Health

‘Best tool we have’ for teen self-harm and suicide


Parents seeking therapy for teens who are self-harming or suffering from anxiety, depression, or suicidal thoughts face a wide range of treatment options and imposing acronyms: whether cognitive behavioral therapy (CBT), parental management training (PMT), collaborative assessment and management of suicidality (CAMS), acceptance and commitment therapy (ACT), and others.

Each approach can benefit a specific group of people. But for adolescents at risk of acute self-harm and suicide, health professionals and researchers are increasingly pointing to dialectical behavioral therapy, or DBT, as a means of treatment. effective treatment.

“At this point, it’s probably the best tool we have,” said Michele Berk, a child and adolescent psychiatrist at Stanford University.

In a 2018 study in the Journal of the American Medical Association, Dr. Berk and her colleagues found that DBT led to a greater reduction in suicide attempts and self-harm in adolescents than in adolescents. with a more general therapy. A 2014 study by researchers in Norway found a similar effect, noting that the therapy also had a relatively low drop-out rate and concluding that it was “really possible for adolescents to participate in , retention and treatment” using DBT. as an important evidence-based treatment by the American Academy of Pediatrics. Dr. Berk said, if anything, DBT “doesn’t have enough.”

Dialectical behavior therapy is a subset of cognitive behavioral therapy, which aims to reframe a person’s thoughts and behaviors. DBT initially focuses on raw behavior and emotions, helping individuals work through moments of crisis and understand what prompted the behavior in the first place.

DBT is intensive. The most complete version of the program, which can take six months to a year to complete, has four components: individualized therapy for adolescents; group therapy; training for teens and their parents to teach emotional regulation and to reach out to a therapist for help during a crisis.

Jill Rathus, a psychologist at Long Island, said: The first step is to teach patients to recognize sensations in the body when dangerous impulses are present, such as “tumours in the throat, pulse, shoulder. stress”. In the 1990s, Dr. Rathus was part of a team that adapted the adult version of DBT for use by teenagers and their families.

The patient then learns to put those feelings into words. It’s important to “introduce language” into physical and emotional experiences, says Dr. Rathus; this involves parts of the brain, like the prefrontal cortex, that help regulate emotions. In young people, these brain regions are not fully developed and can easily become overwhelmed.

The next step is to learn how to reduce arousal with specific, often simple techniques: splashing cold water on the face, doing short but intense exercise, putting ice packs on the eyes – to “stimulate the body” chemistry”, in the language of DBT

The intensive nature of DBT reflects the difficulty of the challenge it faces: emotional regulation of adolescents who are overwhelmed to the point of rational struggle. At that age, teenage brains are often not developed enough to handle the flood of news and social information, says Dr. Rathus.

“The brain goes into a state of overload, overflowing with emotions and you can’t learn anything new, can’t process incoming information and, therefore, suggestions of what to do or do,” says Dr. Rathus. Trial is only given immediately. friend.”

This is why teenagers can’t seem to hear suggestions to curb their dangerous impulses, no matter how well-intentioned or benevolent the birth, Dr. idea. Some teens can’t start DBT without medication, such as an antidepressant or an anti-anxiety medication, to calm the brain enough for treatment to pause.

The drug is a cause of tension among adolescent mental health professionals, who note that the drug can be over-prescribed or prescribed in combination with unspecified side effects. But they can be important as a tool to stabilize adolescence.

“The drug really helps to deliver outstanding benefits,” said Dr. Berk of Stanford. “But there is no cure for suicide. Medicines treat depression and anxiety, and patients need to learn other behavioral skills that drugs don’t teach you.”

Therapists trained in dialectical behavior therapy can be expensive and difficult to find, and are often booked.

Rates vary by state and provider, but doctors say it’s not uncommon for an hour of an individual consultation to cost $150 to $200 or more, with group therapy costing just by half. Over six months, the treatment can cost up to $10,000 for someone to pay out of pocket. But out-of-pocket costs can also vary widely depending on the type of insurance plan being used and whether the treatment is covered by Medicaid, the state’s insurance program.

