Skip to main content
SpringerLink
Log in

Abbreviated Dialectical Behavior Therapy Virtual Skills Group for Caregivers of Adolescents: An Exploratory Study of Service User and Clinical Outcomes

  • Research
  • Published:
Child Psychiatry & Human Development Aims and scope Submit manuscript

Abstract

Prior work emphasizes involving caregivers in youth mental health services. To support youth with emotion dysregulation, dialectical behavior therapy for adolescents (DBT-A) includes a multi-family skills group, wherein adolescents and caregivers learn skills together. However, limited work has examined the impact of caregiver involvement within DBT-A. The current study examines outcomes of two caregiver-only DBT-A skills groups adapted for abbreviated telehealth delivery. We report on caregivers’ (N = 11, 100% mothers, 55% Hispanic) service user outcomes (e.g. self-efficacy at skill usage, group cohesion, therapeutic alliance) and clinical outcomes (i.e. their own emotion functioning, criticism, responses to their adolescent’s negative emotions). Results indicate caregiver-only groups were feasible and acceptable, and suggest preliminary efficacy, including improvements in caregiver emotion functioning, distress during interactions with their adolescents, and adolescent-reported criticism. Caregivers also reported reductions in unsupportive responses with their adolescents. Overall, while we caution interpretation due to a small sample size, findings support the preliminary feasibility and efficacy of modifying caregiver participation in DBT-A to be less time-consuming and administered via telehealth.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data Availability

A de-identified version of the data that support the findings of this study may be made available upon reasonable request.

References

  1. Alfonsson S, Olsson E, Hursti T (2016) Motivation and treatment credibility predicts dropout, treatment adherence, and clinical outcomes in an internet-based cognitive behavioral relaxation program: a randomized controlled trial [Original Paper]. J Med Internet Res 18(3):e52. https://doi.org/10.2196/jmir.5352

    Article  PubMed  PubMed Central  Google Scholar 

  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (Fifth ed.). American Psychiatric Publishing.

  3. Ardito RB, Rabellino D (2011) Therapeutic alliance and outcome of psychotherapy: historical excursus, measurements, and prospects for research. Front Psychol 2:270

    Article  PubMed  PubMed Central  Google Scholar 

  4. Baetens I, Claes L, Hasking P, Smits D, Grietens H, Onghena P, Martin G (2015) The relationship between parental expressed emotions and non-suicidal self-injury: The mediating roles of self-criticism and depression. J Child Fam Stud 24(2):491–498

    Article  Google Scholar 

  5. Bariola E, Gullone E, Hughes EK (2011) Child and adolescent emotion regulation: The role of parental emotion regulation and expression. Clin Child Fam Psychol Rev 14(2):198–212

    Article  PubMed  Google Scholar 

  6. Berk, M. S. (2020). Dialectical behavior therapy with parents of youth at risk for suicide.

  7. Bock MM, Graf T, Woeber V, Kothgassner OD, Buerger A, Plener PL (2022) Radical acceptance of reality: putting DBT®-a skill groups online during the COVID-19 pandemic: a qualitative study. Front Psychiatry. https://doi.org/10.3389/fpsyt.2022.617941

    Article  PubMed  PubMed Central  Google Scholar 

  8. Burlingame GM, McClendon DT, Yang C (2018) Cohesion in group therapy: A meta-analysis. Psychotherapy 55(4):384–398. https://doi.org/10.1037/pst0000173

    Article  PubMed  Google Scholar 

  9. Conroy K, Kehrer SM, Georgiadis C, Hare M, Ringle VM, Shaw AM (2024) Learning from adolescents and caregivers to enhance acceptability and engagement within virtual dialectical behavior therapy for adolescents skills groups: a qualitative study. Child Psychiat Human Development 1–15

  10. Crowe TP, Grenyer BF (2008) Is therapist alliance or whole group cohesion more influential in group psychotherapy outcomes? Clin Psychol Psychother 15(4):239–246

    Article  PubMed  Google Scholar 

  11. Dowell KA, Ogles BM (2010) The effects of parent participation on child psychotherapy outcome: A meta-analytic review. J Clin Child Adolesc Psychol 39(2):151–162

    Article  PubMed  Google Scholar 

  12. Durlak JA (2009) How to select, calculate, and interpret effect sizes. J Pediatr Psychol 34(9):917–928

    Article  PubMed  Google Scholar 

  13. Fabes, R., Eisenberg, N., & Bernzweig, J. (1990). The coping with children’s negative emotions scale: Procedures and scoring. Available from authors. Arizona State University, 10, J002v034n003_005.

