رفتار درمانی دیالکتیکی برای امتناع از مدرسه: توسعه درمان و اختلاط مربیگری تحت وب

Abstract Youth school refusal is a significant societal problem with broad negative long-term consequences, yet few treatments have been developed for this population. This paper reports on the development and implementation of a novel treatment program, Dialectical Behavior Therapy for School Refusal (DBT-SR), that attempts to address limitations in both existing treatment models and current delivery systems. DBT-SR employs a multimodal approach to directly address the severe emotional and behavioral dysregulation mechanisms maintaining school refusal behavior. It also incorporates a web-based coaching component to provide active, real-time skills coaching to youth and parents at the times, and in the context, of greatest need (at home, during morning hours). A pilot trial and illustrative case examples provide “proof of concept” that DBT-SR is reasonably feasible and acceptable to clients and therapists and that web-based coaching provides incremental, unique benefit. Significant development remains, as participant recruitment proved a challenge in this trial. However, results suggest that DBT-SR is a promising, novel intervention that deserves further development.

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Conclusions and Future Directions This pilot study demonstrated reasonable “proof of concept” that DBT could be applied to SR-specific concerns, that a DBT-SR group could be run with reasonable feasibility and acceptability, and that the WBC component could add incremental benefit to traditional in-person sessions. Considerable development remains as two of the invited families dropped out of treatment within the first two meetings, raising questions about the appeal of DBT-SR, the particular challenge that exists in recruiting youth with SR behavior, or both. Future efforts will want to explore techniques to improve motivation and engagement in cases of severe attendance problems and lack of parent involvement. Further development of WBC is also encouraged to take advantage of ever-changing advances in technology. The reach of DBT-SR might also be reconsidered as it was currently designed for anxiety and mixed forms of SR and not severe conduct problems. Future research might consider incorporating greater use of contingency management, parent management, and anger control techniques to address mild-to-moderate conduct problems. In contrast, SR may result from peer victimization and bullying in schools. In these cases, specific modules might be incorporated to help build protective social networks and navigate school mediation between affected parties. Such extensions of DBT-SR may benefit from greater involvement of teachers and schools (e.g., teaching school staff DBT skills; school staff conducting WBC sessions). As it stands, DBT-SR presents a novel approach to a vexing problem and deserves further development and testing to establish its efficacy and potential reach.