Evidence based Therapy for Adolescent internalizing Disorder

04 Mar 2025,9:34 AM

Give 2 types of evidence-based therapeutic interventions open to this client, and explain how you will utilize them

Given the adolescent client’s high-risk status and history of suicidal ideation, the two types of evidence-based therapeutic interventions open to the adolescent client are cognitive-behavioral therapy (CBT) and Dialectical Behavior Therapy (DBT). CBT is a psychological treatment based on the core principles that psychological problems are partly based on unhelpful or faulty ways of thinking and on learned patterns of unhelpful behavior (American Psychological Association, 2017). CBT’s change of unhealthy thinking patterns involves teaching those affected to identify how their thinking is distorted, reevaluating such thinking in light of reality, and improving the patient's understanding of their behavior and motivation of others. This changing of unhealthy patterns also entails initiating the use of problem-solving skills to handle challenging situations, and nurturing the development of a greater sense of confidence in one’s abilities. In contrast to CBT’s change of unhealthy thinking, CBT’s efforts to change behavioral patterns includes helping those affected to face their fears instead of evading them and preparing them for likely problematic interactions with others using role-play, and teaching them to calm their minds and relax their bodies. Therefore, CBT challenges automatic thoughts, illuminates negative thinking, and restructures maladaptive thinking to adaptive ones. It focuses on positive mood development and teaches those affected to reframe negative thought patterns (Wilmshurts, 2015). As a result, CBT ensures the improvement of self-management skills through trigger awareness and development of adaptive trigger response.

In addition to CBT, Dialectical behavior therapy (DBT), initially developed by Linehan and colleagues (2001) as a method for treating adults suffering from borderline personality disorder that features challenges with self-control and emotion regulation, is an integrated program that assimilates cognitive-behavioral methods and psychodynamic sessions focusing on acceptance, mindfulness, and change (Granato et al., 2021; Wilmshurt, 2025). It is a type of talking treatment based on CBT that has been designed to assist individuals experiencing intense emotions. Although DBT is similar to CBT in helping alter unhelpful behavior and ways of thinking, DBT is different in its focus on accepting an individual as they are. Therefore, DBT stresses the relationship between those affected and their therapists, which is utilized for active motivation of change.  Its aim is to help those affected understand and accept their difficult feelings, gain skills to help manage such feelings, and gain the ability to make positive life changes. Ultimately, the client’s symptoms are consistent with an internalizing disorder, specifically a mood disorder such as major depressive disorder (MDD) or bipolar disorder, thereby warranting the integration of CBT and DBT where CBT focuses on changing negative thought patterns and DBT emphasizes emotional regulation and distress tolerance.

In the use of CBT and DBT, I will begin with CBT to address the immediate cognitive distortions and suicidal thoughts of the adolescent client. After the client has acquired some tools to manage his thoughts, I will transition to DBT to build the client’s emotional regulation and distress tolerance skills. As a result, the first five weeks of my intervention will begin with the use of CBT in individual sessions to illuminate and challenge the negative thoughts of the client. This session will be followed by an introduction of DBT mindfulness skills to increase his awareness of his emotions and thoughts without judgment. A safety plan will then follow to address his immediate suicidal ideation and his self-harm attempt. The next 8 weeks will involve a continuation of CBT to address specific cognitive behaviors and distortions, followed by an enrollment in a DBT Skills Group to gain the necessary skills for tolerating distress and regulating emotions, and acquiring interpersonal skills. DBT phone coaching will also be included during this period to assist with his application of learned skills during crisis moments (Edwards et al., 2021). The final four weeks will focus on preventing relapses using CBT techniques, like identification of early suicidal thought warnings, and reinforcing DBT skills to safeguard the client’s continuation of emotion and relationship management. Together, these therapies will help address both the cognitive and emotional aspects of the client’s struggles within a 4 month period to reduce his suicidal ideation and self-harm, which will ultimately prevent his “high-risk” status and remove him as a regular at the local mental health crisis unit.

What type of therapy do you suggest as the best recommendation for this client to attend?

Given the adolescent client’s high-risk status, history of suicidal ideation, and self-harming behaviors, I suggest Dialectical Behavior Therapy (DBT) as the best recommendation for him to attend, if I had to pick one between DBT and CBT. My suggestion of DBT as the best recommendation for this client, which does not diminish CBT’s effectiveness in helping the client, is rooted in DBT’s design in treating clients with chronic suicidal ideation, self-harm, and emotional dysregulation, which aligns with the client’s history (DeCou et al., 2019; Kothgassner et al., 2021; Mossini, 2024). DBT is also a treatment that teaches emotional regulation skills and distress tolerance techniques, which come in handy in helping the client manage his intense emotions that may trigger his suicidal thoughts and self-harm in the form of cuts. DBT’s success rate in reducing suicidal behaviors and self-harm among teens further affirms its recommendation as the client. For example, participants in Turner’s (2000) study showed a decrease in suicidal behavior with the use of DBT.