  14. First MB, Gibbon M, Spitzer RL, Williams JBW, Smith Benjamin LS (1997) Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). American Psychiatric Press Inc, USA

    Google Scholar 

  15. Flynn D, Gillespie C, Joyce M, Spillane A (2020) An evaluation of the skills group component of DBT-A for parent/guardians: a mixed methods study. Irish J Psychol Med 40(2):143–151

    Article  Google Scholar 

  16. Glenn CR, Esposito EC, Porter AC, Robinson DJ (2019) Evidence base update of psychosocial treatments for self-injurious thoughts and behaviors in youth. J Clin Child Adolesc Psychol 48(3):357–392

    Article  PubMed  PubMed Central  Google Scholar 

  17. Gopalan, G., Goldstein, L., Klingenstein, K., Sicher, C., Blake, C., & McKay, M. M. (2010). Engaging families into child mental health treatment: updates and special considerations. Journal of the Canadian Academy of Child and Adolescent Psychiatry/Journal de l'Académie canadienne de psychiatrie de l'enfant et de l'adolescent.

  18. Gratz KLR, L. (2004) Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. J Psychopathol Behav Assess 26:41–54

    Article  Google Scholar 

  19. Hare MM, Garcia AM, Hart KC, Graziano PA (2021) Intervention response among preschoolers with ADHD: The role of emotion understanding. J Sch Psychol 84:19–31

    Article  PubMed  Google Scholar 

  20. Hedges LV (1981) Distribution theory for Glass’s estimator of effect size and related estimators. J Educ Stat 6(2):107–128

    Article  Google Scholar 

  21. Hooley JM, Teasdale JD (1989) Predictors of relapse in unipolar depressives: expressed emotion, marital distress, and perceived criticism. J Abnorm Psychol 98(3):229

    Article  PubMed  Google Scholar 

  22. Hunnicutt Hollenbaugh KM, Lenz AS (2018) Preliminary evidence for the effectiveness of dialectical behavior therapy for adolescents. J Couns Dev 96(2):119–131

    Article  Google Scholar 

  23. Israel P, Hove Thomsen P, Langeveld JH, Stormark KM (2004) Parental engagement in psychotherapy with adolescents: A preliminary study. Nord J Psychiatry 58(2):133–138

    Article  PubMed  Google Scholar 

  24. Jensen J, Burlingame G (2018) An item reduction analysis of the group questionnaire. Psychotherapy 55(2):144–150. https://doi.org/10.1037/pst0000145

    Article  PubMed  Google Scholar 

  25. Linehan MM (1993) Skills training manual for treating borderline personality disorder. Guilford press, NY

    Google Scholar 

  26. Macdonald E, Lee E, Geraghty K, McCann K, Mohay H, O’Brien T (2007) Towards a developmental framework of consumer and carer participation in child and adolescent mental health services. Australas Psychiatry 15(6):504–508

    Article  PubMed  Google Scholar 

  27. Martin CG, Kim HK, Freyd JJ (2018) In the spirit of full disclosure: Maternal distress, emotion validation, and adolescent disclosure of distressing experiences. Emotion 18(3):400

    Article  PubMed  Google Scholar 

  28. Martin CG, Roos LE, Zalewski M, Cummins N (2017) A dialectical behavior therapy skills group case study on mothers with severe emotion dysregulation. Cogn Behav Pract 24(4):405–415

    Article  Google Scholar 

  29. Martin DJ, Garske JP, Davis MK (2000) Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. J Consult Clin Psychol 68(3):438

    Article  PubMed  Google Scholar 

  30. Mazursky-Horowitz H, Felton JW, MacPherson L, Ehrlich KB, Cassidy J, Lejuez C, Chronis-Tuscano A (2015) Maternal emotion regulation mediates the association between adult attention-deficit/hyperactivity disorder symptoms and parenting. J Abnorm Child Psychol 43(1):121–131

    Article  PubMed  PubMed Central  Google Scholar 

  31. Miller, A. L., Rathus, J. H., DuBose, A. P., Dexter-Mazza, E. T., & Goldklang, A. R. (2007). Dialectical behavior therapy for adolescents.

