A mixed method evaluation of change in young people attending Dialectical Behaviour Therapy for Adolescents (DBT-A)

Background: Suicidal behaviour among adolescents is considered a significant public health concern. It is associated with an array of risk factors and complex mental health problems, in particular, Borderline Personality Disorder (BPD). There is a reluctance to diagnose BPD during adolescence given the absence of a stable personality structure. However, there exists a cohort of adolescents attending Child and Adolescent Mental Health Services in Ireland presenting with ongoing, pervasive difficulties and co-morbid psychopathology. Dialectical Behaviour Therapy for Adolescents (DBT-A), an adapted version of standard DBT, was developed with this cohort in mind. Given the relative recency of its development, research on the efficacy of DBT-A is in its infancy. Research to date examining the effectiveness of DBTA has predominantly focussed on symptom reduction pre- and post- treatment using quantitative research methods and has shown promising results. Less is known about how or why changes in symptomatology have been found. Method: This research used both qualitative and quantitative methods, i.e. mixed methods, to evaluate change in symptoms from beginning to end of treatment (quantitative phase) and examine the process of change through qualitative interviews. Quantitative data (n=30) were analysed using non-parametric tests comparing symptoms pre- and post- treatment. Interpretive Phenomenological Analysis (IPA) was used to examine the qualitative findings (n=6). The overarching mixed methodology utilised was the embedded design. Results: Quantitative results showed significant reductions in depression, hopelessness, suicidal ideation, self-harming behaviour and anger from pre-treatment to post-treatment. The qualitative phase resulted in the emergence of five superordinate themes related to the process of change, namely, ‘Then vs. Now’, ‘Skills Acquisition’, ‘Internal Processes of Change’, ‘Therapeutic Components’ and ‘Toward a Better DBT’. Findings indicated that the quantitative results supported previous research on the effectiveness of DBT-A using pre-post measurement design. The qualitative results both contextualised and expanded on quantitative findings. Conclusion: Results from this research added to the quantitative literature on the evaluation of DBT-A and supports preliminary positive findings on the effectiveness of DBT-A. It also addressed a number of gaps in the existing literature on DBT-A, namely, providing insight into adolescents’ experience of change, deconstructing the meaning of change, offering potential explanations of how change was made possible, and isolating therapeutic factors influencing the process of change through qualitative evaluation.