What treatment approaches are recommended for young adults?

Treatment Approaches for Young Adults

Dialectical Behavior Therapy for Adolescents (DBT-A) shows the most promise for reducing self-harm in young adults and should be the first-line treatment approach for those with serious mental health challenges. 1

Assessment and Initial Approach

When treating young adults with mental health concerns, a comprehensive therapeutic assessment should be conducted that:

• Develops a formulation clarifying what needs to be addressed in treatment
• Identifies concurrent disorders (depression, eating disorders)
• Evaluates contributory factors such as harmful internet/social media use
• Incorporates safety planning to reduce future risk 1

Establishing an empathic therapeutic relationship is crucial during initial assessment and subsequent interventions. Models such as the Collaborative Assessment and Management of Suicidality and Therapeutic Assessment have been found to improve engagement between therapists and young people. 1

Evidence-Based Treatment Options

First-Line Treatments

1. Dialectical Behavior Therapy for Adolescents (DBT-A)

   • Shows the most promise for reducing both absolute repetition of self-harm and frequency of repeated self-harm
   • Note: DBT-A is relatively prolonged and intensive, requiring 3-6 months of treatment 1

2. Cognitive Behavioral Therapy (CBT)

   • May benefit some young adults, though evidence is currently lacking specifically for this age group
   • Should include specific adaptations:
     • Modified language suitable for younger age group
     • Appropriate family involvement
     • Inclusion of self-harm and suicide-related content 1

3. Behavioral Therapies

   • Essential part of substance use disorder treatment
   • Help build motivation to change
   • Teach skills to address cravings or contextual antecedents
   • Identify positive and rewarding activities 1

Pharmacological Approaches

For young adults with mental health conditions requiring medication:

1. SSRIs for Body Dysmorphic Disorder (BDD)

   • Recommended as second-line treatment for those aged 12-18 with moderate to severe BDD-related impairment who haven't responded to CBT
   • Fluoxetine and sertraline are commonly prescribed options 1, 2, 3

2. For substance use disorders:

   • Treatment should incorporate other needs beyond substance use
   • Focus on co-occurring mental health disorders using a harm reduction approach 1

Family and Support System Involvement

Greater family involvement in treatment may reduce non-adherence and improve outcomes 1. The extent of family involvement should be carefully tailored based on:

• The specific context
• The young person's views
• The nature of family dynamics

Family and community support are important features of treatment for substance use disorders, with most evidence-based services involving family members and individuals in the youth's community 1.

Special Considerations for Different Conditions

For Self-Harm and Suicidal Behavior

1. Safety planning interventions may be effective in reducing suicidal behavior post-discharge 1
2. Brief, single-encounter interventions (safety planning, care coordination) may be effective in emergency settings 1
3. Regular follow-up telephone contact may be effective in lower resource settings 1

For Substance Use Disorders

Treatment should:

1. Be tailored to the adolescent's developmental needs
2. Address co-occurring mental health disorders
3. Include STI testing and treatment when appropriate
4. Incorporate behavioral therapies
5. Involve family and community support 1

For Young Adults with Cancer

Care should be provided at medical centers with:

1. Broad access to clinical trials
2. Experience in treating cancer in this population
3. Access to supportive care services specific to young adults
4. Medical subspecialty services appropriate to the cancer diagnosis 1

Barriers to Treatment and How to Address Them

Young adults face significant barriers to seeking mental health services:

• 36% deny having problems
• 37% perceive problems as self-limiting
• 24% perceive help-seeking negatively 4

To address these barriers:

1. Improve mental health literacy among young adults
2. Enhance treatment accessibility
3. Tailor services to engage young people effectively 4

Common Pitfalls and Caveats

• Most evidence-based psychosocial approaches require prolonged duration of treatment and are highly time-intensive, making them ill-suited for lower resource settings 1
• Young adults often have poor rates of engagement with mental health services, requiring special attention to establishing therapeutic alliance
• The transition from pediatric to adult services can be challenging and requires careful planning
• Failure to address co-occurring conditions can limit treatment effectiveness

By implementing these treatment approaches with attention to the unique developmental needs of young adults, clinicians can provide more effective care for this vulnerable population.