Acceptance and Commitment Therapy Group
Once per week, residents will engage in a 60-minute ACT group. The ACT curriculum is graciously shared with our program from Yale New-Haven Hospital’s Adolescent Intensive Outpatient Program. ACT is a third wave behavioral treatment with the goal of creating psychological flexibility in responses to cognitions and emotions so that people may live a more values consistent life. While this group is didactic in nature, it is taught with experiential exercises aimed to help residents absorb the fundamental principles of ACT by practicing acceptance as an alternative to avoidance, diffusion from difficult thoughts, target an overarching theme of their self-view, and engage in identity exploration and discovery consistent with their values. Research supports the use of ACT with adolescents (i.e., Halliburton & Cooper, 2015; Miller & Scherbarth, 2006).
#Adulting (Chores) Group
Residents will engage in one, 90-minute experiential group on Sunday in which they learn how to do various household chores. In this group they will learn the specific cleaning methods for various parts of their dwelling (i.e., kitchen, bathroom) as well as maintenance and sanitation principles. Research maintains that engagement in chores is predictor of positive mental health outcomes (i.e., Campos et al., 2019; Rende, 2015).
Residents will engage in a 60-minute art therapy group once a week. Art therapy has many positive therapeutic benefits as it allows clients a creative and tangible way to express and enrich their experiences. Research supports the use of art therapy with adolescents (i.e., Lyshak-Selzer et al., 2007).
Cognitive Behavior Therapy Group
Three times a week, residents engage in 60-minute CBT group. The CBT curriculum is the Unified Protocol for Adolescents and is graciously shared with our program from Children’s Hospital Colorado Adolescent Partial Hospitalization Program. The Unified Protocol is a transdiagnostic approach with research supporting its use for the treatment of emotional disorders, such as anxiety, depression, PTSD, somatic symptoms disorders, OCD and many others (i.e., Ehrenreich-May et al., 2017). While this group is didactic in nature, it is taught with experiential exercises aimed to help residents counteract emotional avoidance, identify and modify thinking traps, and understand and implement the principles of exposure.
Community group is an optional group residents may attend once per week for 30 minutes. In this group, residents have the opportunity to provide agenda items related to feedback regarding the program, staff supports and general concerns. In line with previous research and other DBT programs housed in milieu-based settings (i.e., Swenson, Witterholt, and Bohus, 2007), residents will be guided to solve such concerns with DBT skills.
Dialectical Behavior Therapy Skills Group
Three times per week, residents engage in a 90-minute DBT skills group. This group is structured like a class, in that it is didactic in nature, even though skill leaders do often teach in an experiential and engaging way. Owing to an average 30-day length of stay in our program, the curriculum for the DBT skills group does not include the full 24-week DBT skills curriculum that is typically delivered in outpatient therapy. Rather, there are 12 lessons taught that cover the Distress Tolerance and Emotion Regulation modules. The other modules of Mindfulness and Interpersonal Effectiveness are covered in other elements of the programming. Each resident gets focused time to review homework followed by presentation of new material each week. The purpose of the skills group is to learn and intentionally practice coping skills. The skills are then used to help residents address problems in other parts of the program. Research supports the use of DBT for Adolescents (i.e., McCauley et al., 2018; Miller, Rathus and Linehan, 2007).
Executive Functioning Coaching
Executive function is the ability to self-regulate thoughts and organize behavior. Challenges to executive functioning may appear in daily life as difficulty beginning tasks, initiating a task but not seeing it through, inability to follow a full set of directions, struggling to express ideas, etc. Five days a week, residents will participate in a 30-minute Executive Functioning group before completing schoolwork and/or therapy assignments. The group structure will include a brief lesson on an executive function strategy followed by skills practice to support residents as they transition to doing their work for the day. Since consistency is critical to executive function, the primary objective of the curriculum is for residents to learn success-promoting strategies they can apply outside of residential treatment. Research supports the use of executive function coaching with Adolescents (i.e., Staiano, Abraham, and Calvert, 2012).
