Effectiveness of Dialectic Behavioral Therapy in Adolescents (DBT-A) in the treatment of depression and emotional dysregulation: A Colombian prospective cohort study

Abstract

Abstract Background Dialectic behavioral therapy (DBT) is a psychotherapeutic treatment to address emotional dysregulation (EDys) through acceptance and change strategies. It has been specifically adapted for use in adolescents (DBT-A). The aim of this study was to determine the effectiveness of a DBT-A skills training program in two different group formats, compared with standard care, for the treatment of EDys and depressive symptoms in adolescents. Methods We carried out a prospective cohort study on adolescents who were exposed to DBT-A skills training compared with standard care. The program included 14 sessions, two hours in duration, fortnightly. We examined clinical outcomes and measures of EDys (with the Difficulties in Emotion Regulation Scale - DERS) and depression (with the Children’s Depression Inventory - CDI) in three groups: Group A corresponded to separate DBT group skills training for patients and their caregivers; Group B-Multifamily, in which adolescents and their caregivers participated in the same sessions; and Group C was the treatment as usual group, with no DBT skills training. Group assignment was non-random and was subject to training group availability at time of inclusion. Linear models were used to control the effect of potential confounders. Results We identified a final sample of 130 subjects. Groups were significantly different only in sex distribution, and problematic alcohol/substance use. Significant differences in DERS and CDI scores were observed when comparing training groups (A and B) with the control (ANOVA p value < 0.001). The adjusted model for the difference in DERS scores showed a significant association between either of the intervention groups vs. treatment as usual. The model for change in the CDI scores showed a significant effect of Group B assignment over treatment as usual, but not of group A. Age showed a significant effect with an average decrease in the difference between pre and post scores of -1.207 per year (95%CI -2.292;-0.122). The use of antidepressants showed a significant effect with a magnitude of 5.411 (95%CI 1.415;9.407). Conclusions The implementation of DBT-A skills training, in either a separate or multifamily format, was both effective and safe for EDys treatment. DBT-A skills training delivered in a multifamily format may have the added benefit of impacting symptoms of depression.