Program Teaches Adolescents Skills for Life
By Keely Savoie
At 14, Joseph (not his real name) started grappling with debilitating depression and anxiety to such an extent that for five months he was unable to attend school. He struggled with suicidal thoughts and persistent urges to injure himself. Then he enrolled in Columbia’s adolescent
psychiatry program, for teens 14 to 18.
The program, designed by Frederic Kass, MD, professor of psychiatry at CUMC and department vice chair; Lourival Baptista Neto, MD, associate professor of psychiatry; and Allison Baker, MD, instructor in psychiatry at CUMC, addresses the needs of teens struggling with the emotional and social tumult of adolescence, when the emotional skills of childhood may be outmatched by new stresses and demands. “What’s so nice about working with kids at this time in their lives is that interventions can be very dramatic, in spite of the chaos and other challenges of working with adolescents,” says Dr. Baker, the program’s director. “You still have development on your side.”
The program works on an outpatient basis, enabling troubled adolescents to stay active and engaged with their regular activities while imbuing them with the tools they need to cope with emotional and social stressors.
“This is a time of tremendous change, when we often see serious psychiatric problems begin to surface,” says Barbara Stanley, PhD, professor of medical psychology (in psychiatry) at CUMC and director of the suicide intervention center at the New York State Psychiatric Institute. “Putting adolescents in the hospital is a huge disruption in their lives and can even be counterproductive.”
Like Columbia’s adult programs in psychiatry, the adolescent program is rooted in dialectical behavioral therapy (DBT), in which teens learn coping mechanisms to tolerate distressing thoughts without acting on them. The foundation of DBT is “mindful awareness,” a practice derived from Eastern philosophy in which participants learn to recognize and accept their emotions instead of struggling against them. Between mindful awareness sessions, groups of teens rotate through other modules, each focused on developing a specific skill to manage emotions and navigate complex relationships. A teen-specific module, “Walking the Middle Path,” emphasizes empathy and compromise in handling conflict within the family.
“DBT is ideal for adolescents. It is the treatment of choice for the multi-problem adolescent, struggling with mood, anxiety, and behavioral issues such as self-injury, substance use, and general impulsivity,” says Dr. Baker. “But just as important, they really like it.”
Patients also participate in a weekly group session with their parents and three to five other families. “There is the experiential piece of being in a room with other families who are struggling with similar issues,” says Dr. Baker. “It not only shows that other families have similar challenges, but adolescents also enjoy applying their new skills to their peers’ situations where it may be a bit easier to see more clearly.”
DBT has proved remarkably effective, which is reflected in Joseph’s case. “Over time, Joseph learned to manage his urges to self-harm and to communicate with his parents and express his need for more independence,” says Dr. Baptista, who oversaw Joseph’s treatment. “This helped him build the confidence to navigate social situations with greater ease.”
Six months after entering the program, Joseph was no longer depressed and no longer experiencing suicidal thoughts. He was re-integrated into school, spent more time with friends, and made plans for his newly bright future.
“By diagnosing and treating emerging psychiatric problems, our goal is to prevent larger difficulties down the road,” says Dr. Baker. “What’s especially great about working with these kids is that they really get it. I find myself thinking, ‘Gosh, I wish I had learned this stuff as a teenager.’ It’s just good life stuff.”
The Adolescent Program can be reached at 212-326-8441.
This article first appeared in the Fall 2013 issue of Columbia Medicine, the magazine of the Columbia University College of Physicians & Surgeons.