Dialectical Behavior Therapy for Kids

It can be challenging to select the best therapy given the wide range of options available. Some of them concentrate on our behaviors, while others probe into our past and childhood, and yet others challenge us to confront our deepest fears. The primary goal of dialectical behavioral therapy or DBT for kids is to teach children skills that will enable them to deal with difficult or upsetting emotions, which reduces conflict in their relationships and allow them to lead lives they believe are worthwhile.

Here’s everything you need to know about DBT for kids.

What is DBT?

Dialectical behavior therapy (DBT) is one type of talk therapy. It is based on the widely popular cognitive behavioral therapy (CBT). The main difference is that DBT is more focused on people who feel emotions very intensely.

“Dialectical” means understanding how two opposites seem to coexist. For instance, accepting and changing your behavior simultaneously might seem contradictory. But DBT can teach you how to achieve both goals together.

The main aim of DBT is to help kids understand and accept difficult feelings, learn the skills to manage them, and ultimately be able to make positive changes in their lives [*].

A Brief History of DBT

Dr. Marsha Linehan developed dialectical behavior therapy in the 1970s. The goal was to use this type of therapy to treat adults with borderline personality disorder, which is a mental condition that has symptoms ranging from anxiety and depression to suicidal thoughts and self-harming behaviors. Such patients were often seen as “difficult” or impossible to treat. What Dr. Linehan did was redefine the disorder by looking at it as a specific problem with a person’s emotional regulation system. According to her, this could be addressed with a structured intervention.

Individuals with borderline personality disorder have difficulty regulating their moods. This may lead to impulsivity and conflict in relationships. As a result, they often feel misunderstood by those around them. Dr. Linehan first tried treating her patients with CBT without much success. She then shifted to a more acceptance-based approach influenced by her meditation and mindfulness practices; this, too, failed.

Dialectical behavior therapy was created when she combined the change strategies of CBT with the acceptance-based approach of mindfulness.

Why is DBT Important for Kids?

Kids are still learning to deal with their emotions, and with puberty, such feelings can feel overwhelming and out of control. Add that to difficulties in life, and you may have kids who feel misunderstood and have difficulty regulating their moods. DBT is important for kids because it can help those struggling with impulsivity and emotional regulation difficulties to improve their relationships and outlook in life.

How Does DBT Work?

At its very core, DBT is all about balancing opposites. Psychotherapists work with patients to balance two opposite perspectives at the same time: accepting things the way they are and working to change things for the better. This helps promote emotional regulation and allows children undergoing therapy to avoid black-and-white thinking. This is a crucial objective of the therapeutic process as thinking in extremes can distort how the patient sees themselves and can negatively impact their relationships.

The overall goal of DBT is to promote radical self-acceptance and change in the patient. It can be done in one-on-one settings, group therapy, or even a combination of both methods. Sessions usually last up to two hours, but this depends on the patient’s needs and progress.

The 4 Components of DBT

The four components of DBT (Dialectical Behavior Therapy) are:

1. Mindfulness

Mindfulness is a skill that helps an individual focus on the present. Others may call this being able to “live in the moment.” Mindfulness can help children focus on their thoughts, feelings, sensations, and impulses. It also allows kids to tune into what’s happening around them in non-judgmental ways.

Mindfulness strategies involve simple steps such as deep breathing, paying attention, and being present. You can also use mindfulness skills handouts to guide your kids. These strategies can help kids avoid impulsive behaviors and spiraling into negative thought patterns.

2. Emotional Regulation

Emotional regulation teaches kids how to control their emotions rather than letting their emotions control them. DBT skills for kids involve accepting emotions, reality-checking, and learning opposite actions of behaviors associated with specific emotions. For instance, if you feel sad, you might be tempted to hole up in a dark room. The opposite action would mean going out for a walk and getting some fresh air and sunlight.

Ways to practice emotional regulation include cultivating an awareness of feelings and being more intentional about them instead of letting emotions take the reins. You can use this emotional regulation skills handout to learn more about regulating your emotions.

3. Distress Tolerance

Distress tolerance is a component of DBT for children that helps them cope with painful or stressful situations. The aim is to use the right coping mechanisms when confronted with emotional pain.

Some strategies for distress tolerance include grounding techniques, such as taking cold showers or engaging in intense physical activity. Radical acceptance is also a DBT skill that kids can learn to help them tolerate distress in various situations [*]. This helps them move towards a place of acceptance for situations, emotions, and thoughts that can’t be changed. While this does not mean approving of the situation, it can help a person accept it so they can move on.

4. Interpersonal Effectiveness

Interpersonal effectiveness is the fourth component of DBT. The goal in developing this set of skills is to help children develop healthy relationships with themselves and others. There are three goals in interpersonal effectiveness: objective effectiveness (getting what you want), connection effectiveness (improving and maintaining your relationships), and self-respect effectiveness (cultivating self-respect).

Interpersonal effectiveness teaches kids how to set boundaries, speak up for their own needs, and respect themselves. For instance, learning how to say “no” is an essential interpersonal effectiveness skill that kids can use to show other people what they really want while caring for themselves.

Frequently Asked Questions

There is much to learn about DBT. Here are some frequently asked questions about this type of therapy:

What skills does DBT teach to kids?

DBT teaches kids mindfulness, which increases awareness of one’s experience. Kids also learn distress tolerance, particularly increasing one’s ability to tolerate difficult situations while embracing reality to respond to things more skillfully. DBT also teaches kids how to regulate their emotions and build healthier relationships.

What age is DBT appropriate for?

DBT can start as early as age 7 and is a therapy that can be done throughout adolescence and through adulthood [*]. Using DBT worksheets can help make DBT treatment easier for children.

What is DBT used for to treat kids?

Dialectical behavior therapy for children can be helpful for those experiencing depression, anxiety, ADHD, bipolar disorder, eating disorders, and even drug abuse. This type of therapy is often helpful for children who have struggled with other forms of therapy. It is also effective in helping kids and teens who are self-harming or think about dying often.

The Bottom Line

Dialectical behavior therapy is an effective treatment for both adults and children, especially if they are experiencing intense emotions and thinking of self-harm. This approach usually takes time (from six months to a year), but mental health conditions are complex and each individual is unique. How quickly symptoms are alleviated may depend on the child and their circumstances. Any progress is good progress, and DBT activities can definitely help kids get where they need to be.

References:

1. Chapman A. Dialectical Behavior Therapy. September 2006.
2. Görg N, Priebe K, Böhnke J, et al. Trauma-related emotions and radical acceptance in dialectical behavior therapy for posttraumatic stress disorder after childhood sexual abuse. 13 July 2017.
3. Perepletchikova F, Nathanson D, Axelrod S, et al. Randomized Clinical Trial of Dialectical Behavior Therapy for Preadolescent Children With Disruptive Mood Dysregulation Disorder: Feasibility and Outcomes. October 2017.