From the NYU Child Study Center: Ask the Expert
What is the Best Treatment for My Child’s Psychiatric Disorder?
By Glenn S. Hirsch, M.D.
Despite advances, there are still many psychiatric disorders in which the symptoms are perplexing, the progression of the illness is confusing, and the treatments are less than satisfactory. At different points throughout the year, I will be highlighting focused, effective, well-researched, and tested treatments for various disorders, starting with Dialectical Behavioral Therapy (DBT).
DBT is a specialized cognitive behavioral therapy used with adolescents and adults who exhibit the following symptoms: an unusually high number of mood changes, suicidal thoughts and/or attempts, difficulty managing anger, chaotic relationships, impulsive actions, and self-injurious behavior (such as self-cutting). In our current nomenclature, psychiatrists often use the term Borderline Personality Disorder (BPD) to signify this constellation of symptoms. While both males and females can exhibit characteristics of BPD, the majority of teens who have BPD are female.
DBT is a research-supported therapy that is based on a two-part theory. First, individuals who experience characteristics of BPD are particularly sensitive and emotionally vulnerable to events that occur in their lives. Second, these individuals may feel that the people in their lives (such as teachers, parents, and friends) misunderstand them and don’t allow them to express certain emotions. When a teen feels that it is not acceptable to express certain emotions, and experiences the world with heightened sensitivity, s/he may exhibit BPD behaviors as a way of regulating his/her own emotions.
DBT itself consists of several elements that include a weekly individual therapy session, a weekly skills training group, and phone consultations when the teen is in crisis. The individual sessions focus on the teen’s behaviors, such as self-injury, and address suicidal thoughts and changes in mood. As a part of these sessions each week the teen is expected to complete a diary card, which monitors these behaviors. These cards are meant to identify the triggers and consequences of a particular behavior, and are then used as a basis to replace the dysfunctional behavior with healthier skills and, by extension, more constructive behavior. The group sessions are designed to teach skills that help the teen develop practical coping strategies, such as improving interpersonal communication, building tolerance of emotional distress, managing emotions more effectively, and employing strategies to help the teens become more aware of the changes in their moods.
DBT is a highly effective program for teens with BPD characteristics as compared with conventional therapeutic methods. Since the symptoms of these youngsters are often also found in individuals who meet criteria for Bipolar Disorder, DBT is starting to be investigated as a treatment for this condition as well. Because these teens often experience a sense of chaos and instability in their lives due to an elevated number of mood changes, conventional therapy that consists only of individual therapy sessions tends to address the “crisis of the week” rather than helping the teen to learn valuable behavior management skills. DBT is successful because it combines a training group that teaches essential coping strategies that the teen can use to regulate his/her emotions more effectively with individual sessions structured to treat and prevent life-threatening behavior.
This monthly column provides educators, parents and families with important information about child and adolescent mental health issues. Please submit questions for ASK THE EXPERT to Glenn S. Hirsch, M.D., Medical Director at the NYU Child Study Center at glenn.hirsch@med.nyu.edu. To subscribe to the ASK THE EXPERT Newsletter or for more information about the NYU Child Study Center, visit www.AboutOurKids.org or call 212-263-6622.