Provide a description of 2 benefits and 1 drawback that each evidence-based therapeutic intervention provides.

CBT is of benefit to the client due to a number of reasons. One such reason is its short time span since it does not take long. CBT can be completed in a short period when compared to other forms of talking therapy (National Institute of Health, 2022). Another advantage is that CBT is very structured, primarily due to its popularity. As such, it can be provided in different forms, like groups, self-help books, and online to cater to a diverse range of users. However, facing one’s anxieties can be challenging and distressing. As such, one of the drawbacks of CBT is its likelihood to make the participant feel "wobbly" in the beginning, in addition to negatively affecting relationships with others (National Institute of Health, 2022).

DBT is also beneficial to the client due to its adaptability. It can be combined with other therapy forms to increase its effectiveness. It also emphasizes a group approach where those affected take part in group therapy sessions alongside individual coaching to help the patients feel validated, help them practice learned skills and provide them with perspectives on handling their problems by observing others. However, unlike CBT that takes a relatively short time, DBT is time-intensive, requiring an expensive period of time to complete.

How might your client react to this assistance, and how might you convince him to try them

The adolescent client may react to my therapy assistance by resisting, especially if he has a past history with mental health treatment. He might therefore end up doubting that my combination of CBT and DBT can be of use for him. The client may also fear judgment from me as his therapist. He may worry about what I think of self-inflicting cuts and suicidal thought, which can make him feel ashamed and embarrassed to openly discuss his concerns.

However, I may convince him to try out the combination of CBT and DBT by addressing his concerns and starting small. Addressing his concerns could involve the acknowledgement of his skepticism and fears by providing reassurance that the therapy is a safe place to explore his feelings without shame or worry.  I may also suggest starting with a two sessions to see how it goes as a way of relieving pressure. Furthermore, I may prove the success CBT and DBT has had over the years to increase his confidence in my approach.

References

American Psychological Association. (2017). What is Cognitive Behavioral Therapy? Https://Www.apa.org. https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral

DeCou, C. R., Comtois, K. A., & Landes, S. J. (2019). Dialectical behavior therapy is effective for the treatment of suicidal behavior: A meta-analysis. Behavior therapy, 50(1), 60-72. https://www.dialexisadvies.nl/wp-content/uploads/2019/05/Dialectical-Behavior-Therapy-Is-Effective-for-the-Treatment-ofSuicidal-Behavior.pdf

Edwards, E. R., Kober, H., Rinne, G. R., Griffin, S. A., Axelrod, S., & Cooney, E. B. (2021). Skills‐homework completion and phone coaching as predictors of therapeutic change and outcomes in completers of a DBT intensive outpatient programme. Psychology and Psychotherapy: Theory, Research and Practice, 94(3), 504-522. https://DOI:10.1111/papt.12325

Granato, H. F., Sewart, A. R., Vinograd, M., & McFarr, L. (2021). Dialectical behavior therapy. https://www.researchgate.net/profile/Meghan-Vinograd/publication/356492489_Dialectical_behavior_therapy/links/63bc43f5c3c99660ebdf4c49/Dialectical-behavior-therapy.pdf?_tp=eyJjb250ZXh0Ijp7ImZpcnN0UGFnZSI6InB1YmxpY2F0aW9uIiwicGFnZSI6InB1YmxpY2F0aW9uIn19

Kothgassner, O. D., Goreis, A., Robinson, K., Huscsava, M. M., Schmahl, C., & Plener, P. L. (2021). Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis. Psychological medicine, 51(7), 1057-1067. https://doi.org/10.1017/S0033291721001355

Linehan, M. M., Comtois, K. A., Murray, A., Brown, N. Z., Gallop, R. J., & Heard, H. L. (2001). Two-year randomized trial and follow-up of a dialectical behavior therapy vs. therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63, 757–766.

Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard, H. L., ... & Lindenboim, N. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of general psychiatry, 63(7), 757-766.

Mossini, M. (2024). Efficacy of Dialectical Behavioral Therapy Skills in Addressing Emotional Dysregulation among Adolescents: A Systematic Literature Review. International Journal on Social and Education Sciences, 6(3), 439-451. https://doi.org/10.46328/ijonses.684

National Institute of Health. (2022). In brief: Cognitive behavioral therapy (CBT). InformedHealth.org. https://www.ncbi.nlm.nih.gov/books/NBK279297/

Turner, R. M. (2000). Naturalistic evaluation of dialectical behavior therapy-oriented treatment for borderline personality disorder. Cognitive and Behavioral Practice, 7(4), 413-419.

Wilmshurts, L. (2015). Essentials of Child and Adolescent Psychopathology. 2^nd Edition. John Wiley & Sons, Inc.