DBT for Teens: How it Works, Skills, and FAQs

Dealing with the challenges of adolescence can be complicated, and teens need the right tools to manage this pivotal period in their lives. Dialectical Behavior Therapy (DBT) is one such tool. DBT can equip teenagers with skills that can help them with life’s ups and downs. Here, we’ll explore how DBT works, the skills that it teaches teens, and some commonly asked questions. This will help you get a better idea of how DBT can be beneficial for your teen and empower them to take charge of their emotional well-being.

What is DBT?

Dialectical behavior therapy (DBT) is a type of talk therapy (psychotherapy) that is based on cognitive behavioral therapy (CBT). The main difference is that DBT has been adapted for people who experience emotions very intensely.

The word “dialectical” means combining opposite ideas. This makes DBT unique as it is one of the first therapies to balance both acceptance and change. In this way, DBT helps people accept the reality of their behaviors while helping them learn to change their lives for the better. This balance provides the support and motivation for individuals to learn the skills they lack to make the changes they need.

Dr. Marsha Linehan, an American psychologist, developed DBT in the late 1970s.

How Does DBT for Teens (DBT-A) Work?

While DBT was originally developed for adults with suicidal tendencies, research has shown that the treatment is effective for individuals with difficulties in emotional regulation. Since its first use, the treatment has become more flexible and adaptable and can be used for various conditions across different age groups, including adolescence [*].

There is a version of DBT that is geared specifically toward teens called DBT-A (dialectical behavior therapy for adolescents). It has been shown to be effective in treating many disorders, including teen depression, substance use disorder, eating disorders, and post-traumatic stress disorder (PTSD). This is because many adolescents struggle with symptoms that parallel those found with borderline personality disorder, including nonsuicidal self-injury, dichotomous thinking, impulsive behaviors, and unstable interpersonal relationships.

DBT is most useful in helping teens cope with and regulate their emotions [*], while its main goal is to teach adolescents the skills needed to cope with and change unhealthy behaviors.

Adolescent DBT typically has two main components. The first is individual therapy sessions, which emphasize problem-solving behavior for issues or maladaptive behaviors. They also focus on decreasing and dealing with post-traumatic stress responses to any previous trauma. The second main component is group therapy, which helps promote self-confidence and self-esteem.

DBT for adolescents also differs from DBT for adults in several key ways. The most significant difference is the inclusion of caregivers in DBT-A. Caregivers will often be included in skills training or have their own separate sessions. They may also be involved in individual therapy or additional family sessions if needed. Therapists will coach parents or guardians in addition to providing therapy for the adolescent. This is critical for getting the most improvement.

What are the Benefits of DBT for Teens?

DBT for teenagers has many benefits, including the following:

• Learn how to accept and tolerate life circumstances, emotions, and oneself
• Develop skills that can help make positive changes in one’s behavior
• Increased self-awareness
• Improve ability to change unhelpful thoughts and beliefs
• Better academic performance
• Learn how to replace destructive behavior patterns with healthier and more effective ones
• Communicate effectively with others
• Recognize one’s own strengths and attributes and develop and use them
• Develop problem-solving skills
• Reduce self-harming behaviors
• Long-term well-being

Common Issues Addressed by DBT for Teens

Some issues are commonly addressed by or treated with DBT for teens, including the following:

• Emotion regulation
• Borderline personality disorder
• Identity issues
• Distress tolerance
• Family involvement
• Interpersonal effectiveness
• ADHD
• Mindfulness
• Post-traumatic stress disorder
• Depression
• Alcohol addiction
• Suicidal tendencies
• Bipolar disorder
• Anger issues
• Impulsivity
• Eating disorders

DBT Skills for Teens

There are several skills that teens will learn, given the DBT approach.

Mindfulness Skills

Mindfulness is a practice that involves being aware, without judgment, of what’s happening in the present moment, both within and outside oneself. It has become an integral part of mental health treatment. Studies have found that mindfulness can lead to positive psychological effects, including “increased subjective well-being, reduced psychological symptoms and emotional reactivity, and improved behavioral regulation [*].

Mindfulness DBT skills for teens can help them become more aware of and more accepting of their emotions. The goal is not to clear the mind or stop thinking but, rather, to become aware of one’s feelings instead of getting lost in them. It is important that teens lean to observe and acknowledge their emotions without judgment, which is part of DBT What Skills. For instance, they may feel anxious and state to themselves, “I notice that I am feeling anxious,” without trying to judge or change the feeling.

Distress Tolerance

It is common for teens to think their problems are simply out of their control. Adolescents can also easily react and become emotional because of these problems. DBT for young adults can help teens learn to be less reactive and intensely emotional when they experience difficult emotions.

Radical acceptance is a distress tolerance skill in DBT that describes healthier ways of thinking during stressful situations. Simply put, radical acceptance involves accepting emotions, thoughts, and circumstances that are unchangeable and outside of one’s control. Instead of focusing on how badly they want something to be different, teens can learn to recognize and accept the problem or situation as it is. This leads to less anxiety, anger, and sadness when dealing with the said situation.

Emotional Regulation

When teens experience different emotions, various behaviors usually come with it. For instance, an angry adolescent might fight or argue, while someone who is sad might withdraw from friends and family. Some of these behaviors are automatic, while others might be conscious choices.

