Behavioral Health: Treatment Options for Children and Teens

DBT, RO DBT, EFFT and Exposure: these are some of the different therapy interventions that we use to provide highly effective and compassionate behavioral health treatment for young people seeking care for mood and anxiety disorders.

These therapies allow us to teach new skills to our child and adolescent patients, instead of just focusing on crisis stabilization. When patients carry with them a strong foundation of skills, our collaborative care team is better able to support their recovery going forward.  

Offering residential, partial hospitalization and intensive outpatient programming, we have an extremely strong psychotherapy component to our treatment paradigm where we are able to treat mood and anxiety disorders as well as address trauma and traumatic stress head-on, which many higher-level-of-care programs do not do. I outline the primary therapies we use to engage both patients and families in our child and adolescent mood and anxiety program below:

1. Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy is a comprehensive treatment for severe, persistent emotional and behavioral difficulties, including anxiety and mood disorders. Dialectics is the practice of finding the middle ground, while behavioral treatment involves making thoughtful changes. 
 
DBT has several core aspects, including:

1. Mindfulness based skills — including both “what” skills (observe, describe and participate) and “how” skills (non-judgmentally, one-mindfully, effectively).
2. Distress tolerance — and accepting that we cannot change, fix, manipulate, avoid or get rid of our present; learning coping skills.
3. Emotional regulation — to identify, acknowledge, accept and cope with unfamiliar or intense feelings, i.e. “Do you know what you’re feeling?” Some patients what they’re feeling and why, but they don’t know what to do with it, while others know only a few emotions (anxiety, fear, sadness).
4. Interpersonal effectiveness — i.e. improving our relationships, letting go of hopeless relationships, and asking for what we want or saying no to requests we cannot or do not want to fulfill. 

Learn more about Dialectical Behavior Therapy.

2. Multi-Family Dialectical Behavior Therapy (MFDBT)

In Multi-Family Dialectical Behavior Therapy, children and adolescents and their parents learn DBT skills in a supportive environment — discovering more effective behaviors to improve the quality of relationships, enhance communication, and further their understanding of interpersonal dynamics.

In our Multi-Family DBT groups at Pathlight, in addition to Mindfulness, we cover:

1. Distress Tolerance
2. Emotion Regulation
3. Interpersonal Effectiveness
4. Walking the Middle Path

At Pathlight, we see such amazing benefits from our Multi-Family DBT that this group is a required part of our program for children and adolescents and their parents. If a parent can’t attend, a support member is expected to. This may include a guardian, grandparent, aunt/uncle, or older sibling over the age of 18. 
 
Based on a recent study, we see preliminary evidence that adding DBT skills to the traditional Family Based Therapy (FBT) paradigm can enhance one's chances for success at FBT treatment and recovery overall.

3. Emotion-Focused Family Therapy (EFFT)

Our family therapy model utilized in family sessions and caregiver groups is also based on Emotion-Focused Family Therapy — teaching “advanced caregiver skills” that empower parents and caregivers to become effective recovery coaches as they support their loved ones through the treatment journey. It incorporates skills training for both behavior coaching and emotion coaching, as well as utilizing therapeutic apologies as a means to heal the wounds within the relationship.  Lastly, EFFT guides the caregiver to work through and resolve the fears and obstacles that arise in supporting their child.  

Learn more about EFFT here: www.mentalhealthfoundations.ca
 
4. Radically Open Dialectical Behavior Therapy (RO DBT)

Current research is beginning to show that temperament plays a role in the development of mood and anxiety disorders. In Radically Open Dialectical Behavior Therapy, temperament lies on a spectrum, with overcontrolled vs undercontrolled personality types at each end. Here’s what traits each of these distinct personality types might look like:
 
Overcontrolled (OC)

• Detail-oriented
• Threat-averse
• Inhibited
• Rigid or perfectionistic
• Avoidant of risk

Undercontrolled (UC)

• High sensitivity to reward
• Less cautious or sensitive to threat
• Uninhibited
• Emotionally expressive; dramatic
• Actively seek new experiences, sensations and more risk-taking

A combination of genetic, environmental and learned factors contributes to whether an individual leans one way or the other.
 
