Today’s final workshop of the FCP 2016 Spring Series was presented by Shannon Barnett, M.D. and entitled “Mood Disorders and Self-Injury in Adolescents.”

Despite her pleasant and easygoing presentation style, Dr. Barnett’s topic included some very serious material. Although a treatable mental health problem, many adolescents suffer from varying degrees of mood disorder and self-injurious behavior.

Starting with a brief history of mental illness, Dr. Barnett mentioned the various understanding from the Greek concept of Humors and the Temperaments, through Witchcraft, and the “Broken Brain” ideas in the early days of thinking.  Her discussion brought us into recent times with Freudian stages, and Eriksonian phases of development. Dr. Barnett’s review of the past 60 years covered some of the DSM from the first to DSM-V.

Her discussion included treatments from attempts to let the “Humors” out of the brain through boring a hole in the skull, to medications that enhance the neurotransmitters, and genetic manipulation to alleviate or prevent mental illness. This was a nice refresher for most of us, and a good segue into the three goals of her workshop.

Dr. Barnett’s goals for participants in this workshop included:

1. Identify three behaviors of a typical adolescent and three comparable behaviors with clinical significance
2. Describe three psychotherapeutic skills that are particularly useful with adolescents
3. Become familiar with two psychotherapeutic techniques that can be helpful when treating adolescents with self-injurious behaviors

All goals were met, although not in a linear or cookbook manner. Dr. Barnett’s discussion flowed easily between these topics. With a good sense of humor, Dr. Barnett noted that many parents and other adults have trouble distinguishing between abnormal or typical behavior with adolescents. Some adults make light of misbehavior, calling it “teenage behavior”.

Dr. Barnett said that while behavior such as tantrums and calling parent’s names may be “teenage behavior” it is still unacceptable and requires punishment. More serious behaviors such as cutting or other self-injurious behavior (SIB), symptoms of serious depression or anxiety such as sleeping too much, or school avoidance require formal treatment by a mental health professional.

During her presentation, Dr. Barnett talked about psychotherapeutic skills and techniques that are effective with adolescents suffering from mood disorders, including SIB. She pointed out that not all SIB is an attempt at mood self-regulation by the adolescent. SIB may also be a function of attention seeking, sensory stimulation or to escape an undesirable task. She also said that ADHD and OCD are often associated with depression and SIB. It is important that the mental health professional identify the function of the SIB to best determine the most effective treatment technique.

Dr. Barnett presented the “Hopkins Perspective” as a way to think about psychiatric diagnosis and treatment of mood disorders. This view examines four components with a treatment goal for each:

1. The disease (Diagnosis),

2. Dimensional (Person’s characteristics),

3. Behavior (Behaviors to increase or decrease),

4. Life Story (Trauma).

While she touched on several different treatment techniques as part of this perspective, Dr. Barnett focused on Dialectical Behavior Therapy (DBT), Cognitive Behavior Therapy (CBT) and Interpersonal Therapy (IPT). She said that DBT was the most effective with adolescents, in part, because this technique goes beyond the concept of “change” in CBT, to include “acceptance” of the adolescent’s point of view, and training sessions to improve interpersonal and social adaptation skills.

During the conclusion of her workshop, Dr. Barnett presented 5 case studies to amplify and bring her material to life. These were fun. The participants responded with good questions and anecdotes to help enhance the discussion.

In general, a very satisfying workshop! The only negative comment was from several folks in the back of the auditorium stating that Dr. Barnett spoke too softly. This was resolved with the addition of a microphone. Surprisingly, I did not hear the usual complaint about the temperature in the room. During the break, comments were positive and most participants appeared eager to return for the second half.  I’m sure that Dr. Barnett will be invited back in the future.

Any other thoughts?

>> PDF version of Dr. Barnett’s slides: Barnett-5-4-16