Category: Child / Adolescent - Trauma / Maltreatment
Keywords: Adolescents | DBT (Dialectical Behavior Therapy) | Prolonged Exposure
Presentation Type: Clinical Roundtable
The primary purpose of this clinical roundtable is to identify and address complications in the treatment of adolescents with histories of repeated interpersonal trauma, and provide principle-based guidelines for clinical practice. Adolescents with severe Post-Traumatic Stress Disorder (PTSD) often present with impairments across multiple domains of functioning, and can be difficult to engage in regular, structured treatment. Implementation may be complicated by more severe interpersonal dysfunction, emotion dysregulation and difficulties regulating distress both within and outside of sessions, manifesting at times as high-risk behaviors such as active suicidality. Dialectical Behavior Therapy for Adolescents (DBT-A) is increasingly well-established in addressing high-risk behaviors and includes procedures for managing difficulties with treatment engagement. However, emerging adult literature suggests that without a specific, evidence-based protocol for addressing PTSD, treatment gains of DBT-A may not be sustained for traumatized individuals. Prolonged Exposure for Adolescents (PE-A) has also proven effective for treating PTSD, but is without clear procedures for addressing active suicidality or more marked difficulties with treatment engagement. Clinicians in the roundtable, who are either trained in the treatment of trauma, DBT or both, present case examples to highlight difficulties encountered with using exposure alone and DBT alone. A case example is presented representing successful integration of PE-A and DBT-A. Empirical support for this model is based upon growing support for the use of DBT-PE among adults (e.g., Harned et al., 2014). Participants discuss anticipated complications with modifying Harned et al.’s model for adolescents, and implications of recent research supporting integrated rather than “phase-based” treatment approaches for adults with repeated interpersonal trauma.
Behavioral Wellness of NYC; St. John's University
University of Washington
the Uniformed Services University of the Health Sciences.
Cognitive and Behavioral Care Center of Connecticut
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