Last week Benchmarks’ Partnering for Excellence hosted a webinar titled “Old Services, New Lens: A Closer Look at DBT and MST as Trauma-Informed Models for Children.” The presenters highlighted two services that are trauma-informed, but not necessarily recommended often: Dialectal Behavioral Therapy (DBT) and Multi-Systemic Therapy (MST).
Dialectal Behavioral Therapy (DBT)
Dr. Katie Rosanbalm, Senior Research Scientist, Duke Center for Child and Family Policy, shared that DBT historically started as a treatment for Borderline Personality Disorder for patients who were suicidal and had substance use problems. But she believes that DBT has so much more to offer. With Cognitive Behavioral Therapy (CBT) we to try to work to change people’s thoughts and behaviors, and this sometimes makes people feel misunderstood or criticized, or like they are not being heard. DBT tries to really balance the idea of accepting where someone is, who they are, and what they are thinking. It also helps them to accept themselves and the world around them, while balancing that with change-oriented strategies and problem-solving skills. DBT targets 4 specific goals: distress tolerance, emotion regulation, mindfulness, and interpersonal skills.
According to Dr. Rosanbalm, while there is no literature about the use of DBT with adolescents who have PTSD, there are separate studies on the effectiveness of using DBT with adults with PTSD, and using DBT with adolescents.
- Studies have begun to show good evidence that using DBT has resulted in significantly higher reduction in symptoms of PTSD and depression, and overall global functioning in the world.
- Studies also show that DBT helps folks to decrease their feelings of shame, guilt, and disgust. At the end of DBT treatment, 82% reached the level of shame, guilt, and disgust of those of a non-PTSD control group, really bringing those emotions under control. This is strong evidence for using DBT to address a history of trauma.
- DBT has been shown to be significantly effective for teens with Borderline Personality Disorder, and also for those with suicidal ideation, depression, anxiety, bipolar disorder, and eating disorders. Changes in aggressive and impulsive behaviors were noted when using DBT with adolescents, as well as improvements in dissociative symptoms, improved emotion regulation, and improved interpersonal skills.
- There are high treatment completion rates and adherence with DBT.
Amber Miner, M.Ed, LPC, Children's Homes of Cleveland County, recommends DBT for her clients who have a history of suicidal ideation, impulsive behaviors that endanger themselves, or self-harm, as well as clients who have such high emotions that they cannot discuss their trauma without endangering their own mental health. When determining if DBT is appropriate, Amber encouraged clinicians to look at the areas of safety, secondary adversities, and the assessments (high anxiety and avoidance might be indicators) for insight about a child’s needs in addressing life-interfering behaviors first.
DBT can stabilize clients and help them develop more in-depth emotional regulation skills before beginning trauma work; the skills they build with DBT can assist them in feeling supported when doing trauma worker later.
This model is particularly helpful because it gives concrete skills that can be used outside of therapy. Caregiver involvement is encouraged and can help improve the caregiver’s skills, as well as the child’s skills.
Jill Rathus and Alec Miller created DBT Skills Manual for Adolescents specifically for adolescents, modifying the content to be more developmentally appropriate to that age group.
Multi-Systemic Therapy (MST)
Kristin A. Sheridan, MSW, LCSW, EdD Clinical Consultant Coach Youth Villages explained that MST is an evidence-based treatment for adolescents ages 12-17 who are commonly diagnosed with ODD, Conduct Disorder, or Disruptive Mood Dysregulation Disorder. MST targets 5 systems: individual, school, family, community, and peers.
Those appropriate for MST include: youth with willful misconduct behaviors, behavioral diagnoses, unsuccessful previous treatment, and those who have attempted a lower level of care, who live in a long-term family placement with a willing caregiver, who are at-risk for out of home placement, who have legal involvement (or are at-risk), and who have consistent disruption of normal functioning.
Trauma-informed care can occur within MST through the psychoeducation to families, skills building (relaxation, affect regulation, cognitive coping, and communication), and interventions such as safety plans and relationship building.
Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) works through a trauma-informed lens to keep families together, assure safety of children, prevent abuse and neglect, reduce mental health symptoms of family members, and increase use of natural supports.
Participants on the webinar were challenged to consider DBT and MST as additional treatment resources in their toolbox of recommendations, as they work with youth who have experienced trauma.
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