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Clin Child Fam Psychol Rev (2013) 16:5980
DOI 10.1007/s10567-012-0126-7
Dialectical Behavior Therapy for Adolescents: Theory, Treatment Adaptations, and Empirical Outcomes
Heather A. MacPherson Jennifer S. Cheavens
Mary A. Fristad
Published online: 8 December 2012 Springer Science+Business Media New York 2012
Abstract Dialectical behavior therapy (DBT) was originally developed for chronically suicidal adults with borderline personality disorder (BPD) and emotion dysregulation. Randomized controlled trials (RCTs) indicate DBT is associated with improvements in problem behaviors, including suicide ideation and behavior, non-suicidal self-injury (NSSI), attrition, and hospitalization. Positive outcomes with adults have prompted researchers to adapt DBT for adolescents. Given this interest in DBT for adolescents, it is important to review the theoretical rationale and the evidence base for this treatment and its adaptations. A solid theoretical foundation allows for adequate evaluation of content, structural, and developmental adaptations and provides a framework for understanding which symptoms or behaviors are expected to improve with treatment and why. We rst summarize the adult DBT literature, including theory, treatment structure and content, and outcome research. Then, we review theoretical underpinnings, adaptations, and outcomes of DBT for adolescents. DBT has been adapted for adolescents with various psychiatric disorders (i.e., BPD, mood disorders, externalizing disorders, eating disorders, trichotillomania) and problem behaviors (i.e., suicide ideation and behavior, NSSI) across several settings (i.e., outpatient, day program, inpatient, residential, correctional facility). The rationale for using DBT with these adolescents rests in the common underlying dysfunction in emotion regulation among the
aforementioned disorders and problem behaviors. Thus, the theoretical underpinnings of DBT suggest that this treatment is likely to be benecial for adolescents with a broad array of emotion regulation difculties, particularly underregulation of emotion resulting in behavioral excess. Results from open and quasi-experimental adolescent studies are promising; however, RCTs are sorely needed.
Keywords Dialectical behavior therapy Adolescents
Emotion dysregulation Treatment adaptation
Introduction
Dialectical behavior therapy (DBT) is a cognitive behavioral treatment originally developed by Linehan (1993a, b) for the treatment of chronically suicidal individuals, often with borderline personality disorder (BPD). Positive results from randomized controlled trials (RCTs) with adults have prompted researchers to adapt DBT for adolescents who exhibit similar behavioral and emotional dysregulation. Given this interest in DBT for adolescents, it is important to review the theoretical rationale and the evidence base for this treatment...