DBT is a well-established treatment for adults with BPD, with more than 7 randomized controlled trials (RCTs).23,24 To date no RCTs of DBT-A have been published. However, DBT-A has been examined in several open trials and quasiexperimental designs, with encouraging findings. Rathus and Miller21 conducted the initial validity study, comparing DBT with TAU in a nonrandomized study of 111 outpatient adolescents with BPD features, including current suicidal ideation or parasuicidal behavior. Adolescents who received DBT were significantly more likely to complete treatment and had fewer psychiatric hospitalizations (0% vs 13%). There were no significant differences in parasuicidal behaviors, although it is important to note that those with parasuicidal behavior were specifically recruited to the DBT treatment; differences in suicide attempt (1 vs 7) were nonsignificant.
Several smaller pilot studies of nonrandomized adolescents have been conducted using pre-post designs. They compared DBT-A or elements of DBT-A with TAU. Adolescents with nonsuicidal self-injury and other BPD features were treated with DBT or TAU in residential, hospital, and outpatient clinic settings. In each case, adolescents who received DBT evidenced greater reduction of symptoms, such as mood and self-injurious behavior, and evidenced improved relationships and overall functioning.23,25 However, the DBT-A approach awaits randomized controlled trial data, and for this reason, it cannot be designated well-established for adolescents at this time.
Despite the high prevalence of depression among youths, there are empirically supported treatments that have been shown to reduce depressogenic symptoms, including the 3 therapies outlined in this article. When deciding which treatment to employ, the clinical needs of the youth, such as cognitive capabilities, behavioral issues, interpersonal strengths and weaknesses, and suicidality level, should be taken into account.
Psychotherapy Training Resources
•Association for Behavioral and Cognitive Therapies: training and certification programs can be found on the ABCT Web site: www.abct.org
•A directory of certified therapists is available at http://www.abct.org/Members/?m=FindTherapist&fa=FT_Form&nol
•Interpersonal Psychotherapy Institute: certification includes supervision by a certified IPT supervisor for 2 IPT cases. http://iptinstitute.com/ipt-certification-process
•A directory of certified therapists is available at http://iptinstitute.com/find-a-member-ipt-therapist
Dialectical behavior therapy
•Behavioral Tech, LLC: development of a certification process is under way; currently the highest level is Intensive Training (10-day workshop) requiring participants to register as a DBT Team of 4 or more persons (teams can be loosely defined and may not practice in the same setting): http://behavioraltech.org/training
•A directory of Intensive Training therapists is available at http://behavioraltech.org/resources/crd.cfm
Editor’s Note: Our Category 1 CME articles will return shortly. In the meantime, we invite you to test yourself: read the article, take the posttest on the next page, and then check the answer key on the last page.
1. Shaffer D, Fisher P, Dulcan MK, et al. The NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3): description, acceptability, prevalence rates, and performance in the MECA Study. Methods for the Epidemiology of Child and Adolescent Mental Disorders Study. J Am Acad Child Adolesc Psychiatry. 1996;35:865-877.
2. Berman A, Jobes D, Silverman M. Adolescent Suicide: Assessment and Intervention. 2nd ed. Washington, DC: American Psychological Association; 2006.
3. Reinecke MA, Ryan NE, DuBois DL. Cognitive-behavioral therapy for depression and depressive symptoms during adolescence: a review and meta-analysis. J Am Acad Child Adolesc Psychiatry. 1998;37:26-34.
4. Lewinsohn PM, Clarke GN. Psychosocial treatments for adolescent depression. Clin Psychol Rev. 1999;19:329-342.
5. Weisz J, McCarty C, Valeri S. Effects of psychotherapy for depression in children and adolescents: a meta-analysis. Psychol Bull. 2006;132:132-149.
6. Nathan PE, Gorman JM, eds. A Guide to Treatments That Work. 2nd ed. New York: Oxford University Press; 2002.
7. March J, Silva S, Petrycki S, et al; Treatment for Adolescents With Depression Study (TADS) Team. Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial. JAMA. 2004;292:807-820.
8. Brent D, Emslie G, Clarke G, et al. Switching to another SSRI or to venlafaxine with or without cognitive behavioral therapy for adolescents with SSRI-resistant depression: the TORDIA randomized controlled trial. JAMA. 2008;299:901-913.
9. Birmaher B, Brent D; AACAP Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with depressive disorders. J Am Acad Child Adolesc Psychiatry. 2007;46:1503-1526.
10. Stark KD, Streusand W, Krumholz LS, Patel P. Cognitive-behavioral therapy for depression: The ACTION treatment program for girls. In: Weisz JR, Kazdin AE, eds. Evidence-Based Psychotherapies for Children and Adolescents. 2nd ed. New York: Guilford Press; 2010:93-109.
11. Stark KD, Simpson J, Schnoebelen S, et al. Therapist’s Manual for ACTION. Broadmore, PA: Workbook; 2004.
12. Brent DA, Holder D, Kolko D, et al. A clinical psychotherapy trial for adolescent depression comparing cognitive, family, and supportive therapy. Arch Gen Psychiatry. 1997;54:877-885.
13. Mufson L, Moreau D, Weissman MM, et al. Modification of interpersonal psychotherapy with depressed adolescence (IPT-A): phase I and phase II studies. J Am Acad Child Adolesc Psychiatry. 1994;33:695-705.
14. Cuijpers P, Geraedts AS, van Oppen P, et al. Interpersonal psychotherapy for depression: a meta-analysis [published correction appears in Am J Psychiatry. 2011;168:652]. Am J Psychiatry. 2011;168:581-592.
15. Rosselló J, Bernal G. The efficacy of cognitive-behavioral and interpersonal treatments for depression in Puerto Rican adolescents. J Consult Clin Psychol. 1999;67:734-745.
16. Tang TC, Jou SH, Ko CH, et al. Randomized study of school-based intensive interpersonal psychotherapy for depressed adolescents with suicidal risk and parasuicide behaviors. Psychiatry Clin Neurosci. 2009;63:463-470.
17. Bolton P, Bass J, Betancourt T, et al. Interventions for depression symptoms among adolescent survivors of war and displacement in northern Uganda: a randomized controlled trial. JAMA. 2007;298:519-527.
18. de Mello MF, de Jesus Mari J, Bacaltchuk J, et al. A systematic review of research findings on the efficacy of interpersonal therapy for depressive disorders. Eur Arch Psychiatry Clin Neurosci. 2005;255:75-82.
19. Elkin I, Shea MT, Watkins JT, et al. National Institute of Mental Health Treatment of Depression Collaborative Research Program. General effectiveness of treatments. Arch Gen Psychiatry. 1989;46:971-982.
20. Linehan MM. Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press; 1993.
21. Rathus JH, Miller AL. Dialectical behavior therapy adapted for suicidal adolescents. Suicide Life Threat Behav. 2002;32:146-157.
22. Miller AL, Rathus JH, Linehan MM. Dialectical Behavior Therapy With Suicidal Adolescents. New York: Guilford Press; 2007.
23. Salsman NL, Arthur R. Adapting dialectical behavior therapy for suicidal adolescents. Curr Psychiatry. 2011;10:18-23.
24. Lynch TR, Chapman AL, Rosenthal MZ, et al. Mechanisms of change in dialectical behavior therapy: theoretical and empirical observations. J Clin Psychol. 2006;62:459-480.
25. Fleischhaker C, Böhme R, Sixt B, et al. Dialectical behavior therapy for adolescents (DBT-A): a clinical trial for patients with suicidal and self-injurious behavior and borderline symptoms with a one-year follow-up. Child Adolesc Psychiatry Ment Health. 2011;5:3.