Research strongly supports the inclusion of families in adolescent treatment (Frey et al., 2022; Wittenborn et al., 2022), and as a result, residents and their caregivers attend family therapy sessions twice weekly for 90 minutes each session. Our family therapy approach marries key components of Dialectical Behavior Therapy (DBT) with families (Fruzzetti et al., 2007) and attachment-based therapies for adolescents (Foroughe, 2018; Kobak & Kerig, 2015). A recent article (Frey et al., 2022) suggests combining the best elements of these two evidence-based treatment approaches to create a holistic treatment model, and our family therapists, who have training in DBT and attachment-based therapies, unite these approaches as they help families address their negative interaction patterns, increase their awareness and communication of accurate expressions of primary emotions and validation, participate in new emotional experiences, and grow their developmentally-appropriate adolescent-parent attachments. Depending on the needs of the family, residents may or may not be included within family therapy sessions, and family therapy sessions may be facilitated virtually or in-person.
Healthy Lifestyles Multi-Family Group
Healthy Lifestyles Multi-Family Group was designed to provide families with information on evidence-based practices that are associated with enhanced family functioning and cohesion and to offer families the opportunity to experientially rehearse implementing these practices. Broadly, group lessons contain information on effective communication, conflict resolution, and problem-solving and family strengths, responsibilities, routines, and rituals. In this group, patients and their caregivers/families meet once weekly for 1 hour, and the group structure mimics a classroom format. Each group includes a brief lesson followed by an experiential activity to support group members’ generalization of the practices outlined in the lesson. The lessons and practices that comprise the Healthy Lifestyles Multi-Family Group curriculum were developed using and borrow from previous research on positive family outcomes (i.e., DeFrain, 1999; Gottman, 1994; Kumpfer & Brown, 2011; Stinnett & DeFrain, 1985).
Residents will engage in horticulture therapy once a week for an hour. Horticulture therapy is the engagement in gardening and plant-based activities for therapeutic purposes. To this end, residents will engage in gardening activities as part of weekly programming. Research supports positive health outcomes for adolescents who engage in horticulture therapy (i.e., Park et al., 2016).
Interpersonal Effectiveness Group
Residents will engage in an interpersonal effectiveness group once a week for 60-minutes. In this group, residents will participate in four lessons, two of which are from the DBT skills curriculum, and the other two are derived from the Unified Protocol and graciously shared with our program Children’s Hospital Colorado Adolescent Partial Hospitalization Program. This group has a didactic component and is heavily experiential with communication practices each group. Residents will learn how to prioritize their objectives, self-respect and relationship goals, and effective communication strategies to achieve them. Research supports increasing communication skills for adolescents as way to yield positive mental health outcomes (i.e., Kim & White, 2018).
Individual Skills Coaching
Directly after individual therapy, residents will engage in individual skills coaching twice-weekly for 60-minutes. During individual skills coaching, residents work on requisite behavioral rehearsal of skills identified during individual therapy.
Residents will participate in individual therapy twice weekly for 60 minutes. Compass Behavioral Health is proud to hold the standard of all licensed therapists achieving certification in Dialectical Behavior Therapy (DBT) through the DBT Linehan Board of Certification. Compass also has clinicians certified in Cognitive Behavioral Therapy (CBT) through the Academy of Cognitive and Behavioral Therapies. All therapists at Compass Behavioral Health are highly trained and skilled in several evidence-based therapies, including Acceptance and Commitment Therapy, CBT, DBT, Emotion Focused Therapy, Structural Family Therapy, and Behavior Therapy. Additionally, therapists are highly trained and skilled in the following evidence-based CBT modalities, protocols, and transdiagnostic approaches: Motivational Interviewing, Behavior Activation, CBT for Eating Disorders, CBT for Insomnia, Exposure and Response Prevention, Mastery of Anxiety and Panic for Adolescents, Prolonged Exposure, DBT Prolonged Exposure, Relaxation Training, and Mindful Self-Compassion.
Residents will engage in 30-minutes of “love mapping” activities with their caregivers on Saturday. Love mapping is a technique coined by University of Washington professor emeritus, Dr. John Gottman and part of his principles on building sound, effective relationships. Love maps are questions that generate discussion and allow families to increase their understanding of each other. Research supports the use of love mapping in building relationships (i.e., Gottman & Gottman, 2017).