The vast majority of people are what we call “flexibly controlled,” leaning to the overcontrol or undercontrol side — yet having flexibility in their coping and responses. Neither side of the spectrum (over- or under-controlled) is considered better or worse. But, being at an extreme on this spectrum could lead to one’s suffering. 
 
Pathlight is one of only a handful of treatment centers utilizing this valuable new therapy. A number of our clinical leaders have trained directly with RO DBT founder Thomas Lynch, PhD to master this innovative approach. Our treatment team brings this compassionate expertise to the treatment setting to help our young patients work towards richer, more rewarding emotional lives. 
 
Learn more about Radically Open Dialectical Behavior Therapy here: 

• What Role Does Temperament Play in Mental Health?
• Radically Open Dialectical Behavioral Therapy Fact Sheet 
• Radically Open Dialectical Behavior Therapy Website

5. Exposure Therapies 

Early diagnosis and treatment are critical to help young people achieve a long-lasting, full recovery from mental health concerns. We use exposure therapy extensively with our young patients to address anxiety disorders as well as symptoms of post-traumatic stress disorder (PTSD). Some of the methods we use include:

• In vivo exposure - Patients may be exposed to the stimuli directly 
• Imaginal exposure – Patients may be asked to imagine the stimuli when it is not possible or safe for a person to directly confront a fear trigger
• Interoceptive exposure - This is designed to confront the physiological symptoms associated with anxiety, including increased heart rate and shortness of breath.  

The appropriate type and frequency of exposure therapy can be individualized based on the patient’s needs. 
 
Exposure therapy helps patients overcome fear and anxiety in several ways, including:

• Habituation: This is a natural decrease in fearful, anxious reactions to feared stimuli over time.
• Extinction: The therapy weakens learned associations between feared stimuli and negative outcomes.
• Self-efficacy: Therapists work to empower patients to manage feelings of anxiety in response to feared stimuli.
• Emotional processing: This helps patients develop new, more realistic beliefs about feared stimuli; increasing one’s comfort with the universal experience of fear.

We also use Exposure Response Prevention quite often with our child/adolescent patients. We systematically expose them to distressing situations by participating in real or imaginal experiences under controlled conditions. They are then taught techniques to learn how to accept the distress rather than engaging in avoidant or self-destructive behaviors they would typically use to avoid the distress. 
 
Exposure therapy offers patients a guided path to improved emotional wellness—an important step in the journey of recovery from life-disrupting anxiety and fear.

Learn more about Exposure Therapy.

6. Acceptance and Commitment Therapy (ACT)
 
Acceptance and Commitment Therapy (ACT) is an evidence-based therapeutic approach that provides patients at Pathlight the skills they need to work with difficult thoughts, feelings and emotions.

Used extensively in mood disorder and anxiety disorder treatment here at Pathlight, the goal of ACT is to help patients create a rich and meaningful life while also being able to accept the pain that inevitably comes with life.
 
Guided by Pathlight’s compassionate clinical experts, ACT helps people learn how to accept their thoughts, feelings and emotions—even the sad, painful ones. This approach helps our patients understand that humans have very little control over what comes to mind. ACT helps to increase our awareness of the ways that our mind works and teaches practical skills for tolerating the pain that all humans inevitably experience.
 
ACT for anxiety and mood disorders
 
ACT is particularly effective in addressing mood and anxiety disorders because it addresses “experiential avoidance” — one’s tendency to avoid difficult thoughts, feelings and emotions. Experiential avoidance tends to be high in patients struggling with mood and anxiety disorders. ACT teaches individuals to replace experiential avoidance with helpful, values-consistent behaviors to move towards a life worth living.
 
ACT is a simple yet powerful therapy that can bring patients to new places and support lasting recovery from mood and anxiety disorders and trauma-related conditions. 
 
Learn more about ACT here.

