In-Person and Telehealth Adapted DBT Parent Skills Group for Caregivers of Adolescents with Suicidality

• In Event: Integration of Dialectical Behavior Therapy and Parent Training: Results From Three New Dual-Generation Treatment Studies

Abstract

Introduction
Dialectical Behavior Therapy (DBT) is one of the leading effective treatments for adolescent suicidality and nonsuicidal self-injury (NSSI) (Ougrin et al., 2015), and there has been growing interest in the integration of DBT and parenting interventions to further improve outcomes for these youth and their families (Zalewski et al., 2020). Targeting parenting and caregiver functioning may be especially important for this population, given recent evidence that parental validation is linked to adolescent NSSI (Adrian et al., 2018), and parent emotion regulation (ER) and psychopathology are associated with adolescent DBT treatment outcomes (Adrian et al., 2019). Although there has been some prior work in designing and testing DBT based parenting interventions, more research evaluating outcomes of such efforts is needed. The current study describes the development and implementation of a DBT parent skills group designed as an adjunctive mode of treatment as part of a full DBT adolescent outpatient program. We also describe a telehealth adapted version of the program developed in response to the COVID-19 pandemic. We report on adolescent and caregiver outcomes from this open pilot trial of the intervention, with a preliminary comparison between the in person and telehealth adapted versions of the group.
Methods
45 caregivers (67% female) of adolescents (mean age = 15.74, 83% female) referred to outpatient DBT for suicidality, NSSI, and other comorbid concerns participated in either a 9 week DBT parent skills group in person (n = 34), or a 10 week version of the group conducted over telehealth (n = 11) due to COVID-19 health and safety guidelines. The group taught DBT skills, crisis management and safety strategies, and behavioral parent management skills. Caregiver report measures were completed at pre- and post-group assessing adolescent psychological adjustment, caregiver-adolescent conflict, as well as caregiver ER, mindfulness, psychological adjustment, and parenting stress. Caregivers also completed a post-group survey assessing treatment satisfaction, acceptability, and appropriateness.
Results
Effect sizes were examined to estimate treatment effects across both groups combined. Cohen's d ranged in magnitude from small to large, with caregivers reporting improvements in adolescent total difficulties (d = .51), impact of adolescent difficulties (d = .89), caregiver-adolescent conflict (d = .49), caregiver psychological adjustment (d = .62), and caregiver ER dimensions of emotional clarity (d = .27) and strategies (d = .30). General linear models (GLM) were used to test for differences between the two groups, and preliminary results showed that participants in the telehealth group reported particularly positive treatment gains across a range of outcomes. Participants reported high levels of satisfaction, appropriateness, and acceptability of the treatment, with independent samples t-tests showing no significant differences in these ratings between the in person and telehealth groups.
Conclusion
These preliminary findings suggest that the DBT parent skills group has a positive impact on multiple domains of adolescent and caregiver adjustment, as well as on the caregiver-adolescent relationship. The treatment also shows comparably positive outcomes and satisfaction, appropriateness, and acceptability when delivered in person or via telehealth. Implications, limitations, and future directions will be discussed.

Authors

• Kyrill Gurtovenko, University of Washington
  Presenting Author

• Kalina Babeva, Seattle Children's
  Non-Presenting Author

• Hilary Mead, Seattle Children's
  Non-Presenting Author

• James Williamson, University Of Washington
  Non-Presenting Author