A treatment that merges behavioral therapy and mindfulness is aiding suicidal teens and adults at WVU Physicians of Charleston Behavioral Medicine and Psychiatry.
“If we can prevent one teenager or adult from killing themselves and help one person rebuild their life, that’s going to have a ripple effect. We hope that by helping one person change their life, it will also affect the lives of everyone that person is connected to now and in the future,” said Patrick Kerr, PhD, a psychologist at the WVU Charleston Division School of Medicine.
Dr. Kerr is a part of a team of practitioners at WVU Physicians of Charleston offering the only outpatient treatment program for dialectical behavior therapy (DBT) in West Virginia. Dialectical behavior therapy combines behavioral medicine and psychiatry with training in acceptance and mindfulness – concepts that originate in the Buddhist tradition but have found wide use among psychiatrists and therapists across many cultures. Dialectical behavior therapy teaches patients a series of emotional awareness skills to help them break their cycles of self-harming behaviors and keep their stress levels down.
“With DBT, we aim to help patients build a life that feels worth living to them. We want them to be able to fully participate in that life, experience joy, and observe and skillfully tolerate the low points and difficulties in life,” Kerr said.
A core skill of DBT is teaching a patient to simply become more aware of how they are feeling. “It sounds simple, but it takes more effort than one might think. We’re often meeting with people who are struggling with a lot of suffering in their lives, so we may start by getting someone to commit to trying mindfulness for just 30 seconds or a minute,” Kerr said.
Mindfulness involves acknowledging how you are feeling, but not reacting emotionally to those feelings – for example, noticing that you are very angry and the physical sensations that go along with that, but letting go of your anger instead of yelling or taking it out on another person or yourself. “Mindfulness starts with taking a non-judgmental stance on what is happening in the present moment – opening up your sensory gates, observing what you are doing physically, what you’re thinking, what you’re feeling emotionally, being able to put words on that, describing what’s happening – sort of as an outside observer. You are present with your experience, but not attached to your experience. You are allowing it to come and go,” Kerr said.
A female patient in her 20s sought out treatment at WVU Physicians of Charleston because she was cutting herself a couple of times a week and had severe suicidal thoughts almost daily. “A complicating factor for this patient was that she also met criteria for posttraumatic stress disorder (PTSD) from a sexual assault a few years earlier. Her self-injury appeared to function as a way to help her manage overwhelming emotions, especially anger, fear, and shame,” Kerr said.In addition to mindfulness, dialectical behavior therapy also teaches patients how to get through a crisis without making it more difficult; emotional regulation or how to keep your emotions in balance, and skills for building and maintaining healthy relationships with other people.
During the first six months of dialectical behavior therapy, she was able to stop self-injuring, and she also began attending college classes. Once the patient was free of self-injury for two months and her suicidal thoughts were reduced, she felt ready to address her PTSD symptoms. “She was able to stop avoiding situations that reminded her of the sexual assault. She experienced significantly fewer nightmares and reported no flashbacks of the assault by the end of treatment,” Kerr said.
Dialectical behavior therapy is not a cure-all for every patient though some patients do benefit incredibly from the joining of behavioral science and mindfulness. “It is an excellent treatment, but it may not be the treatment that is right for everyone, or it may not be right for a person at a particular time. It is a very time intensive therapy,” Kerr said.
Developed in the 1980s by University of Washington psychology professor Marsha M. Linehan, PhD, patients in adult and teenage dialectical behavior therapy programs engage in weekly individual therapy, group therapy, and after-hours skills coaching via phone as the team of practitioners also consults frequently with one another about best practices for patient care. In addition to Kerr, the dialectical behavior therapy consultation team at WVU Physicians of Charleston Behavioral Medicine and Psychiatry includes: Carol Freas, MD, psychiatrist; Jessica L. Luzier, PhD, psychologist and director of the WVU Disordered Eating Center of Charleston; Laura Wilhelm, PhD, psychologist.
Kerr said dialectical behavior therapy programs remain sparse in this region due to an intensive training program and the required component of a consultation team. “The DBT program at Charleston Division helps WVU as a whole stand out as a leader in the state. For people in West Virginia, we are it. We don’t want to be the only resource available in terms of patients getting the accessible care they need, but in a several hundred-mile radius, we are the only program that is offering this evidence-based treatment,” he said.
WVU Charleston Division is also the only program in the state that offers dialectical behavior therapy training for psychiatry residents, psychology interns, and social work interns. “The universities that provide what we offer in terms of training include Harvard, UCLA, and the University of Washington, where DBT originated. The programs that anyone would want to be in league with, WVU already is when it comes to our DBT training,” Kerr said.
However, as the only program in the state, the waitlist for the WVU Charleston Division dialectical behavior therapy adult and teenage programs is unfortunately longer than the team would prefer. The average wait time for the adult program averages six months, and the adolescent program wait time is about two to three months. “Our team is always looking for ways to optimize our workflow, and we continue to strive to schedule referrals as efficiently as possible. We anticipate that our program will continue to grow as demand for our services also grows. With that being said, West Virginia desperately needs more DBT programs to meet the needs of both adults and adolescents with complex psychiatric disorders, self-injury, and a high risk of suicide,” Kerr said.