Mindful Cooking & Culinary Lab
Residents will be provided with 90-minutes of culinary instruction Monday through Friday. On Saturdays, two families will rotate as they receive a tailored culinary instruction. A primary part of our treatment is Nutritional Psychiatry which is taught at the beginning of culinary lab when teaching didactics on the ingredients and how they stabilize mood and improve focus. Culinary Lab then focuses on building mastery on the skill of cooking the adult living skill of cooking and on how to cook meals that are nutritional, delicious, and bode well for healthy neurotransmission function. Research supports the use of culinary instruction for improving mental health outcomes in adolescents (i.e., Marshall et al., 2016).
Multi-Family Dialectical Behavior Therapy Skills Group
One time per week, residents and their families engage in a 2.5-hour DBT Multifamily Skills Group. The first 30 minutes is pre group and is dedicated time for residents and their families to do homework and socialize and bond with one another. The remaining 2 hours are structured like a class, in that is it didactic in nature, even though skill leaders do often teach in an experiential and engaging way. Each member will get focused time to review homework followed by a presentation of new material each week. The curriculum consists of teaching the DBT Middle Path skills modules which includes behavioral modification, dialectics, and validation. Dialectics helps families merge various perspectives and become less extreme in their thinking as they generate balance and work toward syntheses. A primary dialectical dilemma is balancing the need to change with the need to accept. This is accomplished as families learn behavioral modification skills and validation. The curriculum also contains a lesson on “dirty fighting” that occurs in families, and strategies to reduce these behaviors and increase more effective communication. Research supports to use of DBT Multifamily Skills Group (i.e., McCauley et al., 2018; Miller, Rathus and Linehan, 2007) and research also supports the use of teaching “dirty fighting” in reducing family conflict (i.e., Edmund, 2010).
Mindfulness & Mindful Self-Compassion
Residents begin each day with 30 minutes of mindfulness and mindful self-compassion. This group consists of experiential exercises followed by a brief didactic on the particular practice. Following the practice, residents will set a goal for the day and at the end of the day, they review their goal in another mindfulness group. The mindfulness curriculum is derived from the mindfulness module in DBT skills and the mindful self-compassion curriculum is derived from The Self-Compassion Workbook for Teens (Bluth, 2017). Research supports the use of Mindfulness with adolescents (i.e., Black, 2015; Burke, 2010).
Parent Effectiveness Training
Once a week, caregivers of residents will attend a 90-minute parent effectiveness group once a week. The curriculum for this group is based two sources: 1. DBT-based parent intervention developed in a research trial at Stanford University (Berk et al., 2021), and 2. A “Parenting Teens with Strong Emotions” group at Seattle Children’s Hospital graciously shared with us by Dr. Kyrill Gurtovenko. In this group, parents will receive training in validation, increasing positive time with their teens, crisis management, and contingency management). This group has both strong didactic and experiential components. During the week, caregivers are asked to watch each lesson that is prerecorded during the week prior to the group. During the group, caregivers will have focused time to both practice the steps of each lesson with behavioral rehearsal as well as discuss barriers they encounter to implementing the skill. Research supports the use of Parent Effectiveness Training to yield positive outcomes (i.e., Berk et al., 2021).
Physical Fitness & Yoga
Residents will engage in 60-minutes of physical fitness Monday through Friday and will participate in a 60-minute yoga class on Sunday. The RTC is equip with a state-of-the-art cross fit gym and spacious lawn for these activities. Residents will have access to a physical fitness trainer and trauma informed yoga instructor. Research shows that engagement in physical activity (e.g., exercise, yoga) yields positive metal health outcomes (i.e., Biddle & Asare, 2011; Khalsa et al., 2012).
Sleep Hygiene Group
Residents will participate nightly in a sleep hygiene group that is has a brief didactic component and is chiefly experiential in nature. The curriculum for this group is derived from Children’s Hospital Colorado Adolescent Partial Hospitalization Program CBT group and the CBT for Insomnia protocol. Residents will learn the fundamental components of sleep hygiene and will engage in behavioral rehearsal of sleep hygiene interventions such as progressive muscle relaxation and self-soothing, and cognitive based strategies for rumination. Research supports the use of sleep hygiene practices yielding positive outcomes for adolescents (i.e., Malone, 2011; Peach et al., 2016).