Funding and Affiliations: Research funded by private foundations, behavior training companies, and affiliations with Yale and Cornell.
Mentors and Colleagues: Mentions significant individuals like Seth, John Hoffman, and Lawrence Cahill.
Gratitude: Thanks collaborators, DBT therapists, and institutions like Green Chimneys.
Introduction to Dialectical Behavior Therapy (DBT)
Origins: Therapy designed by Marsha Linehan, initially for adults with borderline personality disorder (BPD).
Core Principle: Balance between acceptance and change.
Skills in DBT: Falls into two main categories—acceptance and change.
Importance of Acceptance: Acceptance is crucial before change can happen. Example: Alcoholics Anonymous.
Outcome of Sole Focus: Sole focus on acceptance without change can lead to feelings of invalidation and lack of problem-solving.
DBT for Children
Differences with Adults: Adaptation needed for children’s understanding. Includes simplified language and didactics.
Emotion Understanding: Teaching children (and parents) to differentiate between emotions, thoughts, and behaviors.
Skills Adjustments: Example of “STOP” skill to interrupt impulsive reactions.
Use of Games: Games like the three-headed dragon to teach skills in a child-friendly manner.
Implementation and Results
Preliminary Outcomes: Research results still pending, but preliminary implementations and adaptations have shown promising engagement and applicability.
Child Sensitivity: Sensitive children have a high-reactivity threshold. Their emotional responses are often disproportionate to common stimuli.
Importance of Parental Involvement
Family Therapy Approach: Effective DBT for children includes parents actively participating in therapy and learning techniques themselves.
Parent Training: Teaching parents to model desired behaviors, ignore negative behaviors, and reinforce positive behaviors.
Dual Roles: Parents must commit to treatment as much as the child to ensure effective behavior change.
Practical Strategies
Diary Cards: Used to track emotions, suicidality, self-harm, and effective behaviors. Reinforcement from parents where necessary.
Hierarchy in Problem-Solving: Focus more on the function of behavior rather than merely changing behaviors.
Addressing Reinforcement Issues: Implementation of systematic reinforcement in residential treatments.
Neuroscience and Sensory Processing
Treatment Impacts on Brain: Preliminary findings suggest mindfulness impacts brain structure positively, increasing gray matter in areas governing attention and problem-solving, and reducing areas related to fight-or-flight responses.
Sensory Processing: Many children in study exhibited sensory processing issues, tying into their emotional sensitivity.
Application in Residential Settings
Setup: Implementing DBT in residential settings with separate DBT and non-DBT dorms for clear study conditions.
Challenges and Solutions: Integrating levels of DBT skill groups according to children's progression and addressing lack of staff training in behavioral modification techniques.
Common Questions
Real vs. Perceived Dangers: Teaching children to differ between real dangers and emotional reactivity using fact-checking (e.g., comparing fear of a lion in a cage vs. a charging lion).
Handling Internalizing Issues: Tim Lynch’s work on DBT for adults with internalizing disorders might offer insights for children, although specific methods for children are still under exploration.
Dealing with Resistance: Emphasis on gaining parental commitment rather than child’s, especially with younger or resistant children.