Dialectical behavior therapy for adolescents with bipolar disorder: a 1-year open trial

Abstract

Objective: To describe an adapted version of dialectical behavior therapy for adolescents with bipolar disorder.

Method: The dialectical behavior therapy intervention is delivered over 1 year and consists of two modalities: family skills training (conducted with individual family units) and individual therapy. The acute treatment period (6 months) includes 24 weekly sessions; sessions alternate between the two treatment modalities. Continuation treatment consists of 12 additional sessions tapering in frequency through 1 year. We conducted an open pilot trial of the treatment, designed as an adjunct to pharmacological management, to establish feasibility and acceptability of the treatment for this population. Participants included 10 patients (mean age 15.8 +/- 1.5 years, range 14-18) receiving treatment in an outpatient pediatric bipolar specialty clinic. Symptom severity and functioning were assessed quarterly by an independent evaluator. Consumer satisfaction was also assessed posttreatment.

Results: Feasibility and acceptability of the intervention were high, with 9 of 10 patients completing treatment, 90% of scheduled sessions attended, and high treatment satisfaction ratings. Patients exhibited significant improvement from pre- to posttreatment in suicidality, nonsuicidal self-injurious behavior, emotional dysregulation, and depressive symptoms.

Conclusions: Dialectical behavior therapy may offer promise as an approach to the psychosocial treatment of adolescent bipolar disorder.

Figures

Fig. 1

Sample diary card. Adapted from Miller et al. (2006).

Fig. 1

Sample diary card. Adapted from Miller et al. (2006).

Fig. 2

Posttreatment satisfaction ratings for dialectical behavior therapy.

Fig. 3

Mean ratings of suicidality decrease with dialectical behavior therapy.

Fig. 4

Ratings of emotional dysregulation normalize with dialectical behavior therapy. CALS = Children’s Affective Lability Scale.