This is the fourth in a series of articles on Dialectical Behavior Therapy, or DBT. Be sure to check out the introduction article for a full overview of this therapeutic approach including how it was developed and how it is typically applied. This article will focus on how DBT can help adolescents.
The primary premise of DBT is to assist people in developing skills for coping, clearer thinking, and emotion regulation. If you are a parent or guardian of an adolescent you likely know that many teens struggle with these skills.
When an adolescent is struggling to cope with their various life circumstances and personal mental health challenges, they may benefit from therapy. If you are considering therapy for your adolescent, DBT would be an excellent option. You and your teen may then wonder exactly what you could expect in DBT-based therapy. Learn more about DBT and how it can help adolescents:
The Foundations of DBT for Adolescents
As noted in the previous articles from this series, DBT was initially developed by psychologist Marsha Linehan. She developed the approach to address symptoms of Borderline Personality Disorder. This is a psychological diagnosis that Linehan (and other researchers) saw as being the result of a core difficulty with emotional regulation. In fact, it was Linehan’s own experiences with mental health challenges during her young adult years that drove her to develop this approach. Linehan’s personal experiences and work were quite valuable as the approach proved to be highly effective for the BPD population.
DBT combines elements of Cognitive Behavior Therapy with concepts of acceptance and mindfulness from Eastern philosophies. It is traditionally a very structured and psychoeducational approach in which clients are given information through group instruction in addition to individual therapy.
The information falls within four main modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. Each module is intended to help people with DBT manage the problematic symptoms of the disorder. They learn how to slow down, calm down, maintain their emotions, and effectively communicate their needs to the important people in their life.
Clients are also asked to participate in individual therapy where they learn how to apply the information and the skills they are learning to their unique circumstances. In some cases, clients are also offered the opportunity to communicate with their counselor outside of scheduled sessions for coaching and support. This means that when they face a challenge they do not exactly know how to overcome, their therapist can talk them through it, reminding them of skills to use. The idea is that with instruction and practice, over time, the person will become better and better at applying those skills themselves.
Application of DBT for Adolescents
As noted at the beginning of this post, any teen can struggle with their emotions during the teen years. Teens’ brains continue to develop until mid twenties and one very important part of the brain that takes some time to develop is the pre-frontal cortex. The pre-frontal cortex is in a way the part of the brain that distinguishes humans from other species. It is the part of the brain that allows for the highest level of thinking including executive functions such as decision-making, planning, and impulse control.
Much to the chagrin of parents and guardians, children and teens are not always fully able to think things through and choose the most logical behavior. This is often due to the delayed development of their pre-frontal cortex. It may be alarming and enlightening to learn that research indicates the pre-frontal cortex does not fully develop until approximately age 25! No wonder even young adults and college students sometimes seemingly struggle to make the “best” decisions. Looking back on your own youth, you can probably think of some instances where impulsivity won out over logic.
Added to the barrier of brain development is the stress and pressure of being a child, teen, and young adult. Again, if you think back, you may recall those were often very stressful years. Daily school and extracurricular activities demand time. There are friendships and relationships to navigate, along with the feeling that one must conform to be cool. Young people are also trying to figure out who they are, balancing their own self-exploration with the interests and sometimes demands of their family.
Just reading that may be enough to bring back the sense of stress you may have felt in your teenage years and will likely connect you to the stress your adolescent is probably feeling today. Of course, some teens do have other extra burdens such as chronic health problems, trauma experiences, and resulting mental health symptoms. This imperfectly “perfect storm” can, fortunately, be helped with DBT.
As previously discussed, DBT is divided into four modules and each of these has benefits for not just teens who are struggling but also the average teen, who may want some extra support. Let us look at how each module can benefit adolescents, giving them skills that they can take right on into young adulthood and the rest of their lives.
The first module of DBT is mindfulness and this module is all about helping people learn how to slow down, relax, and to think things through before acting or reacting. These skills can help teens to manage the impulsivity that might otherwise lead them astray. They will learn to observe what is around them and their own internal thoughts/feelings/sensations before acting. This allows them to also consider consequences before the acting.
Often, distress tolerance skills are taught next. Distress is that feeling that any of us can face when life goes awry. Some individuals struggle more with distress, in part because they become distressed about their distress. Teens may sometimes feel overwhelmed by their emotions, especially when they may be in the mindset that nobody “gets” them. Knowing how to manage their most intense emotions in healthy and productive ways can prevent teens from negative actions such as emotional outbursts, substance abuse, behavioral acting out, and self-injury.
Related to this, the emotion regulation module teaches teens how to identify and manage their emotions. Many teens learn this through the course of childhood and adolescence, but sometimes learning is delayed. When a person is more able to identify their emotion, they are more able to deal with it effectively. Thus, it is important for teens to be able to identify and label their emotions because then they can start to think about the ways they want to express or deal with them.
Finally, the interpersonal effectiveness module teaches teens how to best interact with others, whether it is peers, parents, teachers, or coaches. Dealing with other people can be challenging for anyone. It is even more challenging when you are in those teen years, wanting to be your own person and independent, but still largely under the guidance and direction of others. Interpersonal effectiveness skills teach teens how to communicate assertively when needed, without being aggressive, passive aggressive, defensive, or overly emotional. In a way, it also teaches teens how to “pick their battles” so they can decide when they want to prioritize the relationship or their own needs. This is an especially valuable skill for dealing with peers and that infamous, peer pressure.
What is excellent about DBT is not just the information and skills it teaches, but the process that it uses. Many teens benefit from having a therapist to talk to because they enjoy having someone outside of their friends and family, who can be a neutral third party and who will keep everything they discuss confidential. For those who participate in a group therapy setting, it is valuable for them to see and know that they are not alone in their struggles. Sometimes teens can be self-focused and self-conscious, forgetting that everyone struggles and yet not everyone is going to notice when you struggle.
Hearing about their peers’ experiences can be an enlightening and corrective experience for teens. This final part, corrective, is especially helpful if they have had poor peer experiences and this more positive one can give them a sense of success and fulfillment. They may leave therapy with more skills and confidence that can allow them to connect with peers more easily in their day-to-day life.
Evidence Supporting the Use of DBT with Adolescents
An abundance of research indicates DBT is helpful for adults with many mental health concerns. Such positive outcomes did prompt researchers to examine the utility of DBT for adolescents. Fortunately, the results have been similarly favorable. DBT appears to be a valuable approach for teens with anxiety, mood dysfunction, behavioral disorders, eating disorders, and features of borderline personality disorder. Research on the approach is ongoing, but it appears useful in various therapy settings including outpatient therapy, which is what the majority of teens would likely utilize.
If you are interested in DBT for your teen, consider working with a therapist who can provide comprehensive care. All the therapists and prescribers at Mind Body Seven are trained in DBT and some provide coaching and skills classes.
Mind Body Seven clinicians offer treatment in Brooklyn and via teletherapy for adolescents and adults. If have not worked with us and want to get started please contact us here, so we can set you up with the clinicians that best suit your individual needs. If you are an existing patient get in touch with us here to set up your next appointment.