  32. Morgan S, Rickard E, Noone M, Boylan C, Carthy A, Crowley S, Butler J, Guerin S, Fitzpatrick C (2013) Parents of young people with self-harm or suicidal behaviour who seek help–a psychosocial profile. Child Adolesc Psychiatry Ment Health 7(1):1–10

    Article  Google Scholar 

  33. Morie KP, Crowley MJ, Mayes LC, Potenza MN (2022) The process of emotion identification: Considerations for psychiatric disorders. J Psychiatr Res 148:264

    Article  PubMed  PubMed Central  Google Scholar 

  34. Morris AS, Criss MM, Silk JS, Houltberg BJ (2017) The impact of parenting on emotion regulation during childhood and adolescence. Child Dev 11(4):233–238

  35. Morris AS, Silk JS, Steinberg L, Myers SS, Robinson LR (2007) The role of the family context in the development of emotion regulation. Soc Dev 16(2):361–388

    Article  PubMed  PubMed Central  Google Scholar 

  36. Neece CL, Berk MS, Combs-Ronto LA (2013) Dialectical behavior therapy and suicidal behavior in adolescence: linking developmental theory and practice. Prof Psychol: Res Pract 44(4):257

  37. Neumann A, Van Lier PAC, Gratz KL, Koot HM (2010) Multidimensional assessment of emotion regulation difficulties in adolescents using the difficulties in emotion regulation scale. Assessment 17(1):138–149. https://doi.org/10.1177/1073191109349579

    Article  PubMed  Google Scholar 

  38. Oddo LE, Miller NV, Felton JW, Cassidy J, Lejuez CW, Chronis-Tuscano A (2020) Maternal emotion dysregulation predicts emotion socialization practices and adolescent emotion lability: Conditional effects of youth ADHD symptoms. Res Child Adolesc Psychopathol 50(2):211–224

    Article  Google Scholar 

  39. Patrick SW, Henkhaus LE, Zickafoose JS, Lovell K, Halvorson A, Loch S, Letterie M, Davis MM (2020) Well-being of parents and children during the COVID-19 pandemic: a national survey. Pediatrics. https://doi.org/10.1542/peds.2020-016824

    Article  PubMed  Google Scholar 

  40. Radovic A, Reynolds K, McCauley HL, Sucato GS, Stein BD, Miller E (2015) Parents’ role in adolescent depression care: primary care provider perspectives. J Pediatr 167(4):911–918

    Article  PubMed  PubMed Central  Google Scholar 

  41. Ramzan N, Dixey R, Morris A (2022) A qualitative exploration of adolescents’ experiences of digital Dialectical Behaviour Therapy during the COVID-19 pandemic. Cognitive Behav Ther. https://doi.org/10.1017/S1754470X22000460

    Article  Google Scholar 

  42. Rathus J, Campbell B, Miller A, Smith H (2015) Treatment acceptability study of walking the middle path, a new DBT skills module for adolescents and their families. Am J Psychother 69(2):163–178

    Article  PubMed  Google Scholar 

  43. Rathus JH, Miller AL (2002) Dialectical behavior therapy adapted for suicidal adolescents. Suicide Life-Threat Behav 32(2):146–157

    Article  PubMed  Google Scholar 

  44. Rathus JH, Miller AL (2014) DBT skills manual for adolescents. Guilford Publications, NY

    Google Scholar 

  45. Reynolds S, Wilson C, Austin J, Hooper L (2012) Effects of psychotherapy for anxiety in children and adolescents: A meta-analytic review. Clin Psychol Rev 32(4):251–262

    Article  PubMed  Google Scholar 

  46. Rollnick S, Miller W (1995) What is motivational interviewing? Behav Cogn Psychother 23(4):325–334. https://doi.org/10.1017/S135246580001643X