Emotional regulation in DBT teaches teens how to choose a different action in such situations. For instance, if a teen typically yells when angry, they can try talking quietly and calmly instead. If they tend to withdraw from friends and family during bouts of sadness, they can get in touch with or visit a friend. DBT also encourages teens to focus on the positive aspects of an experience instead of just its negative attributes. To manage emotionally distressing situations, teens can also use the DBT IMPROVE skill.

Interpersonal Effectiveness

Interpersonal effectiveness is the last of the four DBT modules, and it is all about how teens understand their behavior and how it affects their relationships in order to make positive changes. Balancing one’s own needs with those of others can be challenging at any age, so learning skills on objective, relationship, and self-respect effectiveness can go a long way.

Objective effectiveness is about clearly expressing your own needs or desires in a healthy way, and this can be improved upon by using the DBT DEAR MAN skill. Relationship effectiveness focuses on fostering positive interactions with others. Teens can use the DBT GIVE skill to get better at this. Lastly, self-respect effectiveness ensures that adolescents do not betray their own values and beliefs for approval or to get what they want, which can be supplemented by the DBT FAST skill.

Walking The Middle Path

Dr. Marsha Linehan, together with Alec Miller and Jill Rathus, also included the addition of a fifth module in DBT called “Walking the Middle Path.” These are a collection of emphasized techniques that include dialectics (when two seemingly conflicting things are true at the same time), validation, and behavior change to support teens with common issues. This module focuses on teaching teenagers and their parents to act dialectically rather than thinking and behaving in extremes. It also emphasizes validation, specifically teaching teens and parents or guardians how to validate their own thoughts and feelings and those of others.

What to Expect During DBT Sessions for Teens?

Teens can expect DBT to be a combination of individual and group therapy. Individual sessions will involve working with a therapist to address personal challenges and goals, while group sessions give adolescents opportunities for peer support and learning practical skills. In therapy, teens can also expect their therapists to utilize the DBT modules discussed above to address specific issues.

Teens can also expect to do exercises and use role-play often in group therapy. Homework is also given to those undergoing DBT to help them practice these skills in daily life.

Adolescents undergoing DBT will also learn how to accept their thoughts, feelings, and behaviors while learning techniques to change them in a healthy way. Personal skills and interpersonal skills are taught in DBT.

Since DBT is a form of psychotherapy, one will not typically expect medication management. However, in some cases with co-occurring mental health conditions, teenagers can expect some form of medication to be prescribed along with therapy. This is a decision that will be made in collaboration between a therapist and a psychiatrist.

How Effective is DBT for Teens?

DBT is meant to help people, including teenagers, successfully improve their coping skills as they learn how to manage various problems and strong emotions. Research has found that DBT is effective regardless of age, sex, gender identity, sexual orientation, and race or ethnicity [*].

Studies done on individuals with borderline personality disorder (BPD) have found that DBT is quite effective at treating symptoms and reducing suicide risk. A study found that more than 75% of people with BPD no longer met the diagnostic criteria for the condition after a year of treatment [*].

Aside from BPD, research has also found that DBT is effective in the treatment of depression, anxiety, and PTSD. [*][*].

While adaptations of DBT for adolescents are still relatively new, meta-analysis review and research by others continue to find positive outcomes of DBT for this age group [*]. Other research supports DBT used in various contexts, including inpatient treatment and juvenile corrections [*][*].

Further research will continue to develop more adaptations to improve the knowledge base that currently exists for DBT.

DBT Worksheets for Teens

Working on your DBT skills doesn’t just stop at the therapist’s office. Teens can also take advantage of the following DBT worksheets to practice what they’ve learned in therapy at home:

• DBT Skills Introduction
• DBT Coping Skills
• DBT Mindfulness Skills
• DBT Distress Tolerance Skills
• DBT Emotion Regulation Skills
• DBT Interpersonal Effectiveness Skills
• DBT Walking the Middle Path Skills
• DBT Coping Statements

Frequently Asked Questions

How does DBT for teens differ from DBT for adults?

The addition of family members or caregivers to skills training sessions is the biggest modification to the DBT treatment approach for teenagers. Therapy can be significantly improved by involving caregivers because home-life difficulties that could compromise treatment can be addressed.

What role do parents play in the DBT process for teens?

Aside from benefiting from learning the DBT skills themselves, parents learn to serve as coaches for their teenagers. Families play an essential role in DBT for adolescents.

Can DBT for teens be combined with other forms of therapy?

Yes, DBT can be used in conjunction with a number of other techniques and approaches. The treatment plan for each teen will be different depending on their needs, and therapists may include other forms of therapy to be used alongside DBT.

How long does DBT for teens take to show results?

It is highly dependent on the individual, their condition(s), how skilled the therapist is, and how much effort the teen puts into therapy. Generally, standard outpatient DBT that takes place once a week can last from six months to a year.

The Bottom Line

Ultimately, DBT is an excellent evidence-based form of psychotherapy that can equip teens with essential coping skills. It combines mindfulness, distress tolerance, emotion regulation, and interpersonal skills to help teens face the multifaceted challenges that are found in adolescence. Whether life gets complex, emotional, or difficult during teen years, DBT teaches adolescents that there are ways to navigate these experiences while aiming for positive change in their emotional well-being and relationships.

References:

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