(PS11-B43) Exploring Adolescent DBT Patients’ Commitment to Treatment and Their Perceptions of Caregivers’ Commitment to Treatment

INTRODUCTION: Dialectical Behavior Therapy (DBT) is an evidence-based therapy intended to treat a range of symptoms related to chronic emotional and behavioral dysregulation across different domains of functioning (Bedics et al., 2015; Brodsky et al., 2017). In DBT, the pretreatment phase focuses on setting goals that align with building a life worth living (Coyle, et al. 2019), which lays the foundation for each patient’s commitment to treatment (Bolton & Scherer, 2003). This pretreatment commitment is especially important for adolescents, who may have additional difficulties with executive function and future-oriented thinking. The current study focuses on DBT for adolescents (DBT-A) and specifically examines how adolescent and parental commitment to treatment relate to outcomes. The authors examined adolescents’ perception of their own commitment to treatment, as well as their perception of their caregivers' commitment. It was hypothesized that greater commitment to treatment, reported by the adolescent, as well as their perceived commitment from their caregivers, would be related with improved treatment outcomes.

METHODS: Participants (n = 17; 71% female; mean age 15.6 years) were adolescent patients completing comprehensive DBT-A treatment at an outpatient clinic in California during the COVID-19 pandemic. Measures included the PHQ-9, GAD-7, BSL-23, DERS-18, WSASY, and USSIS as well as eight self-reported survey items assessing the commitment to treatment for both the adolescent and their primary caregiver. One of the four survey items used to assess parental commitment was, “This grown-up is working to change their part of the problems I'm working on in therapy.” One of the four items used to assess adolescents' self-rated commitment to treatment was, “This skills group is helpful, this skills group meets my needs.” All items were Likert-style (i.e., “Strongly Disagree” to “Strongly Agree”). Participants completed measures at intake and every two months throughout treatment. Multi-level models were fit to examine the within- and between-person associations of treatment outcomes with adolescents’ ratings of their own and their caregivers’ commitment to treatment.

RESULTS: The results of the multi-level models showed that higher adolescent ratings of self-commitment to treatment were associated with significant improvements for all outcomes measured (all ps < .05). Adolescent ratings of their caregivers' commitment were not associated with treatment outcomes. 

Discussion: As hypothesized, more ‘buy-in’ or commitment from adolescents was associated with improvements across many treatment outcomes, including depression, anxiety, borderline symptoms, emotional dysregulation, and suicidality. However, contrary to our hypothesis, adolescents’ perception of their caregivers’ willingness to commit to treatment was not significantly related to treatment outcomes. While strong conclusions cannot be drawn from this small, uncontrolled study, the results suggest that adolescents’ own commitment, but perhaps not necessarily their caregivers’, is a critical contributor to treatment success. Future research might examine other factors that contribute to adolescent commitment to DBT.