Dialectical Behavior Therapy for Adolescents (DBT-A)

Dialectical Behavior Therapy for Adolescents (DBT-A) is the treatment of choice for teens presenting with multiple, serious behavioral concerns – problems like self-harm, eating disorders, substance use, high-risk sexual behaviors, oppositional behavior, and suicidal ideation or actions. DBT can also be helpful with problematic but less severe issues like interpersonal difficulties, moodiness, anxiety, anger dyscontrol, and school avoidance.

Of note, at Columbus Park, we use a form of DBT-A that has been formally adopted to treat the needs of teens with eating disorders. This treatment is ideal for patients with eating disorders and other co-occurring emotional or behavioral difficulties like any of those mentioned above. DBT-A is structured to effectively target multiple concerns at the same time.

Proven Treatment

Dialectical Behavior Therapy is a comprehensive therapeutic intervention grounded in science-based principles of behavior change. Extensive research on DBT in both adults and adolescents has demonstrated its efficacy in treating a wide range of difficulties including:

• Disruptive or impulsive behaviors

• Mood swings, including anger

• Depression or anxiety

• Self-injury or suicidal behaviors

• Eating disorders

• Substance abuse

• High-risk sexual behaviors

• Chronic conflict with peers or family members

DBT is based on the understanding that difficulty managing emotion can lead to impulsive actions, poor decision-making, and destructive behaviors. These behaviors may serve to relieve distress in the short term but in the long term, they can be damaging to physical health, self-esteem, relationships, and overall quality of life.

DBT focuses on teaching a broad range of skills for coping that replace familiar, but ultimately damaging,  behaviors that negatively impact the quality of life. With treatment, the patient gains a broader repertory of resources to help themselves, not hurt themselves,  when challenges arise.

Parents as a Resource for Teens

In DBT there is recognition of the interplay between the individual and their environment and acknowledgment that there may be ways that environmental factors reinforce dysfunctional behaviors. For youth struggling with emotional and behavioral challenges, a strength of DBT is that it acknowledges the important role of family, a central part of the teen’s environment, in supporting the client through change. Teens are in the midst of a family system and their struggles cannot be addressed in isolation; the system needs to work together to repair and improve communication, mutual respect and establish an appropriate structure of parental support.

DBT for Adolescents calls for parental involvement, including parent skills training, so that the family system can share the same “language” and work towards change together most effectively. With this purpose, parents learn the same skills that the teen is learning. Parents also have access to a “Parent Coach” who guides them in strategies to validate and support their teen, improve communication, set limits, and bolster their teen’s implementation of new skills. The Parent Coach is available between sessions to troubleshoot challenging moments and reinforce skillful interactions in real-time. The teen has their own separate therapist so they can feel a sense of privacy and separation from parents but at the same time, the team is working together in the service of creating harmony and health within the family unit as a whole.

“True” DBT

Over the last two decades, DBT has increased in popularity; it’s a “hot” treatment with a lot of buzz and positive references in the field. Many providers integrate elements of DBT as part of a broader treatment alongside other techniques. It’s essential to note that this “light” version of DBT can be helpful in some cases but it is not consistent with how DBT is intended to be delivered and shouldn’t be the course for patients with serious or chronic emotional and behavioral concerns. Adherent DBT (the “full dose”) incorporates individual therapy, skills training, between-session coaching (for patient and parent[s]), and should be delivered by clinicians with intensive training who are part of a DBT Team. The therapist meets weekly with their team with the intention of collaborating and working together in service of delivering the treatment at the highest level.

Comprehensive DBT-A Core Components

• Skills Training Sessions where teens and parents learn dozens of skills for improved emotion regulation, distress management, interpersonal effectiveness, and increased emotional awareness.

• Individual Therapy where the teen works one-on-one with a therapist to track behaviors and progress, build emotional awareness, fine-tune skills, and gain support in generalizing the skills in real life.

• Phone coaching for the patient and parent[s] to troubleshoot challenges that arise between sessions. The parent[s] use phone coaching with the Parent Coach and the teen uses coaching with their Individual Therapist.

• A team consultation serves as a tool for the therapist so that the patient/family benefits from the input of other DBT experts; team support reinforces the efficacy of this type of treatment.