Only two states – Minnesota and Missouri – offer widespread support for DBT, according to Anthony DuBose, head of training for Behavioral Tech, an organization that trains DBT therapists. He cites another reason for the relative scarcity of DBT counseling: Some therapists fear that the therapy is too intensive and may exceed their available time. “We need to convince mental health providers that they can do this,” he said.

The upfront costs may be worth it in the long run: Several studies compiled by researchers at the University of Washington show that DBT interventions, although costly initially, can reduce repetitive, costly emergency room visits. According to the university’s Center for Behavioral Technology, DBT is cost-effective and “accumulating evidence shows that DBT reduces treatment costs”.

Shredded versions of DBT exist, and they may also work for teens prone to self-harm and suicide, experts say. However, these experts warn, many of these emerging variants have not been studied with the same rigor as more complete treatments.

According to Dr. Stephanie Kennebeck, a pediatric emergency room physician at Cincinnati Children’s Hospital, adolescents who have received training in DBT or CBT appear to be better equipped to cope with feelings of distress and want to be on their own. death.

Dr Kennebeck said she has seen first-hand the value of training in cases of teenagers who come to the emergency room with intense emotions. Kennebeck said adolescents who are untreated and not retrained often need to be kept in the emergency room longer, until they can be placed on a treatment program. She adds that she feels more comfortable sending a child home if they are knowledgeable about how to deal with difficult emotional situations.

“Patients who have been through some CBT or DBT have the ability to name their emotions, let me know how their feelings might translate into what they would do next,” says Dr. Kennebeck. “It’s priceless.”

There are many models of therapy that help deal with different emotional issues including anxiety, depression, and trauma. When acute behavioral risk, such as self-harm and suicide, is a concern, the American Foundation for Suicide Prevention recommends several options beyond DBT, including CAMS, which has been demonstrated in studies are effective in reducing suicidal thoughts and behaviors cognitive behavioral suicide prevention therapy, or CBT-SP, has been shown in studies to be effective in stopping attempts subsequent suicide in adults with at least one prior attempt.

In DBT, teenagers are not the only ones learning. Parents are trained to validate their teen’s feelings, even if they seem irrational.

“The mistake of parents, even good and loving parents, is to minimize emotions,” says Dr. Rathus. Telling a distraught teen to “just go for a walk, or focus on schoolwork, is like telling them to climb Everest.”

Teens can’t hear words, she says, and they quickly “learn to distrust” strong feelings or emotions. Parents participate in group classes where they are guided to understand what teenagers are going through and teach specific ways to deal with distress.

Valerie, a Silicon Valley executive, described her family’s experience with DBT (She asked her last name not to be used to protect their privacy.) Mid-2021, her daughter Valerie’s 12-year-old daughter became increasingly distraught; Once a good student, she started acting out in school, suffering from seemingly uncontrollable tantrums and becoming obsessed with her appearance and weight.

The girl started DBT, and Valerie followed her parents’ instructions to teach her more effective ways to respond to her daughter, she said – by pre-validating her feelings of pain, for example. girl instead immediately suggested a solution.

If her daughter is afraid of dealing with a difficult subject or teacher at school, Valerie tries to control her fear: “I would say, ‘Okay, you’re going to have this bad experience. So get a good night’s sleep first, eat some snacks, then arrange to meet a friend, bring a furry bear to class. ‘”

Valerie added: “It’s like filling up your gas tank before you go on a long trip.” She said the concepts are ones she has begun to apply in her life as she considers “anxious thoughts,” such as “Will I be lonely after selling my business?” are not?”

She says her daughter is making progress. Valerie said: “It helped her get out of feeling hopeless or stuck in everything. “She makes things worse” and “no longer goes down rabbit holes she can’t get out of.”



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