DBT increases anxiety, depression and family conflict

[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.

Yes - I can see it being harmful without the individual therapy where you learn to process and implement the skills and the parent component which affects the social context in which the adolescent lives. Those are critical parts of DBT.

[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.

My H did real DBT for PTSD and it was over 400 hours of therapy over 4 years plus EMDR so yea, this is not DBT and it does sound irresponsible.

Also calling it DBT is irresponsible.

[Anonymous]

We spent a ton of time, energy, money trying to force my ADHD teen boy to do real-deal DBT because all the professionals (who stood to make a fortune on us) said this is EXACTLY what he needed. Guess what? It never took. It was too complicated, required too much buy in, and created more resentment in our house. Also, DH hated the group work, so it strained my marriage too.

What did work? A softer approach and ACT.

I'm not saying it doesn't work, but it's not for everyone.

[Anonymous]

DBT is a very specific type of therapy originally developed for those with Borderline Personality Disorder, but they found it quite helpful for those struggling with intense emotions with depression, etc. There are many useful aspects of it and it the research with BPD has been pretty positive.

I don't think it was ever intended to be taught to all. DBT is best suited for those with extreme challenges with emotional regulation. CBT is better for the general population to help prevent depression and manage anxiety and the research with that is pretty positive.

Some apsects of DBT can be useful for anyone, but some of the skills taught in DBT seem off for most people. The "interpersonal effectriveness" skills can be so easily misapplied to the wrong situation. They list goals as things like obtaining your rights, and getting someone to do something for you. That is useful for someone who is severely impaired in this area, but the first step should always be understanding the relationship and if your desires are even appropriate.

For example, I have a sibling with major interpersonal issues that result in explosive relationships. My brother and I distanced ourselves and never felt close. She would have these DBT style confrontations with us without understanding she has abusive our whole life (she is oldest) and we do not want a relationship. There is no fixing a close relationship to make it better. There is no closeness. She would start making friends with someone and use the skills right away and created drama. A person who barely knows you and was willing to go to coffee doesn't want to to have a full discussion of how it makes you feel when she can't be available for your ever request to get together or she won't watch your cat.

[Anonymous]

I hit post too soon. Have another example. I bought a workbook and got some training when I taught at risk youth with mental health issues and there are some great aspects, but another example is this whole "cheer-leading statements" page. it says things like the fact someone says "no" doesn't mean you should not have asked for something. My sibling thinks friendship is all about people doing her favors and at this point all her neighbors avoid her. Better to teach about how relationships are not all about meeting your own needs.

There's a myth and challenge page with things like Myth: "I don't deserve to get what I want." and then you add a Challenge. Not a great exercise for someone highly entitled.

[Anonymous]

Anonymous wrote: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?

It’s causing the kids to focus on negative emotions that they were previously letting go. In people who are suicidal/self-harming, they are already focused on negative emotions, and DBT teaches them to manage that. The first step is always to recognize and acknowledge your negative emotion. If people don’t have a negative focus to start out with, DBT teaches them to have a negative focus. We all have lots of fleeting negative emotions that come and go throughout our day. If you don’t have a focus on them, teaching someone to focus on them is going to exacerbate the emotions that would have otherwise just passed.

[Anonymous]

Anonymous wrote:

Anonymous wrote: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?

It’s causing the kids to focus on negative emotions that they were previously letting go. In people who are suicidal/self-harming, they are already focused on negative emotions, and DBT teaches them to manage that. The first step is always to recognize and acknowledge your negative emotion. If people don’t have a negative focus to start out with, DBT teaches them to have a negative focus. We all have lots of fleeting negative emotions that come and go throughout our day. If you don’t have a focus on them, teaching someone to focus on them is going to exacerbate the emotions that would have otherwise just passed.

