Evaluating the Effectiveness of an Adapted-Dialectical Behavior Therapy (A-DBT)

Method and Design Male juvenile offenders (N = 14) aged 13-18 years were recruited as study's participants. A one group pre-test- post-test quasi experimental design was used in this study. Participants were included based on moderate to high scores on the study measures i.e., FDS, BFRS and CMDQ at pre-test. Only those juveniles who met the study criteria and agreed to participate were included in the intervention phase. While those who were non-convicts and unwilling were excluded from the present study. The participants completed standardized assessments with established psychometric properties at pre-test, post-test, and follow-up.

Mental disorders were defined here as manifestations of any significant psychological or behavioral illness that is associated with either painful or distressing symptoms or an impairment in one or more important areas of functioning. Further characterizing mental diseases by concentrating on the pathophysiology of psychological problems as well as their significance and impact on a person's life, in addition to describing psychological signs and symptoms (Brückner, 2023 ). Which is discussed further in (2.) Common Mental Health Disorders Questionnaire in instrument section as follows:

Instrument

1. The Frustration Discomfort Scale (FDS) This is a 28-item scale comprised of four subscales with 7 items each for (A) achievement frustration, (B) entitlement, (C) emotional intolerance, and (D) discomfort intolerance. There responses were recorded on a 5-point Likert- type scale, using the following scoring i.e., Absent (1), mild (2), moderate (3), strong (4), and extremely strong (5). Previous study of Harrington (2005a) has demonstrated an Alpha reliability coefficient of the total scale (α =0.96 ) including subscales i.e., (A) achievement frustration (α =0.84), (B) entitlement (α = 0.85 ), (C) emotional intolerance (α =0.87), and (D) discomfort intolerance (α =0.88). The present study demonstrated an α = 0.90 as a whole and the subscales has an Alpha reliability coefficient ranging for (A) achievement frustration (α = .80 ), (B) entitlement (α = .90), (C) emotional intolerance (α =.90 ), and (D) discomfort intolerance (α = .88 ) (Khurshid, 2023).
2. Common Mental Disorders Questionnaire (CMDQ) This is a 38-item questionnaire designed to assess common mental health problems (α = .94 to .67 as whole) and comprised of six subscales including somatization (α = 0.67 ), anxiety (α = 0.87) emotional psychiatric disorder (α = 0.78), depression (α = 0.88), illness worry/conviction (Whiteley-7) (α = 0.78), and alcohol abuse/dependence (CAGE) (α = 0.94). Responses on items were rated using a Likert-scale, with the CAGE items scored dichotomously (yes/no) (Christensen, et al., 2005). The final item assesses a perceived general health on a five-point scale from (1)___ to (5)___. The questionnaire is a broad assessment tool used for common mental health symptoms demonstrated valid and reliable psychological and clinical evaluation. However, the present data has demonstrated an Alpha reliability coefficient ranging from α = .91 to .78as a whole, and for its subscales: somatization (α = .91), anxiety (α = .86) emotional psychiatric disorders (α = .81), depression (α = .78), illness worry/conviction (Whiteley-7) (α = .90), and alcohol abuse/dependence (CAGE) (α = .80). Still under processing of this article
3. Brief Family Relationship Scale (BFRS) This is a 16-item scale designed to assess dimensions' family relationship including three basic subscales i.e., cohesion (7 items), expressiveness (3 items), and conflict (6 items). Responses are scaled on a Likert format from 1, Not at all to 4, A lot, indicating healthier family climate if scores are higher. Previous work has demonstrated an alpha reliability coefficient ranging from α = .88) as a whole, and for its subscales i.e., cohesion (α = .83 ), expressiveness (α = .65 ), and conflict (α = .80), (Fok, et al., 2014). however, the present study demonstrated an alpha reliability coefficient ranging from α = __ to __ as a whole, and for its subscales i.e., cohesion (α = .86 ), expressiveness (α = .71), and conflict (α = .83) (). Still under processing of this article Procedure Male juvenile offenders (N= 14) in the group received an A-DBT intervention. The researchers were partially blinded to the intervention prospect for outcome purposes. Researcher follow and take proper guidance from clinical psychologist (supervisor) and time for the sessions (from participants). Each session twicely per week has lost for a duration of around 40 minutes, with proper feedback on homework assignments were provided via checklist activities. A six week A-DBT intervention was implemented after pretest assessment following a posttest assessment and follow-up assessment (after 3-months) for juvenile offenders.

Adapted-Dialectical Behavioral Therapy (A-DBT) Adolescence Manual (Urdu version)

An A-DBT Adolescence Urdu version Manual was used consisted of techniques related to mindfulness, emotion regulation, interpersonal effectiveness and distress tolerance skills. These skills were drawn from the first edition of the Dialectical Behavioral Therapy (DBT) training manual (Linehan, 1993b). The administered module was implemented in the sequence, as follows:

Mindfulness: A core component of A-DBT mindfulness was covered in 2 sessions. Beginning with rapport building, where confidentiality and program objectives were discussed (session 1). Participant's present-day emotions were identified and categorized into mindful activities in session 2. The module was set to enhance learning strategies involving cognitive, emotional, physical sensations, and to avoid activities that includes judgment and criticism.

Emotion Regulation: In session 1, participants learned new and effective ways of gratitude to manage negative emotions with enhanced control over positive feelings. While in session 2, participant's learned to avoiding negative emotions with the help of paying attention to their current emotional states.

Distress Tolerance: In session 1, participants were engaged in coping skills involved tolerate sufferings and accept it a moment-happen to all to control intense impulses.

In session 2, participants were taught how to spot the signs of suicidal thoughts and behaviors in crisis situations resolving with self- soothing and faithfulness.

Interpersonal Effectiveness: In the first session, the importance of interpersonal effectiveness including a) one accepting others opinions, carry out requests, and fulfill their commitments were discussed. However, is essential for stopping toxic or dysfunctional relationships. While fostering a balance between change and acceptance is meaningful in establishing and maintaining equilibrium in relationships. In the second session, effective interpersonal abilities a must learned not innate emotions to form lasting bonds were discussed to start new relationships end problematic ones.

The A-DBT module was administered in the manner of four stages. The juvenile's actions were defined by the severity of problems discussed in each stage, as follows.

In Stage 1, mindful training was provided for behavioral control addressing self-harm, use psychoactive substances, and other self- destructive behaviors.

In Stage 2, emotional regulation skills were used for experiencing emotive desperations.

In Stage 3, fostering self-respect and even happiness were used for addressing misery and intense impulses.

In Stage 4, a must learned not innate emotions techniques were fostered addressing dysfunctional relationships.