Every Monday at 9am, 3East leadership holds a unique two-hour session that is part support group, part tutorial. The participants, who join in person or by conference call, are learning the ins and outs of dialectical behavior therapy (DBT). Each is a parent of a child who is—or has been—part of the McLean Hospital DBT program known as 3East.
“What is remarkable is we have parents of adolescents who completed the program months or even two or three years ago continue to call in,” said Blaise Aguirre, MD, medical director of 3East, adding that some live abroad, as far away as Australia and China. Aguirre is known internationally for his work on borderline personality disorder (BPD) in adolescents.
“Allowing parents to continue to connect with us helps with their ongoing learning of DBT,” added Michael R. Hollander, PhD, director of training at 3East. “We role-play issues they are having with their teens and can give them on-the-ground coaching.”
DBT is a cognitive behavioral treatment approach that emphasizes the development of four skills: mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. At 3East, patients and their parents learn the skills through an intensive four- to six-week program.
“We require that everybody on the units, including mental health workers, actually learn the treatment, use the skills, and be part of the consultation team,” said Janna Hobbs, LICSW, clinical director of 3East.
3East, which derives its name from the original location—the third floor of East House on the McLean campus, has grown since its inception in September 2007 to a total of 28 beds at five locations, and includes a coed partial hospital program and outpatient clinic. The residential program works with adolescent girls ages 13-21, treating suicidal behavior, self-injury, impulsivity, depression, anxiety, disordered eating, substance use disorders, and post-traumatic stress disorder. It also was one of the first programs nationally to utilize DBT as the primary model for the treatment of BPD in teens and young people.
“There are over 30 randomized trials substantiating the efficacy of DBT in psychiatric disorders and BPD. It has been shown to be particularly effective in addressing suicidal behaviors and self-injury,” noted Hollander, who is internationally recognized for his work on self-injury. “In the course of the treatment, we are seeing big reductions in suicidality, self-injury, and hospitalizations.”
One of the benefits of the 3East program is its integration with McLean Hospital, a premier psychiatric clinical and research facility and a teaching hospital of Harvard Medical School. For patients who need specialty consultations, McLean offers world-renowned experts in eating disorders, neurology, trauma, medication evaluation and management, educational testing, and attention deficit disorder.
“Each patient receives a specialized treatment plan. If something is not working, our experience and expertise can find a different approach that may be more effective and incorporate that,” noted Aguirre.
“We also truly offer a continuum of care. You can enter at the residential or partial hospital level. We have group residences for high school and college-age kids and the DBT outpatient clinic. We are about to start a similar program for boys as well,” added Hollander.
3East is actively researching the effects of DBT in adolescents, including tracking outcomes and changes in neurobiology through neuro-scanning. The data is used to amend program offerings and provide better outcomes. They are also piloting a program that combines DBT with prolonged exposure (PE) therapy for individuals with post-traumatic stress disorder, under the directorship of Cynthia S. Kaplan, PhD. Studies in adults have been promising, but little is known about its efficacy in young people. 3East is collaborating with the DBT PE treatment developer to bring this important treatment to this age group. They are conducting research to further clinical knowledge in this area.
The program takes referrals from around the country and the world. Some patients come to 3East because they lack motivation or may not be a good fit for existing programs nearby.
“Our dedicated team is experienced in working with tough cases and each clinician made the deliberate choice to work with what can be a challenging population. The hallmark of our programs is technical expertise coupled with compassion,” explained Hobbs. “We simply don’t give up on patients.”
Many patients with a history of multiple hospitalizations and many medications are admitted.
“As a result of our program, these young people are leaving with far fewer medications and fewer side effects,” noted Aguirre. “Through the use of DBT and skillful living, they are able to change how they think and act and live better lives.”