Behavioral health therapies for children and teens

Families play a very important role in their loved ones’ treatment and are an integral part of their recovery. As clinicians, we have a role to empower families to help them thrive together.
 
A family-based treatment model is such a necessary component to treatment that we require parents (or surrogate others) to participate in our programs with their children. By engaging and supporting families in treatment, we can address family dynamics, communication patterns, stressors within the family and other experiences. 
 
Our goal is to educate, engage and support the entire family since family members play an important role in helping patients recover. At Pathlight, we hire experienced clinicians with strong expertise in DBT, CBT, and other behavioral modalities as listed above. Focusing on evidence-based principles and measuring outcomes of our approaches to refine our work help identify the most pressing issues and develop innovative, collaborative, comprehensive treatment strategies to help engage our young patients and their families and move them forward in their recovery. 
 
Get more information about our child and adolescent treatment program here.

Note: Treatment offerings may vary by program location.

Susan McClanahan, PhD, CEDS is Chief Clinical Development Officer and Founder of Pathlight Behavioral Health Centers. Dr. Susan F. McClanahan is a licensed clinical psychologist, the Chief Clinical Officer of Eating Recovery Center and the President and Founder of Pathlight Behavioral Health Centers, an accredited clinical center with a commitment to leadership, teaching, training, research and advocacy. Dr. McClanahan is Founder of the Mood and Anxiety Treatment Program at Pathlight as well. Having specialized in the treatment for anorexia and bulimia, as well as treatment for binge eating disorder for over 20 years, Dr. McClanahan is a leading expert in the field. Additionally, she frequently works with clients struggling with depressive and anxiety disorders and has expertise in the psychological aspects of pregnancy and infertility.

Dr. McClanahan is active on the boards of several professional organizations, including iaedp, where she is the past-Secretary for the Heartland Alliance Chapter.  She is a Board Member on the Residential Eating Disorders Consortium and is a founding member of the Medical and Scientific Advisory Board for the National Association of Anorexia Nervosa and Associated Disorders.  Dr. McClanahan is part of the Executive Board of Eating Recovery Center, where she helps to drive decisions related to growth and expansion of clinical services.  Specific to her leadership contribution to iaedp, Dr. McClanahan is an Approved Supervisor, providing ongoing mentorship and supervision to two of her top clinical staff who also hold leadership positions within iaedp: Michelle Gebhardt, President of the Heartland Chapter, and Anne Kubal, Pathlight’s Director of Clinical Training.

Dr. McClanahan holds an Assistant Professor position at both Rush Medical Center and Northwestern University Feinberg School of Medicine.  She coordinates and supervises the training of medical and psychiatry residents and post-doctoral fellows and interns.  Under her direction, Pathlight has developed a large and well-regarded training program and last year became a clinical training site for Northwestern University interns. Additionally, Dr. McClanahan’s expertise is sought out for local and national presentations. Recently, she was invited to speak on panels at the annual Academy for Eating Disorders’ ICED conference and at the Eating Recovery Center Foundation Eating Disorders conference.  In 2014, she was invited to join an elite group of female businesswomen to participate in the Women’s Business Symposia in Chicago.

Dr. McClanahan has designed and implemented a study at Pathlight’s residential treatment centers in Illinois to elucidate factors that predict positive responses to treatment, including therapeutic alliance, motivation, DBT skills acquisition and ERP engagement to outcomes.  The results of this study have important implications for the design and implementation of residential treatment services at Pathlight and elsewhere in the field.  Additionally, Dr. McClanahan recently spearheaded a research collaboration with Dr. Daniel Le Grange examining the inclusion of DBT in certain cases of FBT in order to improve treatment outcomes.

Dr. McClanahan has also proven to be an advocate for mental health treatment and Chicago eating disorder treatment in particular.  In 2010 she raised local awareness of discrepancies in an insurance company’s interpretation of parity laws and was instrumental in making changes on a state level to ensure proper care for Illinois residents.

Learn more about Dr. Susan McClanahan here.