Yes. If you are overwhelmed with negative emotion and need to validated it might be useful to understand your emotions more, but for a person who already knows how to cope in a way that works for them it can be too much,

Also, there is too much emphasis on relationships as a way to get what you want and not enough on just enjoying other people and accepting them as they are. With certain personality disorders relationships can be seen as transactional and they become frustrated when they can't manipulate people into meeting their needs. It might be helpful for someone with a personality disorder to learn methods which aren't abusive, but they also need to stop looking at relationships as all about getting what they want. They need a different kind of therapy to learn to get along and stop assuming every around them should be validating them/doing favors/giving in to requests. Yes, we all should expect respect, but there is way to much emphasis on how to make requests of others. Good for a boss who needs better interpersonal skills, but for equals, you shouldn't spend your friendship making constant requests of others beyond "hey do you want to see that movie?" or "I'm sorry your spouse is sick. Can I bring over dinner?"

[Anonymous]

My kid did DBT after an in patient hospitalization and we found it tremendously helpful. It was several hours a week for over a year.

Doing it whole scale in schools for kids without mental health problems seems like a bad idea. You don’t give insulin to kids without diabetes or adderral to kids with adhd.

For my kid, the mental health awareness stuff they received in McPS middle school definitely made her mental health worse. It took a kid that was struggling a bit with friendship and hormonal adjustments and made her really perseverance on her mental health and also made her feel like things like depression and cutting were normal responses to stressors. One of the things I liked about DBT was that it did not focus on endless dialog about what’s wrong with your life but instead focused on acknowledging that things aren’t always perfect, and that’s okay, and giving you skills respond when things are going negatively. I didn’t love everything about DBT but it’s better than the alternatives for a certain subset of kids.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote: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?

It’s causing the kids to focus on negative emotions that they were previously letting go. In people who are suicidal/self-harming, they are already focused on negative emotions, and DBT teaches them to manage that. The first step is always to recognize and acknowledge your negative emotion. If people don’t have a negative focus to start out with, DBT teaches them to have a negative focus. We all have lots of fleeting negative emotions that come and go throughout our day. If you don’t have a focus on them, teaching someone to focus on them is going to exacerbate the emotions that would have otherwise just passed.

Yes. If you are overwhelmed with negative emotion and need to validated it might be useful to understand your emotions more, but for a person who already knows how to cope in a way that works for them it can be too much,

Also, there is too much emphasis on relationships as a way to get what you want and not enough on just enjoying other people and accepting them as they are. With certain personality disorders relationships can be seen as transactional and they become frustrated when they can't manipulate people into meeting their needs. It might be helpful for someone with a personality disorder to learn methods which aren't abusive, but they also need to stop looking at relationships as all about getting what they want. They need a different kind of therapy to learn to get along and stop assuming every around them should be validating them/doing favors/giving in to requests. Yes, we all should expect respect, but there is way too much emphasis on how to make requests of others. Good for a boss who needs better interpersonal skills, but for equals, you shouldn't spend your friendship making constant requests of others beyond "hey do you want to see that movie?" or "I'm sorry your spouse is sick. Can I bring over dinner?"

I disagree with that if your'e talking about DBT generally. The major problem with BPD is that sufferers tend to manipulate others to get what they want without regard to others' feelings. There is a lot of instruction in DBT about how you need to ask nicely, accept a no, and be willing to do things and change for others.

[Anonymous]

Anonymous wrote:

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.

My H did real DBT for PTSD and it was over 400 hours of therapy over 4 years plus EMDR so yea, this is not DBT and it does sound irresponsible.

Also calling it DBT is irresponsible.

I hope your H was helped. That sounds like it was a difficult time for you both.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote: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?

It’s causing the kids to focus on negative emotions that they were previously letting go. In people who are suicidal/self-harming, they are already focused on negative emotions, and DBT teaches them to manage that. The first step is always to recognize and acknowledge your negative emotion. If people don’t have a negative focus to start out with, DBT teaches them to have a negative focus. We all have lots of fleeting negative emotions that come and go throughout our day. If you don’t have a focus on them, teaching someone to focus on them is going to exacerbate the emotions that would have otherwise just passed.

Yes. If you are overwhelmed with negative emotion and need to validated it might be useful to understand your emotions more, but for a person who already knows how to cope in a way that works for them it can be too much,

Also, there is too much emphasis on relationships as a way to get what you want and not enough on just enjoying other people and accepting them as they are. With certain personality disorders relationships can be seen as transactional and they become frustrated when they can't manipulate people into meeting their needs. It might be helpful for someone with a personality disorder to learn methods which aren't abusive, but they also need to stop looking at relationships as all about getting what they want. They need a different kind of therapy to learn to get along and stop assuming every around them should be validating them/doing favors/giving in to requests. Yes, we all should expect respect, but there is way too much emphasis on how to make requests of others. Good for a boss who needs better interpersonal skills, but for equals, you shouldn't spend your friendship making constant requests of others beyond "hey do you want to see that movie?" or "I'm sorry your spouse is sick. Can I bring over dinner?"

