could backfire in adolescents in particular. At least those not dealing with the emotions that DBT was designed to address (depression, extreme anxiety, suicidality). Because adolescence is an intense time emotionally but a lot of that roller coaster is truly just due to hormones. If a 14 year old learns to take every one of their strong or negative emotions seriously and use DBT techniques to deconstruct it... I can definitely see ho that could lead to more conflict and anxiety. Sometimes you really do just need to ride stuff out.

- An adult with chronic depression who is learning it functions really differently in peri-menopause than it did before

[Anonymous]

Anonymous wrote:

Anonymous wrote:Therapy is designed by women for girls. Bringing a boy to any kind of talk or "awareness " therapy is nuts

Um, no. Both these sentences are totally wrong.

Also, I don't know about boys, but my husband experienced tremendous benefits from six months therapy from a therapist who uses a DBT approach.

That's accurate

[Anonymous]

Anonymous wrote:

Anonymous wrote:This study was about the application of DBT universally via the schools, not about DBT in the clinical setting. Two different things. Probably associated with whether the parental unit in these school based programs was involved the way clinical adolescent programs are structured.

I cannot imagine for a minute that any school personnel would be able to deliver DBT effectively to students - neither counselors, nor teachers, nor school psychologists.

Well, the article says:

“The sessions were delivered by clinical psychologists with DBT training and at least a year’s experience doing DBT in their practice.”

Pretty damning study. Just one study, but still.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:This study was about the application of DBT universally via the schools, not about DBT in the clinical setting. Two different things. Probably associated with whether the parental unit in these school based programs was involved the way clinical adolescent programs are structured.

I cannot imagine for a minute that any school personnel would be able to deliver DBT effectively to students - neither counselors, nor teachers, nor school psychologists.

Well, the article says:

“The sessions were delivered by clinical psychologists with DBT training and at least a year’s experience doing DBT in their practice.”

Pretty damning study. Just one study, but still.

Yeah but they didn't actually do DBT. DBT has multiple components (individual therapy, group skills training, phone consultation with the therapist, and then the therapist themselves consults with other therapists regularly.) This is only the group skills training part, and not only that, but it's only 8 hours of group skills training (rather than dozens of hours like in actual DBT.) It's a super duper watered-down version of DBT.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:This study was about the application of DBT universally via the schools, not about DBT in the clinical setting. Two different things. Probably associated with whether the parental unit in these school based programs was involved the way clinical adolescent programs are structured.

I cannot imagine for a minute that any school personnel would be able to deliver DBT effectively to students - neither counselors, nor teachers, nor school psychologists.

Well, the article says:

“The sessions were delivered by clinical psychologists with DBT training and at least a year’s experience doing DBT in their practice.”

Pretty damning study. Just one study, but still.

Yeah but they didn't actually do DBT. DBT has multiple components (individual therapy, group skills training, phone consultation with the therapist, and then the therapist themselves consults with other therapists regularly.) This is only the group skills training part, and not only that, but it's only 8 hours of group skills training (rather than dozens of hours like in actual DBT.) It's a super duper watered-down version of DBT.

DP. If you have familiarity with DBT (I don't have any and it sounds like you do), would you anticipate that a super duper watered-down version of DBT would be harmful to students and families, immediately and six months later?

This point is important. This stuff isn't harmless and can be damaging.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:This study was about the application of DBT universally via the schools, not about DBT in the clinical setting. Two different things. Probably associated with whether the parental unit in these school based programs was involved the way clinical adolescent programs are structured.

I cannot imagine for a minute that any school personnel would be able to deliver DBT effectively to students - neither counselors, nor teachers, nor school psychologists.

Well, the article says:

“The sessions were delivered by clinical psychologists with DBT training and at least a year’s experience doing DBT in their practice.”

Pretty damning study. Just one study, but still.

Yeah but they didn't actually do DBT. DBT has multiple components (individual therapy, group skills training, phone consultation with the therapist, and then the therapist themselves consults with other therapists regularly.) This is only the group skills training part, and not only that, but it's only 8 hours of group skills training (rather than dozens of hours like in actual DBT.) It's a super duper watered-down version of DBT.

DP. If you have familiarity with DBT (I don't have any and it sounds like you do), would you anticipate that a super duper watered-down version of DBT would be harmful to students and families, immediately and six months later?

This point is important. This stuff isn't harmless and can be damaging.

Different Pp. If you're asking kids to sit with some challenging thoughts and sensations and then wrap up the session without ongoing support, you are irresponsible psychologist.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:This study was about the application of DBT universally via the schools, not about DBT in the clinical setting. Two different things. Probably associated with whether the parental unit in these school based programs was involved the way clinical adolescent programs are structured.

