Getting young people to not act impulsively could be the goal of parents everywhere. But it's an especially lofty and significant goal when it comes to young people who are striving to overcome addiction, a disease marked by impulsivity.

Better managing emotions and impulsive behaviors is the goal of a group process new to Hazelden called DBT--Dialectical Behavioral Therapy--a therapy being piloted among female patients at the Center for Youth and Families in Plymouth, Minn. "DBT is a behavioral health therapy and one of many adjuncts to our Twelve Step, gender-specific treatment model at the Center for Youth and Families (CYF)," says Von King, PsyD, manager of Mental Health Services at CYF.

The goal of DBT is to increase young people's ability to manage their emotions and behavior, thereby enabling them to become more receptive to addiction treatment. At the same time, DBT will help them build the skills they need to manage their emotions and behaviors and improve their overall mental health. These young people will need these skills as they face the lifelong task of managing their chronic disease and dealing with stresses of life.

Sheila Becking, PsyD, who along with Kelly Caywood co-leads the twice-a-week group sessions and once-weekly individual DBT sessions, says DBT is a mix of principles from several therapies, including cognitive behavioral and relaxation therapy. Originally designed for individuals with borderline personality disorder, DBT is useful to people who have problems in relationships, with impulsive behavior, regulating emotions, tolerating distress, and focusing their attention. DBT is an effective approach for retention of patients and for reducing suicidal and self-injurious behaviors. It was created by Marsha Linehan, PhD, from the University of Washington in Seattle.

Tolerating emotional turmoil
DBT is a way to help young people tolerate emotional turmoil. It teaches mindfulness skills to help patients increase awareness and learn to control their attention. It teaches distress tolerance skills to manage or tolerate a stressful situation. "For instance, one mindfulness skill teaches our patients to 'stay in the moment,'" says Becking. "It's like a mini version of living One Day at a Time. The idea is to not overreact--not respond impulsively. For instance, if one feels anger, it is okay to just feel it, stay with it, and really get the essence of the feeling. It doesn't mean one has to express it."

"The DBT concept of 'dysregulation' relates to how a girl's emotions are so jumbled up and confused (by the use of chemicals, her own development, etc.) that she is virtually unable to respond to others in a meaningful way," says King. "The DBT group puts a frame around acceptable behavior, and, within the safety of that group, allows her to express her emotions in appropriate ways. We cannot always feel comfortable in the moment, but we can learn to recognize that discomfort, accept it, and move beyond it."

King says there have been several instances where the girls/women began to form cliques in the general treatment community. When they attempted to bring this exclusivity into the DBT group, they were able to learn how this cliquishness worked against them rather than for them. They learn that to be inclusive allowed them freedom to express themselves in positive rather than negative ways.

"DBT is a very nice complement to Twelve Step treatment," she adds. "It meets the girls where they are developmentally, never shaming or blaming, but completely accepting, gently nurturing, and always expecting the best of who they can be."

Parent education about DBT is key as well. Parents are provided a written overview of DBT, they receive a follow-up call from a mental health professional, and they discuss the application of DBT when they attend the Parent Program. Parents are assigned tasks to work on with their child at the Parent Program. Other people, such as teachers and referents who are in close contact with the patient after discharge, are also informed of DBT.

Interdiciplinary team is key
In preparation for the initiation of the DBT pilot, staff from all disciplines at CYF participated in a training to better understand the principles of DBT and its fit with the entire treatment process.

The DBT program was funded by a generous grant from the Frederick & Margaret L. Weyerhaeuser Foundation. The one-year pilot will end in September. Once all the data is reviewed and if it is deemed a success, it will continue and services for male patients may be added.

King and other therapists admit it's hard to measure the success of DBT in a short time. But they have recognized a decrease in disruptive behaviors overall among their female clients, and the patients have responded positively. A DBT graduation ceremony helps reinforce to the patients that recovery is a lifelong process and that DBT skills can help throughout.

Said one patient: "I thought I hated going to DBT, but now that I'm leaving, I know how much I've learned and how many skills I can take with me."

--by Marty Duda

Published in The Voice, Summer 2007