In later WBC, the therapist targeted implementing the contingency management plan, completing morning

exposures, and helping Lance use DBT skills to complete the morning routine and exposures. For example, coaching often focused on helping the parents use the Walking the Middle Path skills to help Lance get out of bed and to execute the rewards plan faithfully. selleck kinase inhibitor Mindfulness was also used, particularly with the mother, who was coached to use the “Describe” skill and to avoid judgments when discussing other family members’ behavior. The mother was also coached to use Wise Mind, particularly by staying focused on the present moment, when implementing the reward plan. During WBC in which Lance was particularly tired or distressed, Lance was coached in using self-soothe with music and in opposite action. Video 2 demonstrates a range of skills used during WBC sessions with Lance’s family. Parents reported that having WBC scheduled in the morning helped to keep Lance accountable for getting out of bed and starting his morning routine. Waking at a consistent time to participate in WBC may have helped Lance regulate his sleep. In addition, it appeared that daily WBC increased his parents’ coordination of childcare, and it helped parents follow Dasatinib mouse through with treatment recommendations. Unscheduled phone coaching was often used when Lance had difficulty getting to therapy.

These calls often focused on helping Mom regulate her emotions, encouraging his parents to use Validate and Cheerlead, and coaching his parents to follow through with the contingency management plan. It is notable that a significant portion of treatment focused on implementing contingency management plan, helping

balance dialectical dilemmas in the family, and helping the mother regulate her emotions. At posttreatment and follow-up assessments, Anidulafungin (LY303366) Lance no longer met criteria for any diagnoses or SR. This article describes the development and conceptual underpinnings of a novel DBT-SR program and provided two illustrative case examples. DBT-SR is unique in that it uses DBT strategies to target the significant emotional and behavioral dysregulation observed in youth with SR behavior, even when the primary underlying disorders are internalizing in nature (anxiety, depression). DBT-SR also incorporated web-based conferencing technology to increase dose and ecological validity of its interventions, placing the therapist directly into the trenches in the client’s primary time of need. This pilot trial demonstrated promise in feasibility and acceptability of DBT-SR and raised questions to consider as development continues. Who Is the Client? Parents and other family members are almost always involved in any youth-based treatment, whether to provide psychoeducation, reinforce skills at home, provide direct parent management training, or intervene at the family interaction level.