RecruitingNot ApplicableNCT06566235

Cultural Adaptation and Implementation of DBT for Adolescents With Emotional Disorders

Cultural Adaptation and Implementation of Dialectical Behavior Therapy Skills Training Group for Adolescents With Emotional Disorders: a Feasibility Study and a Randomized Controlled Trial

Sponsor

Mackay Memorial Hospital

Enrollment

160 participants

Start Date

Nov 5, 2024

Study Type

INTERVENTIONAL

Conditions

Emotional Disorders

Summary

The goal of this study is to learn if Dialectical behavior therapy Skills Training for Adolescents (DBT-A-ST) works on emotional disorders in adolescents. The main questions it aims to answer are: Does DBT-A-ST produce faster improvements (i.e., steeper slopes), compared to ASG, on primary and secondary outcome measures during treatment and 3-month follow-up? Does DBT-A-ST produce greater improvements, compared to ASG, on primary and secondary outcome measures? Participants will: Randomly assigned to (a) a culturally adapted DBT-A-ST or (b) activities-based support group (ASG). Received five assessments before the start of the trial (T1), after 4, 8 sessions (T2, T3), at post-intervention (T4), and 3-month follow-up (T5).

Eligibility

Min Age: 12 YearsMax Age: 17 Years

Inclusion Criteria6

-17 years of age,
informed consent is provided by the youth and one of the parents,
Mandarin Chinese language proficiency sufficient to complete study questionnaire,
a total score of either the PHQ-9≥ 10 or the GAD-7 ≥ 10,
a current diagnosis of depressive or anxiety disorder from a K-SADS-E interview, including depression (F32-33); persistent mood disorder (F34), phobic anxiety disorder (F40), other anxiety disorder (F41), and adjustment disorders (F43.2).
Individuals with comorbid diagnoses of several emotional disorders are also enrolled. Comorbidities will not be stratified because this will significantly increase the complexity of the design (i.e., some patients may have multiple comorbid diagnoses).

Exclusion Criteria8

diagnoses of intellectual disability, schizophrenia, pervasive developmental disorder, anorexia nervosa and substance use disorder in the past 3 months,
active suicidal ideation with a plan or a history of frequent or recent suicide risk in the past 3 months,
ADHD without elevations in the areas of anxiety, depression, or stress problems on the CBCL,
recent (past 4 weeks) change in psychiatric medication or unwillingness to maintain a stable dosage of medication during study participation,
had received five or more sessions of CBT in the past or unwilling to stop concurrent psychotherapy,
any mental or physical condition requiring hospital admission,
severe medical condition.
As we also aim for a naturalistic setting, we do not exclude patients who undergo medication changes during the trial if the treating clinician judges this to be necessary or clinically important.

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Interventions

BEHAVIORALCulturally adapted DBT-A-ST group

The culturally adapted DBT-A-ST consists of 15 weekly group sessions, each lasting 120 minutes, including a 10-minute break. It maintains the core elements of standard DBT-A, including its philosophical foundation and treatment strategies. Therapists focus on teaching DBT skills through various methods such as modeling, structured behavioral rehearsals, and feedback. Each session begins with a 40-minute group mindfulness exercise and homework review, followed by 60 minutes dedicated to skill-specific didactics and experiential activities, concluding with a 10-minute homework assignment. Two group leaders facilitate the sessions, and participants track their skill usage daily with diary cards, which are reviewed weekly.

BEHAVIORALActivities-based support group (ASG)

ASG, based on principles of client-centered supportive therapy, is widely used by occupational therapists in mental health settings. ASG therapists aim to foster a sense of belongingness, maintain unconditional positive regard, provide empathy, psychoeducational and a treatment structure. Two group leaders held the sessions, teaching DBT skills and using cognitive behavioral strategies are prohibited. Each session starts with a review of their experiences over the last week (30 min), a support-building activity (30 min), and ends with an open group discussion about topics participants choose each week (50 min). For homework, participants will be asked to think about issues discussed and to track daily social support on diary cards.