What is DBT Therapy?
Suicide is the second leading cause of death for adolescents in the US,1 with self-harm rates at about 16.9%.2 With the rate of suicide among adolescents on the rise (a report from the CDC found the national average among ten to twenty-four-year-olds increased by 47.1% from 2007-2018), many parents and adolescents find themselves looking for pathways to relief.3 If you are struggling with non-suicidal self-injuring (NSSI) behaviors, suicidal thoughts, or issues managing intense emotions or impulses, then DBT therapy could be a beneficial option.
Dialectical behavioral therapy (DBT) is a widely used and effective tool to teach emotional regulation skills and resilience for people struggling with self-harm, suicidal ideation, borderline personality disorder (BPD), and emotional regulation and impulse control issues.
Dialectical means “concerned with or acting through opposing forces.” In this case, these opposing forces refer to DBT’s core yet antithetical principles of acceptance of self alongside the desire to change.
Evidence-Based Therapy
DBT is a subset of the widely used behavioral psychotherapy, cognitive-behavioral therapy (CBT), discussed below. It is an evidence-based theory that has become the gold standard in treatment for borderline personality disorder, especially in reducing the risk of suicide and the rate of suicidal thoughts and self-harm.
A History of DBT Therapy
This type of treatment was created by Dr. Marsha Linehan, who was searching for a therapeutic tool to relieve the debilitating waves of emotion and affected quality of life for her patients struggling with a borderline personality disorder.
BPD is a personality disorder characterized by extreme, unpredictable, and seemingly uncontrollable mood shifts and poor self-image, which often leads to impulsive behavior that can impact relationships and other aspects of life.
After finding the logic-based principles of CBT did not help her patients, whose emotions were so overwhelming that learning to process thoughts differently wasn’t possible, Dr. Linehan sought a different solution.
Dr. Linehan combined mindfulness techniques to help patients accept themselves and their experience alongside emotional coping tools and CBT techniques to help manage behaviors and impulsivity towards more intentional and desired outcomes.
Biosocial Theory
DBT therapy is based on the premise of the biosocial theory, which structures treatment based on the understanding that psychiatric disorders, emotion dysregulation conditions, disabilities, and mental illness (such as BPD) are biologically-based traits that are stimulated and reinforced by one’s environment.
DBT takes the approach that its patients are born biologically hard-wired towards emotional vulnerability and that people with BPD or other emotion dysregulation conditions were not given the support in childhood to understand and accept their emotions to develop helpful behaviors and manage emotional wellbeing.
Dialectical behavioral therapy seeks to provide that support through four core behavioral components.
Behavioral Components
Part of what makes DBT for adolescents so promising is its unique blend of acceptance (e.g., accepting that you are good enough, just as you are), balanced with the desire for change (e.g., skills to help cultivate different outcomes in our lives).
Core Mindfulness
When people practice mindfulness, they often become more aware of themselves and their thoughts, which helps them become more comfortable with the present moment. With mindfulness, the goal is not to change ourselves, but rather to accept that we are enough just as we are.
For those struggling with emotion dysregulation, mindfulness techniques can reduce the intensity of emotions by having them slow down and reflect – without judgment – on the sensations and thoughts you are feeling. This aspect makes DBT for adolescents particularly appealing, as it can help children learn to remain calm as emotions approach rather than engaging in automatic negative thought patterns and behaviors.
Distress Tolerance
Distress tolerance seeks to help people recognize and accept that they are not their pain or emotions and that while the circumstances of our pain may be beyond our control, we will survive and can act towards our goals regardless. Tools like distraction and self-soothing skills are features of distress tolerance.
Emotion Regulation
The emotion regulation component of DBT therapy seeks to grow patients’ ability to identify emotions as they arise without judging them. This module of dialect behavioral therapy helps people connect the dots between what obstacles make it more difficult for them to control their emotions, so they can avoid those settings when possible in the future. DBT therapy also helps provide a greater understanding of how emotions guide our behavior.
Interpersonal Effectiveness
The fourth core component of dialectical behavioral therapy is interpersonal effectiveness. In this module, people learn how to balance their emotions with the needs of others with skills involving communication, creating clear boundaries, listening skills, learning to work through conflict, and more.
DBT for Adolescents: Stop Exercise
Evidence-Based Therapy
One popular tool that is regularly used in DBT for adolescents and teens is the “STOP” skill.4
Step #1: Stop! Freeze and don’t move a muscle! Even as your emotions try to overpower you, hold on and stay still.
