Dialectical Behavior Therapy-Based Interventions (DBT-A) in Externalizing Problems Among Adolescents: Ecological Momentary Assessment of Change

PI: Aleksandra Kaurin

Coordinator: Paula Philippi

Collaborator: Marco Walg, Center for Child and Adolescent Mental Health, Sana Clinic Remscheid

Project Duration: 2024

Adolescent mental health is a critical public health concern because the onset of major mental health disorders often occurs during this period (e.g., anxiety disorders typically onset between ages 5.5 to 15.5, Solmi et al., 2022; impulse control disorders between ages 7 to 15, Kessler et al., 2007). Adolescence is marked by significant cognitive and emotional changes, increased impulsivity, and heightened reactivity, with adolescents being more inclined to engage in risk-taking behaviors, particularly in peer contexts, before transitioning into adulthood when cognitive control and self-regulation improve (Andrews et al., 2021). Given the multitude of stressors associated with this developmental transition, the acquisition of effective coping skills is crucial (Modecki et al., 2017; Kaurin et al., 2023). Adolescents who struggle with self-regulation and fail to develop adequate coping strategies may be at risk for externalizing problems, including defiance, interpersonal/relational aggression, impulsivity, antisocial behaviors, as well as borderline personality disorder (BPD). These symptoms predict a host of poor outcomes among youth, even in the absence of a full diagnosis, underscoring the importance of modifying risk factors during this sensitive developmental window.

Interventions for externalizing problems among youth may be most effective when targeting youths’ coping skills in the face of an emotional crisis or acute stress (McCart & Sheidow, 2016; Kaurin et al., 2022). The present study aims to quantitatively model changes in socio-affective dynamics in the daily lives of youth undergoing dialectical behavior therapy for adolescents (DBT-A). DBT-A is a well-studied, evidence-based intervention (Mehlum et al., 2019) that addresses these issues and aims to reduce maladaptive and destructive behavior by enhancing emotion regulation, thereby reducing externalizing symptoms among adolescents. DBT, initially developed based on a biosocial theory that combines emotional vulnerabilities with an emotionally invalidating childhood environment (Linehan, 1993), integrates CBT behavior change strategies, mindfulness, and an acceptance framework, differentiating itself by promoting dialectical balance between change and self-acceptance in the journey of reshaping thoughts and behaviors. Adaptations for adolescents (DBT-A) aim to enhance treatment compliance and accessibility by shortening treatment duration, incorporating age-appropriate modifications, and emphasizing in vivo and experiential exercises (MacPherson et al., 2013).

To date, there is a lack of studies examining changes in real-world affect-regulatory processes, including stress generation, sensitivity and reactivity, in response to DBT-A treatment. Our study aims to address this gap using Ecological Momentary Assessment (EMA), collecting data from the daily lives of youth presenting with clinically meaningful externalizing problems including the diagnosis of borderline personality disorder in the final weeks of outpatient DBT-A treatment (n=50) relative to a wait list control group for the same treatment (n=50). EMA allows for a dense (i.e., repeated daily surveys) and ecologically valid assessment of the use of skills and affect-regulatory processes in the daily lives of patients. We test the hypothesis, that DBT-A will modify processes of socio-affective dysregulation in youth’s daily lives contributing to lowered (interpersonal) stress generation, sensitivity and reactivity in response to real-world stressors. Additionally, the study seeks to determine whether changes in emotional experiences coincide with clinical improvement, shedding light on the emotional pathways through which DBT-A exerts its effects on externalizing symptoms in youth.

 

References

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