November 01, 2019

Adolescent Mood and Anxiety Treatment: Engaging & Supporting Families – Dr. Susan McClanahan

adolescent mood and anxiety treatmentJoin me on December 5, 2019 where I’ll be presenting "Innovative Strategies for Engaging and Supporting Families of Adolescents with Mood and Anxiety Disorders: The use of DBT, Multi-Family DBT, EFFT, RO-DBT and Exposure Therapies in Family Work” at the Complex Healing: Guiding our Child & Adolescent Patients Through a Mood, Anxiety and Eating Disorder Symposium in Deerfield, IL.

Register here to join us in-person or via Livestream.

Adolescent mood and anxiety treatment

Families play a very important role in their loved ones’ treatment and are an integral part of their recovery. As clinicians, we have a role to empower families to help them thrive together.
 
A family-based treatment model is such a necessary component to treatment that we require parents (or surrogate others) to participate in our programs. By engaging and supporting families in treatment, we can address family dynamics, communication patterns, stressors within the family and other experiences. 
 
Here at ERC/Insight we draw on a number of different therapy interventions to engage and support our families during the treatment process. In this way, we are able to help all parties involved focus on skills development, instead of crisis stabilization ‑ supporting their recovery going forward.  

In addition, we have an extremely strong psychotherapy component to our treatment paradigm where we are able to treat mood and anxiety disorders as well as address trauma and traumatic stress head-on, which many higher-level-of-care programs do not do. Some of the primary therapies we use to engage both patients and families in our adolescent mood and anxiety program are listed below:

1. Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy is a comprehensive treatment for severe, persistent emotional and behavioral difficulties, including anxiety and mood disorders. Dialectics is the practice of finding the middle ground, while behavioral treatment involves making thoughtful changes. 
 
DBT has several core aspects, including:

  1. Mindfulness based skills — including both “what” skills (observe, describe and participate) and “how” skills (non-judgmentally, one-mindfully, effectively).
  2. Distress tolerance — and accepting that we cannot change, fix, manipulate, avoid or get rid of our present; learning coping skills.
  3. Emotional regulation — to identify, acknowledge, accept and cope with unfamiliar or intense feelings, i.e. “Do you know what you’re feeling?” Some patients what they’re feeling and why, but they don’t know what to do with it, while others know only a few emotions (anxiety, fear, sadness).
  4. Interpersonal effectiveness — i.e. improving our relationships, letting go of hopeless relationships, and asking for what we want or saying no to requests we cannot or do not want to fulfill. 
2. Multi-Family Dialectical Behavior Therapy (MFDBT)
 
In Multi-Family Dialectical Behavior Therapy, adolescents and parents learn DBT skills in a supportive environment — discovering more effective behaviors to improve the quality of relationships, enhance communication, and further their understanding of interpersonal dynamics.

In our Multi-Family DBT groups at ERC/Insight, in addition to Mindfulness, we cover:
  1. Distress Tolerance
  2. Emotion Regulation
  3. Interpersonal Effectiveness
  4. Walking the Middle Path
At ERC/Insight we see such amazing benefits from our Multi-Family DBT that this group is a required part of our program for both adolescents and their parents. If a parent can’t attend, a support member is expected to. This may include a guardian, grandparent, aunt/uncle, or older sibling over the age of 18. 
 
Based on a recent study, we see preliminary evidence that adding DBT skills to the traditional Family Based Therapy (FBT) paradigm can enhance one's chances for success at FBT treatment and recovery overall.

3. Emotion-Focused Family Therapy (EFFT)
 
Our family therapy model utilized in family sessions is also based on Emotion Focused Family Therapy — teaching advanced caregiver skills that empower parents and guardians to become effective emotional coaches to help their children through the treatment process. 
 
Emotion Focused Family Therapy incorporates both behavior coaching and emotion coaching, including skills training. EFFT doesn’t just focus on the families. The protocol offers a number of skills trainings for clinicians, as well. 
 
One of the most powerful EFFT interventions for professionals is that it teaches clinicians how to look at their own biases, blocks, and fears. These blocks are behaviors (denial, avoidance, enabling, blame), fueled by unprocessed or maladaptive emotions (grief, shame, helplessness), that keep us from effectively behavior coaching and emotion coaching our patients. Indeed, as clinicians teach caregivers the skills and techniques of EFFT, clinicians will ideally be doing their own work to process any emotional blocks that may interfere with their ability to provide EFFT.
  
With EFFT, we can free ourselves and support our families to free themselves from blocks through self-examination, guidance and supervision. At the same time, EFFT teaches us vital skills to help us deal with and manage these obstacles.  
 
4. Radically Open Dialectical Behavior Therapy (RO DBT)

Current research is beginning to show that temperament plays a role in the development of mood and anxiety disorders. In Radically Open Dialectical Behavior Therapy, temperament lies on a spectrum, with overcontrolled vs undercontrolled personality types at each end. Here’s what traits each of these distinct personality types might look like:
 
Overcontrolled (OC)
  • Detail-oriented
  • Threat-averse
  • Inhibited
  • Rigid or perfectionistic
  • Avoidant of risk
Undercontrolled (UC)
  • High sensitivity to reward
  • Less cautious or sensitive to threat
  • Uninhibited
  • Emotionally expressive; dramatic
  • Actively seek new experiences, sensations and more risk-taking
A combination of genetic, environmental and learned factors contributes to whether an individual leans one way or the other.
 
The vast majority of people are what we call “flexibly controlled,” leaning to the overcontrol or undercontrol side — yet having flexibility in their coping and responses. Neither side of the spectrum (over- or under-controlled) is considered better or worse. But, being at an extreme on this spectrum could lead to one’s suffering. 
 
