Featured pediatric expert
Micaela Thordarson, PhD
Dr. Thordarson began her journey with CHOC in 2017 when she was brought on board to develop and run the adolescent intensive outpatient program. She and her team are intensively trained in Dialectical Behavior Therapy (DBT) and use their expertise to treat teens experiencing severe forms of depression and anxiety that often manifest with suicidal and self-harming behaviors. To Dr. Thordarson, the very best part of her job is getting to see how families feel so supported by what they learn in DBT and the intensive outpatient program.
Transcription
Melanie Cole, MS (Host): This is Long Live Childhood, a pediatric health and wellness podcast presented by Children’s Health of Orange County. Together, we can keep kids happy and healthy. I’m Melanie Cole. And today we’re discussing Dialectical Behavior Therapy, what it is and how it can help. Joining us is Dr. Micaela Thordarson, she’s the Program Supervisor in Adolescent Intensive Outpatient Program with Children’s Health of Orange County. Dr. Thordarson I’m so glad to have you with us today. Well, this is something that I think not a lot of the listeners have really even heard about. Tell us a little bit about Dialectical Behavior Therapy. What is it? How did it come about?
Micaela Thordarson, PhD (Guest): Yeah, thank you for having me today. Dialectical Behavior Therapy is a really interesting treatment in the sense that it was originally founded for a group of adults who had been previously thought to be unhelpable by treatment. And so the inventor of this therapy, Dr. Marsha Linehan said that can’t possibly be true.
And so she did invent a therapy that was able to help people with really serious issues. Lo and behold, when you apply that treatment to pretty much every other population, whether that’s adults with substance use disorders, kids with depression, even little youngsters, all the way down to age seven or eight, this therapy can be helpful because it treats people by looking at how to help them regulate their emotions better and respond more adaptively to stressful situations.
Host: So then thank you for that definition too. So how does it differ from other kinds of therapy then?
Dr. Thordarson: Yeah, so Dialectical Behavior Therapy or how I’ll call it DBT is different in the sense that it takes some of the more complicated things that we do in our lives, and it breaks them down into really concrete skills. So you are learning how to navigate just anything that might come up in really easy to manage and easy to understand ways.
And so people are able to, it just makes sense. And so people really are able to use these skills and put them into practice and then feel successful, which of course feels amazing to everybody, which motivates them to keep going and keep trying and do more skills.
Host: So then let’s talk about the main areas of concentration for Dialectical Behavior Therapy. Because as I understand it, it involves so many of the things that we look to today that involve in Cognitive Behavioral Therapy techniques, mindfulness, distress tolerance, emotion regulation. Tell us about some of these things and how they’re put together as the areas of concentration.
Dr. Thordarson: Yeah. So you mentioned Cognitive Behavioral Therapy and Dialectical Behavior Therapy basically takes most of the skills that you learn in Cognitive Behavioral Therapy, and then adds a whole bunch of emphasis on the importance of balance and flexibility and then helping people kind of identify what are the things that they need to accept in every given moment and what are the things that they can then really focus their efforts on to change.
And then by breaking down the skills into those separate chapters or modules that you described, so distress tolerance. Those are the sets of skills that we use when our emotions are very intense or when we’re going through stressful situations versus the skills like interpersonal effectiveness might be skills that help us have healthier relationships and improve our self-respect in the context of our interactions with other people.
And then we have other skills, mindfulness is not my favorite skill because I am a multitasker. I want to do a million things at once. Mindfulness is the opposite. It helps me slow down and pay attention to what’s going on right now in this moment. And even though those skills kind of annoy me, they’re the most important skills to be used across pretty much all settings.
Host: I agree with you there. And I am also a multi-tasker. So I get that feeling of frustration. Now tell us a little bit for whom this works well and how does it work?
Dr. Thordarson: Yeah. In the DBT field, we have a saying that DBT skills are really just life skills. I’m sure you can tell I’m a big fan of the Dialectical Behavior Therapy. So in my biased opinion, I think the whole world could benefit from DBT. Now the literature says that DBT is at its core, a treatment for emotion dysregulation. So anytime you’re working with a person or you are a person where your emotions kind of get the best of you in certain situations, then DBT has something to offer for you.
Host: And what makes it so successful, Dr. Thordarson in your opinion?
Dr. Thordarson: I think for me in my both personal life and my professional practice, the thing that makes DBT so successful is that it creates a common language between people so that instead of saying, you need to go calm down or I need to take a break. I can actually kind of say, hey, I need to use this skill. And we have names for each of the skills. And so I think that’s really helpful. And DBT really focuses on teaching you when to get the return on the investment from your skill use. So we’re, we all know that taking a bath, a bubble bath, or watching a movie can sometimes be helpful. And DBT really teaches people here are the really concrete steps you can take and here’s when you need them. And when you need to kind of lean into the more uncomfortable or distressful times, when to take a break from the uncomfortable or distressful times, when to stick with a relationship, when to give up on a relationship. And so I think that it’s that really easy to apply nature that makes it so helpful.
