Adolescent inpatient completers of dialectical behaviour therapy

Publication Date06 December 2019
AuthorElla Hancock-Johnson,Charlotte Staniforth,Lucy Pomroy,Kieran Breen
SubjectHealth & social care,Criminology & forensic psychology,Forensic practice,Sociology,Sociology of crime & law,Law enforcement/correctional,Public policy & environmental management,Policing,Criminal justice
Adolescent inpatient completers of
dialectical behaviour therapy
Ella Hancock-Johnson, Charlotte Staniforth, Lucy Pomroy and Kieran Breen
Purpose Dialectical behaviour therapy (DBT) aims to reduce emotional dysregulation and engagement in
less adaptive behaviours for adults with mixed disorders of conductand emotions (MDCE). However, there is
limited evidence available for the effectiveness of DBT skills training for adolescents with MDCE who are
resident within a secure impatient setting. The paper aims to discuss these issues.
Design/methodology/approach A retrospective study investigated changes in aggressive and
self-injurious behaviours in 22 adolescents within a secure inpatient mental health setting with MDCE who
had completed one cycle of DBT skills training. Changes in symptomatic problems, behavioural and social
impairment were also investigated in 17 of the 22 participants who completed the DBT skills training cycle.
Findings There were statistically significant decreases in the frequencies of engagementin total aggressive
and deliberate self-harm behaviours after the DBT skills training cycle. There was a significant improvement in
symptomatic and behavioural impairment, but not in social impairment.
Practical implications The findings of this study suggest that DBT skills training may be beneficial for
behavioural and symptomatic outcomes in adolescent inpatients with MDCE.
Originality/value This study provides preliminary evidence for the effectiveness of DBT skills training for
adolescents with MDCE within a secure inpatient setting. Additional studies are required to investigate the
clinical benefits of specific aspects of DBT for individual patients.
Keywords Skills, Adolescent, Inpatient, Dialectical behaviour therapy, Secure, Emotional dysregulation
Paper type Research paper
Mixed disorders of conduct and emotions (MDCE) are characterised by persistent aggression,
defiant behaviour,emotional instability and issueswith conduct (Arola et al., 2016; Sagar-Ouriaghli
et al., 2018), whichis often displayed in inpatientchild and adolescent settings (Deanet al.,2008).
However, reportsto date on the effective treatmentof adolescents with MDCE in inpatient settings
are limited (Nadkarni et al., 2012). As emotional instability is a feature of MDCE, Dialectical
Behaviour Therapy (DBT) a therapy that aims to reduce emotional dysregulation may be of
benefit for the treatment of people who express these symptoms.
Linehans (1993) biosocial theory suggests that difficulties in emotion regulation manifest from a
combination of biological emotional vulnerability and an environment that invalidates the
communication of emotion in childhood. This theory guided the development of DBT, which
focusses on eradicating engagement in maladaptive behaviours by teaching adaptive coping
skills (Neece et al., 2013). It was originally introduced for the treatment of potentially suicidal
patients but has also been effective for adolescents with non-suicidal self-injury (Tebbett-Mock
et al., 2019). The therapy consists of several key modes: individual therapy, telephone coaching,
therapist consultation meetings and skills training. Within the skills training component, patients
are taught adaptive methods of coping through mindfulness, interpersonal effectiveness,
distress tolerance and emotion regulation modules. DBT has since been adapted for
adolescents (DBT-A; Miller et al., 2007), and it can also include a Walking the Middle Path
(WTMP) module which focusses on relationships between young people and their caregivers
Received 11 July 2019
Revised 27 September 2019
11 November 2019
Accepted 11 November 2019
Ethical statement: This study did
not require ethical approval as
routinely collected retrospective
data were analysed. Approval for
the study was granted from the
Clinical Audit team at St Andrews
Healthcare as a service evaluation
on July 4, 2018. Conflicts of
interest: There are no conflicts of
interest to report.
Ella Hancock-Johnson is
based at Research Centre,
St Andrews Healthcare,
Northampton, UK.
Charlotte Staniforth and Lucy
Pomroy are both based at
Child and Adolescent Mental
Health Service, St Andrews
Healthcare, Northampton, UK.
Kieran Breen is based at
Research Centre, St Andrews
Healthcare, Northampton, UK.
DOI 10.1108/JFP-07-2019-0029 VOL. 22 NO. 1 2020, pp. 29-39, © Emerald Publishing Limited, ISSN 2050-8794
PAG E 29

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