ERC/Insight is one of only a handful of treatment centers utilizing this valuable new therapy. Many of our clinical leaders have trained directly with RO DBT founder Thomas Lynch, PhD to master this innovative approach. Our treatment team brings this compassionate expertise to the treatment setting to help patients work towards richer, more rewarding emotional lives. 
 
Learn more about RO DBT here:  5. Exposure Therapies 

Early diagnosis and treatment are critical to help young people achieve a long-lasting, full recovery from mental health concerns. We use exposure therapy extensively to address anxiety disorders as well as symptoms of post-traumatic stress disorder (PTSD). Some of the methods we use include:
  • In vivo exposure - Patients may be exposed to the stimuli directly 
  • Imaginal exposure – Patients may be asked to imagine the stimuli when it is not possible or safe for a person to directly confront a fear trigger
  • Interoceptive exposure - This is designed to confront the physiological symptoms associated with anxiety, including increased heart rate and shortness of breath.  
The appropriate type and frequency of exposure therapy can be individualized based on the patient’s needs. 
 
Exposure therapy helps patients overcome fear and anxiety in several ways, including:
  • Habituation: This is a natural decrease in fearful, anxious reactions to feared stimuli over time.
  • Extinction: The therapy weakens learned associations between feared stimuli and negative outcomes.
  • Self-efficacy: Therapists work to empower patients to manage feelings of anxiety in response to feared stimuli.
  • Emotional processing: This helps patients develop new, more realistic beliefs about feared stimuli; increasing one’s comfort with the universal experience of fear.
We also use Exposure Response Prevention quite often with our adolescent patients. We systematically expose them to distressing situations by participating in real or imaginal experiences under controlled conditions. Adolescents are then taught techniques to accept the distress rather than engaging in avoidant or self-destructive behaviors they would typically use to avoid the distress. 
 
Exposure therapy offers patients a guided path to improved motional wellness—an important step in the journey of recovery from life-disrupting anxiety and fear.
 
Engaging and supporting families
 
Our goal is to educate, engage and support the entire family since family members play an important role in helping patients recover. At ERC/Insight, we hire experienced clinicians with strong expertise in DBT, CBT, and other behavioral modalities as listed above. Focusing on evidence-based principles and measuring outcomes of our approaches to refine our work help identify the most pressing issues and develop innovative, collaborative, comprehensive treatment strategies to help engage patients and their families and move them forward in their recovery. 
 
Get more information about our adolescent treatment program here.

Susan McClanahan, PhD, CEDS is Chief Clinical Development Officer and Founder of Insight Behavioral Health Centers. Dr. Susan F. McClanahan is a licensed clinical psychologist, the Chief Clinical Officer of Eating Recovery Center and the President and Founder of Insight Behavioral Health Centers, an accredited clinical center with a commitment to leadership, teaching, training, research and advocacy. Dr. McClanahan is Founder of the Mood and Anxiety Treatment Program at ERC/Insight as well. Having specialized in the treatment for anorexia and bulimia, as well as treatment for binge eating disorder for over 20 years, Dr. McClanahan is a leading expert in the field. Additionally, she frequently works with clients struggling with depressive and anxiety disorders and has expertise in the psychological aspects of pregnancy and infertility.

Dr. McClanahan is active on the boards of several professional organizations, including iaedp, where she is the past-Secretary for the Heartland Alliance Chapter.  She is a Board Member on the Residential Eating Disorders Consortium and is a founding member of the Medical and Scientific Advisory Board for the National Association of Anorexia Nervosa and Associated Disorders.  Dr. McClanahan is part of the Executive Board of Eating Recovery Center, where she helps to drive decisions related to growth and expansion of clinical services.  Specific to her leadership contribution to iaedp, Dr. McClanahan is an Approved Supervisor, providing ongoing mentorship and supervision to two of her top clinical staff who also hold leadership positions within iaedp: Michelle Gebhardt, President of the Heartland Chapter, and Anne Kubal, Insight’s Director of Clinical Training.

Dr. McClanahan holds an Assistant Professor position at both Rush Medical Center and Northwestern University Feinberg School of Medicine.  She coordinates and supervises the training of medical and psychiatry residents and post-doctoral fellows and interns.  Under her direction, Insight has developed a large and well-regarded training program and last year became a clinical training site for Northwestern University interns. Additionally, Dr. McClanahan’s expertise is sought out for local and national presentations. Recently, she was invited to speak on panels at the annual Academy for Eating Disorders’ ICED conference and at the Eating Recovery Center Foundation Eating Disorders conference.  In 2014, she was invited to join an elite group of female businesswomen to participate in the Women’s Business Symposia in Chicago.

Dr. McClanahan has designed and implemented a study at Insight’s residential treatment centers in Illinois to elucidate factors that predict positive responses to treatment, including therapeutic alliance, motivation, DBT skills acquisition and ERP engagement to outcomes.  The results of this study have important implications for the design and implementation of residential treatment services at Insight and elsewhere in the field.  Additionally, Dr. McClanahan recently spearheaded a research collaboration with Dr. Daniel Le Grange examining the inclusion of DBT in certain cases of FBT in order to improve treatment outcomes.

Dr. McClanahan has also proven to be an advocate for mental health treatment and Chicago eating disorder treatment in particular.  In 2010 she raised local awareness of discrepancies in an insurance company’s interpretation of parity laws and was instrumental in making changes on a state level to ensure proper care for Illinois residents.


Learn more about Dr. Susan McClanahan and ERC/Insight here.
 
 
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