Host: As a parent, if our child is getting this type of therapy and how do we know that that’s really what they’re getting. And while you’re telling parents this, how long or people, anybody who’s getting this, how long does it take to work?
Dr. Thordarson: You can tell you’re really getting DBT if you or your kid are talking about and really learning and applying new skills together. So there are lots of different acronyms that we use for the different skills. So if your kid isn’t coming home and telling you the names of new skills, and putting them into practice, then you’re probably not getting DBT.
If you are seeing that skill use, it’s learning anything. It takes time. So I like to say that the things that we learn in DBT are skills, not tools, because a tool is something that you can pick up, put into use, and it should work the same every single time. My hammer works the same, whether I picked it up today or six months.
Skills are more like muscles. You have to learn them and then you have to practice them and you have to get good at them before they can work. And so it does require investment and commitment to practice. Some people are able to do that right away, and some people are struggling so intensely with their emotions that it takes maybe two months to really start to notice some changes. In our program where we practice therapy, our kids are getting a lot of therapy because it is an intensive program and we can see changes within a week or two. So it really depends. And it should be relatively quickly.
Host: Such an interesting discussion we’re having today. So when is it used Dr. Thordarson? Where is it in the line of available therapies? Because there’s so many now and what can a patient expect an appointment to be like, a session to be like?
Dr. Thordarson: Oh, yes. So one of the problems with DBT is access to really high quality training. Because it is a specialty area, not a lot of people really know how to practice DBT well. And so you end up with a range of clinicians who may say, oh, yes, I know about DBT. And in truth, they may know how to perhaps photocopy some handouts and teach a skill here or there, but they’re not really understanding or very skilled at teaching all of the things that true DBT is intended to impart. That being said, DBT is growing in recognition because of its wild success. And there are in fact, a number of schools in the country that are actually delivering DBT to every student in their schools, these are middle schools and high schools currently, predominantly on the east coast. And at CHOC we have been doing some trainings for local school districts in Orange County, so that some of our school-based clinicians where kids are able to access services more readily, are able to kind of share that DBT with more students or more use in our area.
A DBT appointment might look the same as a CBT appointment, in the sense of, we start by setting an agenda, we do some talking about stressful situations, and then we figure out a skill that is going to need to be applied. And then we assign homework. So DBT is a very active treatment where we’re doing a lot of learning and a lot of practicing. So you can expect to be practicing anything you learned in the session if you’re taking DBT.
Host: And good results, sometimes take hard work. And so, as you’re talking about that homework, I mean, I really do think that’s how you’re seeing these amazing results, as we wrap up, I’d like you to offer parents your best advice about Dialectical Behavior Therapy, how somebody can find it, because as you said, not every practitioner offers this. To whom do they turn for more information?
Dr. Thordarson: You can do an internet search as with anything these days to find a DBT provider in your area. And if you wanted to speak to that clinician for a few minutes before actually scheduling appointment, you could ask them how they learned DBT and what their favorite parts are. And that usually gives parents some good ideas of does this person seem to really understand whatever this treatment is they’re talking about because they can talk about their learning and talk about their favorite pieces.
And the other thing is you can, if you are going through your insurance, you can call your insurance company and tell them you are seeking a provider who does do DBT. And then that insurance company can apply their filters to their list of people and give you a list of clinicians who at the very least say that they are able to, to deliver DBT to you or your child.
And do you have a last final thought about the success of this type of therapy? What you want parents to know about something they may not have heard about before?
Yeah. I think one of the things I love so much is the success. And so what I hear from parents on an almost weekly basis is I wish I had learned this when I was a kid. And why doesn’t everybody get to know this? And so I feel like as a parent, knowing that other parents find such value in DBT, I would be really excited about finding a DBT provider and really motivated to do the hard work, to get connected to somebody, and then keep learning those skills and practicing even when it gets through.
Host: 100% great information, Dr. Thordarson. Thank you so much. And what a great upbeat guest you are. Thank you again for joining us. For more mental health tips and information on Dialectical Behavior Therapy, please visit choc.org/mentalhealth. Thanks so much for listening to Long Live Childhood, a pediatric health and wellness podcast presented by Children’s Health of Orange County. Together we can keep kids happy and healthy. And please always remember to share on your social channels as we’re all learning from the experts at CHOC together. I’m Melanie Cole.
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The mental health team at CHOC curated the following resources on mental health topics common to kids and teens, such as depression, anxiety, suicide prevention and more.
