Dialectical Behavior Therapy for Teens with Emotional Instability

Lindner Center of HOPE has built a reputation on offering the most effective evidence-based treatment methods to patients and families. At Williams House, they bring the latest methods with intensive treatment and clinical skills development being largely based in Dialectical Behavior Therapy, but enhanced by other evidence-based treatment models.

Dialectical Behavior Therapy (DBT) is a form of psychotherapy intended for those who exhibit a more chronic form of emotional instability with numerous coexisting problems.  DBT has been shown to be effective with individuals who are suffering from mental illnesses that include behaviors such as suicidal ideation and addictive disorders. DBT is a form of psychotherapy that asks the individual to look at their problems and behaviors and find a different, more effective way to resolve them. 

What is DBT?

Originally created in the 1970s by psychologist Dr. Marsha Linehan, DBTis a form of psychotherapy intended for those who exhibit a more chronic form of emotional instability with numerous coexisting problems. It has been empirically validated through research and continues to be used successfully across the United States, helping people work toward a life worth living.  DBT was originally developed specifically for chronically suicidal adult patients. These patients have difficulty articulating any reason for living or staying alive, and may attempt suicide or engage in self harming behaviors on multiple occasions.  

More recently, DBT has been shown to be effective with teens who are suffering from mental illnesses that include behaviors such as suicidal ideation, addictions and eating disorders. While healthy teens often have emotional dysregulation due to normal, developmental changes, those with mental illness often have more intensity in their emotions with negative outcomes. The more problem behaviors an adolescent has (such as violent behavior, binge drinking, cigarette smoking, high risk sexual behavior; disturbed eating behavior or illicit drug use) the greater the risk of suicidal behavior.  Adolescent suicide is a major public health problem and accounts for at least 100,000 annual deaths in young people worldwide (WHO, 2002). In the United Stated, suicide accounts for more adolescent deaths than all natural causes combined, with more than 2000 youth dying by suicide per year (Anderson, 2002). Suicide is ranked as the third leading cause of death among the 10-14 year old and 15-19 year old age groups in the US in 2000, preceded only by accidents and homicide (Anderson, 2002).

Dialectical Behavior Therapy is a form of psychotherapy that asks the teen to look at their problems and behaviors and find a different, more effective way to resolve them. It encourages the teen to face their emotions rather than avoiding them and this in turn helps the teen to see their situation more clearly and develop plans more effectively. DBT focuses on the “here and now” and breaks situations into manageable steps toward a long lasting and more positive outcome.

How DBT Works

There are two components to DBT treatment: individual therapy and group skills training therapy. It’s typically a six- to twelve-month commitment to both treatment modalities and requires the therapist and patient to sign a contract to be actively engaged in DBT treatment. As it makes sense that the entire family learns the new coping strategies while the teen is making changes, often the family is involved, too. There are four main components of skills group training:

1. Mindfulness skills:  Helping the person to remain in the present and focus on what is happening right now that is causing problems in living.
2. Distress tolerance skills:  Learning how to put up with the emotions that hurt but cannot be changed.  It helps the teen see that there are situations we find ourselves in that we do not like, but cannot change.  However, in the midst of that, you can learn to tolerate the emotional outcome.
3. Emotion regulation skills:  Learning how to change emotions so that the emotions we like will linger longer than the emotions we do not like.
4. Interpersonal skills:  Learning how to get needs met in interpersonal relationships without compromising our self respect or the other person’s rights.

When we look at the skills taught in DBT skills training groups, it’s easy to see how any person could benefit from learning more in these areas, but especially teens suffering with mental illness.  DBT teaches the teen to validate themselves, recognize their competence and work through crises.  DBT validates the teen’s emotions and current situation, but also encourages change toward a life worth living.  

Help for Parents

DBT also helps parents to increase appropriate authoritative discipline and decrease excessive leniency, which is frequently the result of treating the teen as fragile due to mental illness. When parents learn these skills, teens then increase self-determination and decrease the need for authoritarian control. Also excessive dependence, which is often found in teens who suffer from mental illness, is decreased and the natural move towards autonomy can occur. DBT helps increase the recognition of normative behaviors of teens and decreases pathologizing of the teen when his or her behavior truly falls into normal teen behavior. (Not all behavior of teens who suffer from mental illness is a result of the illness — often times, it is the normal result of moving through the adolescent years.) Helping parents identify what is normal and how to make changes otherwise is critical to long term success.

DBT is most successful when it is implemented by clinicians who have had intensive training in DBT.  While it appears simple because the creators made the concepts quite easy to understand, it takes a skilled clinician to get optimal results from DBT.  

Ongoing research continues to improve DBT treatment for teens and their parents. However, it promises to make a substantial difference for families who support teens struggling to overcome mental health issues. Any treatment that validates the patient and moves them toward changes that improve their quality of life is well worth the investment in time and financial resources.