Step #2: Take a step back. You have stopped your emotions dead in their tracks. Great! Now, breathe and take a step back from the situation. Instead of letting your emotions push your impulsivity over the ledge, inch your way back towards safety.
Step #3: Observe. Start paying attention to what’s going on inside you. How do you feel? Do your emotions feel physical in your body? If so, where? What are your thoughts? What is happening around you right now?
Step #4: Proceed Mindfully. Once the height of emotions and risk of impulsive and destructive behavior has passed, now you can consider your thoughts and feelings, what you want, the thoughts and feelings of those around you, and which actions could help or hurt the situation.
Difference Between CBT and DBT
As mentioned earlier, DBT was created as an offshoot of cognitive-behavioral therapy (CBT), another psychotherapy or talk therapy widely used to treat a range of disorders. CBT is often used to treat a wide variety of conditions, including depression, anxiety disorders, alcohol and drug use problems, eating disorders, and severe mental illness.5
You are likely noticing some overlap between DBT and CBT, so what’s different between these two forms of psychotherapy?
CBT Philosophy
At its core, CBT is a system of behavior change based on logic and reason. Cognitive-behavioral therapy’s guiding philosophy is that by becoming aware and changing our thoughts and feelings, we can take more effective action that improves our quality of life.
For this reason, CBT works beautifully for individuals with conditions or struggles based on cognition-based fears or worries. However, what Dr. Linehan found was that CBT did not work for patients whose emotions were too intense to calmly and rationally explore alternative thinking. There needed to be an intermediary step. This step was mindfulness.
DBT Philosophy
DBT focuses less on exploring thoughts and feelings and more on accepting our emotions and developing coping skills for living and taking mindful, beneficial action alongside the existence of strong emotions as they arise.
Benefits of Dialectical Behavioral Therapy
The benefits of DBT for adolescents and teenagers are expansive, considering how a lack of emotional coping skills can ripple out to impact every aspect of our lives.
Explores Harmful Thought Patterns
By embracing mindfulness and tolerance of emotional distress, DBT enables people to sit with emotions that might otherwise encourage impulse behaviors that impact the quality of life and wellbeing.
Facilitates Alternative Thinking
By beginning with mindfulness, DBT creates space for people to consider their thoughts rather than impulsively engaging in behaviors that avoid or channel our emotions in disruptive ways.
Can Use in Group or Individual Settings
DBT programming often includes weekly individual meetings to build motivation and explore personal triggers alongside group therapy with others on similar journeys. On-demand 1:1 phone calls are often also part of DBT programs, so individuals have access to support and help practicing coping skills in moments of intense emotion.
Incorporates Useful Practices into Everyday Life
By identifying and exploring situations that trigger negative emotion, low self-worth, or impulsive action, DBT helps prepare people with coping skills for when they encounter those situations.
DBT Can Help With...
Research has found strong evidence of DBT as an effective therapy for: 6,7
- Borderline personality disorder
- Non-suicidal self-injurious behavior
- Suicidal thoughts, behaviors, and attempts
- Depression
- Eating disorders
- Substance use disorders (particularly alcohol use disorder)
- Disruptive behaviors and impulsivity issues (e.g., gambling, binging, reckless driving)
DBT therapy may also help with other conditions rooted in emotion dysregulation, including:
- Anger issues
- Mood swings
- Anxiety disorders
- Post-traumatic stress disorder8
DBT Therapy Options
There are many options and structures of therapy you can choose from when it comes to DBT for teenagers and adolescents.
Outpatient and Inpatient Care
If you are considering DBT for yourself or a loved one, your first consideration is inpatient or outpatient care. If you feel you may need a more structured environment with increased access to immediate care, inpatient care could be the best option.
However, for those unable to leave home for extended periods, who feel they need less hands-on help or have strong support systems – outpatient care could be more attractive.
Aftercare
When it comes to mood disorders and emotion dysregulation, the goal is management and maintenance towards enhanced wellbeing rather than “curing” symptoms. For this reason, continuing DBT therapy and practicing DBT skills beyond inpatient or outpatient care is essential if you are hoping to see long-term relief from emotions and behaviors that feel out of control.
Resources
- https://www.nimh.nih.gov/health/statistics/suicide
- https://pubmed.ncbi.nlm.nih.gov/30274648/
- https://www.cdc.gov/nchs/data/nvsr/nvsr69/nvsr-69-11-508.pdf
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3105788/
- https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2963469/
- https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2768029