I disagree with that if your'e talking about DBT generally. The major problem with BPD is that sufferers tend to manipulate others to get what they want without regard to others' feelings. There is a lot of instruction in DBT about how you need to ask nicely, accept a no, and be willing to do things and change for others.

Both posts are correct. DBT is best used by a population that is already struggling. The techniques help them stabilize. But the buy-in is important for longterm success-- defined often as reducing suicidal ideation and self-harm. Otherwise, some of the interpersonal techniques sound like they came from a business leadership text, making it about managing others rather managing yourself.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote: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?

It’s causing the kids to focus on negative emotions that they were previously letting go. In people who are suicidal/self-harming, they are already focused on negative emotions, and DBT teaches them to manage that. The first step is always to recognize and acknowledge your negative emotion. If people don’t have a negative focus to start out with, DBT teaches them to have a negative focus. We all have lots of fleeting negative emotions that come and go throughout our day. If you don’t have a focus on them, teaching someone to focus on them is going to exacerbate the emotions that would have otherwise just passed.

Yes. If you are overwhelmed with negative emotion and need to validated it might be useful to understand your emotions more, but for a person who already knows how to cope in a way that works for them it can be too much,

Also, there is too much emphasis on relationships as a way to get what you want and not enough on just enjoying other people and accepting them as they are. With certain personality disorders relationships can be seen as transactional and they become frustrated when they can't manipulate people into meeting their needs. It might be helpful for someone with a personality disorder to learn methods which aren't abusive, but they also need to stop looking at relationships as all about getting what they want. They need a different kind of therapy to learn to get along and stop assuming every around them should be validating them/doing favors/giving in to requests. Yes, we all should expect respect, but there is way too much emphasis on how to make requests of others. Good for a boss who needs better interpersonal skills, but for equals, you shouldn't spend your friendship making constant requests of others beyond "hey do you want to see that movie?" or "I'm sorry your spouse is sick. Can I bring over dinner?"

I disagree with that if your'e talking about DBT generally. The major problem with BPD is that sufferers tend to manipulate others to get what they want without regard to others' feelings. There is a lot of instruction in DBT about how you need to ask nicely, accept a no, and be willing to do things and change for others.

Both posts are correct. DBT is best used by a population that is already struggling. The techniques help them stabilize. But the buy-in is important for longterm success-- defined often as reducing suicidal ideation and self-harm. Otherwise, some of the interpersonal techniques sound like they came from a business leadership text, making it about managing others rather managing yourself.

This!!!!! Thank you for articulating that.

[Anonymous]

Anonymous wrote:My kid did DBT after an in patient hospitalization and we found it tremendously helpful. It was several hours a week for over a year.

Doing it whole scale in schools for kids without mental health problems seems like a bad idea. You don’t give insulin to kids without diabetes or adderral to kids with adhd.

For my kid, the mental health awareness stuff they received in McPS middle school definitely made her mental health worse. It took a kid that was struggling a bit with friendship and hormonal adjustments and made her really perseverance on her mental health and also made her feel like things like depression and cutting were normal responses to stressors. One of the things I liked about DBT was that it did not focus on endless dialog about what’s wrong with your life but instead focused on acknowledging that things aren’t always perfect, and that’s okay, and giving you skills respond when things are going negatively. I didn’t love everything about DBT but it’s better than the alternatives for a certain subset of kids.

So your kid is a female. The article specifically is talking about boys.

[Anonymous]

This is interesting. School based therapist who said he was doing DBT techniques ended up making my somewhat anxious kid report feeling more anxious after their sessions.

One thing I noticed in the article is that it says that the control group did regular physical education class instead of the intervention. I didn't read the complete study, so maybe they address this, but how is this a control group when physical activity is known to improve mental health? Taking away PE could worsen mental health, right?