Implementing Dialectical Behavior Therapy Skills Training With At-Risk Male Youth in a Military-Style Residential Program

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Recent calls to action rightly emphasize the need for early and preventative intervention for youth at risk for or currently exhibiting borderline personality disorder (BPD) features, nonsuicidal self-injury (NSSI), and/or suicidality. However, there is a lack of information in both the research literature and clinical practice guidelines about the acceptability and effectiveness of such interventions for male youth, particularly those who have dropped out of high school and, thus, are at even greater risk for a multitude of adverse psychological and functional outcomes. The current study aims to address this gap by examining the acceptability and pilot efficacy of a modified Dialectical Behavior Therapy for Adolescents (DBT-A) skills training group intervention among a sample of 73 non-treatment-seeking male youth (aged 16–18) with borderline personality features, self-harm, or suicidal ideation who had dropped out of high school and were enrolled in a military-style residential program (relative to youth participating in the residential program alone). Both quantitative and qualitative feedback from youth point to the high acceptability of DBT-A skills training with this population. Within-subjects and between-groups comparisons support the preliminary efficacy of DBT-A skills training with this population. At posttreatment, participants reported statistically significant decreases in emotion regulation (ER) difficulties (d = 0.43) and increases in distress tolerance (d = -0.50). Further, compared to a similar group of male youth who did not receive DBT-A skills training, those who received skills training showed greater improvements in ER difficulties, albeit not distress tolerance. Data from this pilot trial provide preliminary support for the efficacy of brief, stand-alone DBT-A skills training in improving ER difficulties in a high-risk group of male youth.

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Cognitive and Behavioral Practice

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