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 selfinjurious behavior, emotional dysregulation, and depressive symptoms.Conclusions-Dialectical behavior therapy may offer promise as an approach to the psychosocial treatment of adolescent bipolar disorder.
Keywords bipolar disorder; therapy; psychosocial treatmentOver the past decade, bipolar disorder (BP) in children and adolescents has gained increasing attention. Research suggests that BP affects approximately 1% of community adolescents (Lewinsohn et al., 1995), with estimates as high as 6% to 15% in clinical samples (Biederman et al., 1995;Pavuluri et al., 2006). Adolescents with BP exhibit a difficult illness course characterized by prolonged episodes, substantial inter-episodic symptoms, and marked functional impairment . High rates of psychosis, comorbidity, and hospitalizations have also been reported in this population . BP onset in adolescence is particularly pernicious due to its associations with drug and alcohol abuse, unprotected sex, and suicide (Brent and Lerner, 1994;Goldstein et al., 2005;McClellan et al., 1993). Evidence suggests the majority of adolescent-onset BP patients experience aCorrespondence to Dr. Tina R. Goldstein, Western Psychiatric Institute and Clinic, 100 North Bellefield Avenue, #463, Pittsburgh, PA 15213; goldsteintr@upmc.edu. Disclosure: The authors have no financial relationships to disclose.
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NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript deteriorating course into adulthood, with poor outcomes including chronic functional impairment and treatment resistance (Strober et al., 1995). Given the projected continuity and morbidity associated with adolescent BP, effective early intervention may minimize the longterm debilitating effects of the illness.Althoug...