I cannot imagine for a minute that any school personnel would be able to deliver DBT effectively to students - neither counselors, nor teachers, nor school psychologists.

Well, the article says:

“The sessions were delivered by clinical psychologists with DBT training and at least a year’s experience doing DBT in their practice.”

Pretty damning study. Just one study, but still.

Yeah but they didn't actually do DBT. DBT has multiple components (individual therapy, group skills training, phone consultation with the therapist, and then the therapist themselves consults with other therapists regularly.) This is only the group skills training part, and not only that, but it's only 8 hours of group skills training (rather than dozens of hours like in actual DBT.) It's a super duper watered-down version of DBT.

DP. If you have familiarity with DBT (I don't have any and it sounds like you do), would you anticipate that a super duper watered-down version of DBT would be harmful to students and families, immediately and six months later?

This point is important. This stuff isn't harmless and can be damaging.

NP here. I think a super duper watered-down version of many different ideas can be harmful to students and families. I see it a lot in the public schools.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:This study was about the application of DBT universally via the schools, not about DBT in the clinical setting. Two different things. Probably associated with whether the parental unit in these school based programs was involved the way clinical adolescent programs are structured.

I cannot imagine for a minute that any school personnel would be able to deliver DBT effectively to students - neither counselors, nor teachers, nor school psychologists.

Well, the article says:

“The sessions were delivered by clinical psychologists with DBT training and at least a year’s experience doing DBT in their practice.”

Pretty damning study. Just one study, but still.

Yeah but they didn't actually do DBT. DBT has multiple components (individual therapy, group skills training, phone consultation with the therapist, and then the therapist themselves consults with other therapists regularly.) This is only the group skills training part, and not only that, but it's only 8 hours of group skills training (rather than dozens of hours like in actual DBT.) It's a super duper watered-down version of DBT.

DP. If you have familiarity with DBT (I don't have any and it sounds like you do), would you anticipate that a super duper watered-down version of DBT would be harmful to students and families, immediately and six months later?

This point is important. This stuff isn't harmless and can be damaging.

Different Pp. If you're asking kids to sit with some challenging thoughts and sensations and then wrap up the session without ongoing support, you are irresponsible psychologist.

well this is very trendy to do in schools now so good thing we have some well designed research to show that even ideas that seem benign like “mindfulness” can have negative effects.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:This study was about the application of DBT universally via the schools, not about DBT in the clinical setting. Two different things. Probably associated with whether the parental unit in these school based programs was involved the way clinical adolescent programs are structured.

I cannot imagine for a minute that any school personnel would be able to deliver DBT effectively to students - neither counselors, nor teachers, nor school psychologists.

Well, the article says:

“The sessions were delivered by clinical psychologists with DBT training and at least a year’s experience doing DBT in their practice.”

Pretty damning study. Just one study, but still.

Yeah but they didn't actually do DBT. DBT has multiple components (individual therapy, group skills training, phone consultation with the therapist, and then the therapist themselves consults with other therapists regularly.) This is only the group skills training part, and not only that, but it's only 8 hours of group skills training (rather than dozens of hours like in actual DBT.) It's a super duper watered-down version of DBT.

DP. If you have familiarity with DBT (I don't have any and it sounds like you do), would you anticipate that a super duper watered-down version of DBT would be harmful to students and families, immediately and six months later?

This point is important. This stuff isn't harmless and can be damaging.

DP here. I disagree with PP that unless a treatment isn’t a comprehensive program it’s not really DBT. DBT is a type of CBT that focuses on the apparent paradox that we are okay the way we are and we can improve to have a better life. The main components are distress tolerance, mindfulness, emotional regulation, and interpersonal effectiveness. There is not just one DBT way, although many programs are comprehensive like PP says.

And no, PP, the “watered down” version is not going to be any more harmful than a comprehensive program in a clinical setting, or at least won’t be more harmful than doing therapy for any one of those components on its own.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:This study was about the application of DBT universally via the schools, not about DBT in the clinical setting. Two different things. Probably associated with whether the parental unit in these school based programs was involved the way clinical adolescent programs are structured.

I cannot imagine for a minute that any school personnel would be able to deliver DBT effectively to students - neither counselors, nor teachers, nor school psychologists.

Well, the article says:

“The sessions were delivered by clinical psychologists with DBT training and at least a year’s experience doing DBT in their practice.”

Pretty damning study. Just one study, but still.

Yeah but they didn't actually do DBT. DBT has multiple components (individual therapy, group skills training, phone consultation with the therapist, and then the therapist themselves consults with other therapists regularly.) This is only the group skills training part, and not only that, but it's only 8 hours of group skills training (rather than dozens of hours like in actual DBT.) It's a super duper watered-down version of DBT.

And with a population that didn’t NEED DBT.