Adapting or adopting?

There are two main reasons that support the application of DBT for adolescents who exhibit suicidal risk and self-injurious behaviors.

First, DBT flexibly uses different tools and strategies to treat problems related to emotional dysregulation and behavioral dyscontrol. This aspect is an advantage of DBT over other adolescent therapies that treat one problem at a time (e.g., depression, school avoidance, interpersonal problems). Second, DBT is a multidimensional approach, and among its components, the Skills Training group is an effective treatment modality for adolescents, as peer relationships promote the development of social skills and identity formation.

DBT-A, as developed by Miller and Rathus (2015) provides a similar format to adult DBT by including individual therapy, skills training group, therapist consultation team, and telephone consultations.

A first distinguishing feature from standard DBT is its duration, which is shorter than standard DBT. It also includes an additional Skills Training module, called "Walking the Middle Path",which addresses the dilemmas that characterize the adolescent-family relationship. Finally, parents/guardians attend weekly skills training groups together with the adolescent to increase skills generalization and enhance their ability to validate and support their children more effectively. See Rathus and Miller's manual https://www.raffaellocortina.it/scheda-libro/jill-h-rathus-alec-l-miller/manuale-dbtc2ae-per-adolescenti-9788860308207-2375.html

DBT for the treatment of clients presenting BPD and SUD involves an integrated approach to address addiction problems and simultaneously the other behavioral problems of individuals with BPD. Therefore, DBT for the treatment of individuals with BPD in comorbidity with SUD differs from standard DBT fundamentally by the addition of three elements:

1. a conceptual framework for understanding the overlap between BPD and substance abuse/dependence or misuse;

2. a dialectical philosophy for defining the treatment goals associated with addiction behaviors and addressing relapse. In fact, it is referred to as Dialectical Abstinence, an approach that consists of setting the goal to stop implementing the addictive behavior forever-in other words, to achieve complete abstinence-and at the same time in case the behavior recurs, set the goal to minimize the harm and return to abstinence as soon as possible. Specifically, with regard to relapse management, DBT views relapse in substance abuse as a problem to be solved rather than evidence of patient inadequacy or treatment failure; addiction e per affrontare la ricaduta. Si parla infatti di Astinenza dialettica, un approccio che consiste nel porsi l’obiettivo di smettere di attuare il comportamento di dipendenza per sempre – in altre parole di ottenere l’astinenza completa – e allo stesso tempo nel caso in cui il comportamento si ripresenti, porsi l’obiettivo di minimizzare il danno e tornare all’astinenza il prima possibile. In particolare, per quanto riguarda la gestione della ricaduta, la DBT considera la ricaduta nell’abuso di sostanze come un problema da risolvere piuttosto che la prova dell’inadeguatezza del paziente o il fallimento del trattamento.
3. a modified hierarchy of goals in that it places the main focus on the "dialectical abstinence" cessation of substance use.

The adaptation of DBT to substance use also involves teaching patients, in addition to standard DBT skills, specific skills for substance use problems.

The adaptation of DBT to Eating Behavior Disorders (see Safer et al., Cortina, 2011 https://www.raffaellocortina.it/scheda-libro/debra-l-safer-christy-f-telch-eunice-y-chen/binge-eating-e-bulimia-9788860303790-1115.htmlfocuses mainly on binge eating behaviors, which may or may not be followed by behaviors such as self-induced vomiting, laxative use, food restriction or hyper - physical activity with the aim of compensating for binge eating. According to the model on which DBT is based, all these behaviors are aimed at trying to influence, change or control painful emotional activation and, consequently, can be treated by teaching clients skills to regulate their emotions.

Accordingly, the target behaviors of treatment are specifically related to eating issues and include:

• interrupting binge eating and compensatory behaviors;
• eliminating mindless eating modemindless eatingThis expression refers to episodes that cannot be described as binge eating but are characterized by eating automatically, with little or no awareness (such as eating a packet of chips while watching TV without hardly noticing the food and/or the very fact that you are eating);
• reduce craving and urges related to binge eating or food-related worries;
• reduce the tendency to give in and behave as if binge eating is the only possible behavior;
• reduce seemingly irrelevant behaviors that do not seem to be seemingly related to binge/compensatory behaviors but are in fact risk factors for these problem behaviors (e.g., having a stockpile of foods typically used for binge eating in the house thinking to keep them just to offer them to others in case one invites friends over or going grocery shopping when one does not intend to binge but is emotionally vulnerable).

This adaptation of DBT consists of groups aimed at family members, partners or others close to the patient. These groups, which are multifamily and held periodically, are organized along the same lines as patient Skills Training. Indeed, the goal is to teach skills. Often the people close to the patients are in severe emotional and behavioral distress and are at risk of unknowingly reinforcing the dysfunctional characteristics of their relatives, being convinced instead that they are acting positively. The risk is the establishment of insoluble problematic relational vicious circles, in a generalized climate of suffering.

Based on these considerations, Fruzzetti and Hoffman (2004) developed the Family Connections (FC) program. Family Connections is an adaptation of the Standard DBT Skills Training originally designed for family members of patients with Borderline Personality Disorder with the aim of teaching them the same skills that patients learn, to learn new and more effective ways of relating to the patient themselves.