Cognitive-Behavioral and Dialectical Behavior Therapy in High-Intensity Settings

Youth mental health is a major public health concern. Adolescents experiencing mental health crises are increasingly presenting to high-intensity settings such as inpatient and partial hospitalization programs. These services offer a multimodal approach involving medication management, cognitive-behavioral therapy (CBT), and dialectical behavior therapy (DBT).¹ Treating these distressed youth in intense settings is challenging due to their high acuity, limited lengths of stay, and frequent lack of resources. However, CBT/DBT are typically evaluated in outpatient settings, leaving clinicians in high-intensity programs to adapt models with limited guidance.² While traditional CBT/DBT interventions are not new or unfamiliar, and various literature reviews report their effectiveness, few reports offer specific guidance and practical tips for implementing these procedures.^1-6 This Clinical Perspectives article highlights the necessary adaptations of traditional CBT/DBT for these intense settings in which high acuity, shorter stays, limited resource allocation, and a lack of staff involvement/training are limiting factors.