    Article  Google Scholar 

  47. Rubin DB (1986) Basic ideas of multiple imputation for nonresponse. Surv Methodol 12(1986001):37–47

    Google Scholar 

  48. Samji H, Wu J, Ladak A, Vossen C, Stewart E, Dove N, Long D, Snell G (2022) Mental health impacts of the COVID-19 pandemic on children and youth–a systematic review. Child Adolesc Mental Health 27(2):173–189

    Article  Google Scholar 

  49. Sanders MR, Turner KM, Metzler CW (2019) Applying self-regulation principles in the delivery of parenting interventions. Clin Child Fam Psychol Rev 22(1):24–42

    Article  PubMed  Google Scholar 

  50. Schwartz OS, Sheeber LB, Dudgeon P, Allen NB (2012) Emotion socialization within the family environment and adolescent depression. Clin Psychol Rev 32(6):447–453

    Article  PubMed  Google Scholar 

  51. Shaw AM, Hare MM, Conroy K, Kehrer SM, Cummings LR, Ramos MC, Comer JS (2024) An exploratory study of service user and clinical outcomes in telehealth-delivered dialectical behavior therapy for adolescents. Psychol Ser

  52. Silverman WK, Albano AM (1996) Anxiety Disorders Interview Schedule for DSM-IV. Physiological Corporation, Child & Parent Versions

    Google Scholar 

  53. Steinberg, L., & Silk, J. S. (2002). Parenting adolescents.

  54. Sullivan GM, Feinn R (2012) Using effect size—or why the P value is not enough. J Grad Med Educ 4(3):279–282

    Article  PubMed  PubMed Central  Google Scholar 

  55. Thulin U, Svirsky L, Serlachius E, Andersson G, Öst L-G (2014) The effect of parent involvement in the treatment of anxiety disorders in children: A meta-analysis. Cogn Behav Ther 43(3):185–200

    Article  PubMed  Google Scholar 

  56. Warren JI, Stein JA, Grella CE (2007) Role of social support and self-efficacy in treatment outcomes among clients with co-occurring disorders. Drug Alcohol Depend 89(2–3):267–274. https://doi.org/10.1016/j.drugalcdep.2007.01.009

    Article  PubMed  PubMed Central  Google Scholar 

  57. Woodberry KA, Popenoe EJ (2008) Implementing dialectical behavior therapy with adolescents and their families in a community outpatient clinic. Cogn Behav Pract 15(3):277–286

    Article  Google Scholar 

  58. Zalewski M, Maliken AC, Lengua LJ, Martin CG, Roos LE, Everett Y (2020) Integrating dialectical behavior therapy with child and parent training interventions: A narrative and theoretical review. Clin Psychol. https://doi.org/10.1111/cpsp.12363

    Article  Google Scholar 

Download references

Funding

This work was supported by a fellowship from the American Psychological Foundation (KC).

Author information

Authors and Affiliations

  1. Center for Children and Families, Department of Psychology, Florida International University, Miami, FL, 33199, USA

    Megan Hare, Kristina Conroy, Christopher Georgiadis & Ashley M. Shaw

  2. School of Social and Behavioral Sciences, University of New England, Biddeford, ME, 04005, USA

    Ashley M. Shaw

Authors
  1. Megan Hare
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kristina Conroy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christopher Georgiadis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ashley M. Shaw
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Authors MH and AMS were involved in the conceptualization of the idea for this research. Author MH conducted the formal analyses. Authors MH, KC, and CG wrote the first original draft of the manuscript, with review and editing from MH, KC, CG, and AMS. Authors MH, KC, CG, and AMS were involved in project administration. Author AMS provided supervision on study design, management, and data analysis. All authors have contributed to and approved the final manuscript.

Corresponding author

Correspondence to Ashley M. Shaw.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Ethical Approval

All study procedures were approved by the Florida International University Institutional Review Board, and all participants reviewed and signed a clinical consent form and provided consent for their data to be used in research.

Informed Consent

Verbal and written informed consent to participate in this study was provided by the participants, as they were all adults over the age of 18.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hare, M., Conroy, K., Georgiadis, C. et al. Abbreviated Dialectical Behavior Therapy Virtual Skills Group for Caregivers of Adolescents: An Exploratory Study of Service User and Clinical Outcomes. Child Psychiatry Hum Dev (2024). https://doi.org/10.1007/s10578-024-01681-7

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10578-024-01681-7

Keywords

Search

Navigation