Using Children’s Theater to Teach Dialectical Behavior Therapy-Based Skills to Adolescents

Dale Rominski, LMSWJenna Nienhuis, MDiv, LMSW

Today’s Objectives

• Introduction to DBT

• Why DBT and Theater?

• Group Overview

• Learning and Practicing Interventions

What is Dialectical Behavior Therapy?

• Three principles of DBT:

1. Behavioral Components: Skills training

2. Validation

3. Dialectical: Acceptance vs. Change

Symptom Targets for DBT

• Difficulty tolerating or expressing affect• High impulsivity• Suicidal behavior or NSSI• Unstable interpersonal relationships• Self-image difficulties• Other life-interfering behaviors

Primary Skill Modules

1. Mindfulness

2. Distress Tolerance

3. Emotion Regulation

4. Interpersonal Effectiveness

Utilizing Theater Techniques

• Repetition and practicing skills

• Learning theory

• Fun – good buy-in and commitment getting from kids

• Making skills more concrete and developmentally tailored

The Group

• Medicaid-eligible middle school students• Group composition• Weekly sessions over 10 weeks: – One 1-hr session for teaching skills and theater

techniques– One ½-hour session for individual application and

homework assignment/review

Session Topics

1• Group Introduction

2• Learning to Pay Attention with Mindfulness

3• Recognizing Emotions

4• Our Emotions and Others

5• States of Mind: Working with Emotion Mind

6• States of Mind: Finding Wise Mind

7• Emotion Regulation with Opposite Action

8• Distress Tolerance for Getting through Difficult Emotions

9• Interpersonal Effectiveness with DEAR MAN

10

• Conclusion, Review and Wrap Up

Core Mindfulness Skills

• Goal: Learning to pay attention to the present moment and to participate in life with awareness

• What: observe, describe, participate

• How: non-judgmentally, one-mindfully, effectively

Fuzzy Slippers and Weight Vests

What am I Feeling?

• Affective Education – going beyond sad, mad, and glad

• Recognizing the different components of emotion and intervention points

• Building understanding of how current coping patterns may be maladaptive and identifying more effective behaviors

Model for Describing Emotions

Machines

The basic rule is that 1 person starts with a repetitive sound & movement and others join in

1 at a time.

If the machine doesn’t work we can explore what is going on socially that doesn’t make for a

successful machine. We’ve definitely had ‘No one is listening to each other’ machines.

States of Mind

Reasonable Mind: Finding the Facts

Neutral Scenes

A. You said you would.

B. No, I said I might.

B. No, you said you would.

B. No, I said I might.

C. Now what am I supposed to do?

B. You can do anything you want.

Neutral Scenes and Script Work

A. What’s this?

B. Nothing!

B. It doesn’t look like ‘nothing.’ Well?

B. I said it’s nothing!

C. Okay! Let’s take it outside.

B. Geez…

Recognition

QUESTIONS?

Group References• Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence

and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593-602.

• Roberts, R. E., Roberts, C. R., & Xing, Y. (2007). Rates of DSM-IV psychiatric disorders among adolescents in a large metropolitan area. Journal of Psychiatric Research, 41(11), 959-967.

• Howell, E. M. (2004). Access to children's mental health services under Medicaid and SCHIP. Retrieved April 2014 from http://www.urban.org/url.cfm?renderforprint=1&ID=311053

• Knopf, D. K., Park, J., & Mulye, T. P. (2008). The mental health of adolescents: A national profile, 2008. Retrieved April 2014 from http://nahic.ucsf.edu/downloads/MentalHealthBrief.pdf

• Kataoka, S. H., Zhang, L., & Wells, K. B. (2002). Unmet need for mental health care among US children: Variation by ethnicity and insurance status. American Journal of Psychiatry, 159(9), 1548-1555.

• Merikangas, K. R., He, J. P., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L. & Swendsen, J. (2010). Lifetime prevalence of mental disorders in US adolescents: results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 49(10), 980-989.

Group References Continued• Groves, S., Backer, H. S., van den Bosch, W., & Miller, A. (2012). Dialectical behaviour therapy with

adolescents. Child and Adolescent Mental Health, 17(2), 65-75.

• Hollenbaug, Karen Michelle Hunnicutt. (2013). DBT: An Introduction and application with adolescents. American Counseling Association, March 1, 2013.

• Joronen, K., Rankin, S. H., & Åstedt Kurki, P. (2008). School based drama interventions in health promotion for ‐ ‐children and adolescents: systematic review. Journal of advanced nursing, 63(2), 116-131.

• Greenberg, Hallie. (2010). Social and Academic Benefits of After-School Theatre Programming for Low-Income Adolescents. Applied Theatre, 11( ), 1-18.

• Catterall, James S., Dumais, S. A., & Hampden-Thompson, G. (March 2012). The Arts and Achievement in At-Risk Youth: Findings from Four Longitudinal Studies. National Endowment for the Arts, Research Report #55

• Mangrulkar, L., Whitman, C. V., & Posner, M. (2001). Life skills approach to child and adolescent healthy human development. Pan American Health Organization, Division of Health Promotion and Protection, Family Health and Population Program, Adolescent Health Unit.att, T. C., Cullen, F. T., Sellers, C. S., Thomas Winfree Jr, L., Madensen, T. D., Daigle, L. E., & Gau, J. M. (2010). The empirical status of social learning theory: A meta‐analysis. Justice Quarterly, 27(6), 765-802.