Adolescence comes with many challenges. It’s natural for teens to experience highs and lows. They are finding themselves in new situations and relationships. Their hormones are kicking in. And let’s not overlook social media and its impact

Intense emotions are expected as a normal part of this developmental period. But for adolescents who also suffer from a mental health condition, these events can lead to engaging in self-harm or other high risk and unhealthy behaviors. Learning to manage these intense emotions can be difficult. 

Of course, parents want to protect their child. But they may not know when it’s time to intervene or how to help. Fortunately, there is a treatment method that has been shown to be effective in helping adolescents manage their emotions and accept change. It is called dialectical behavioral therapy for adolescents, or DBT-A.

What is Dialectical Behavioral Therapy (DBT-A)?

You may have heard of cognitive behavioral therapy (CBT). It’s a popular and successful treatment many clinicians use to address mental health concerns. This treatment focuses on the connections between thoughts, feelings, and behaviors.  It is focused on change in one of these areas, as that can lead to change in other areas.

Dialectical behavioral therapy is a treatment that combines CBT with eastern religious philosophy to incorporate mindfulness and an ability to hold more than one truth as you work towards change.  In DBT we say that teens are “doing the best they can AND they can do better, try harder, and be more motivated towards change.”  

At the core of DBT is the concept of dialectics. This refers to the philosophy that two opposite ideas can coexist. Sometimes when people see things in extremes, it can prevent them from having hope, giving others grace, accessing their own strength, or allowing for the support of others. By developing skills, individuals can increase their “cognitive flexibility” and use more effective strategies to manage intensely emotional situations safely while maintaining important relationships.

The overarching goal of DBT is to teach individuals effective skills to regulate their emotions, manage distress, be effective interpersonally, develop mindfulness, and for families to improve their functioning. 

The primary dialectic that comes up repeatedly in DBT treatment is that of acceptance and change. We're constantly doing that dance in our treatment with our families and DBT is a hopeful and skills-based intervention. 

DBT-A history and use

DBT was originally created as a treatment for individuals with suicidal thoughts, then later for borderline personality disorder. Research now supports DBT as a useful tool in treating a range of clinical issues including bipolar disorder, substance use disorder, depression, eating disorders, disruptive mood dysregulation disorder, and post-traumatic stress. Overall, DBT is a way to help teens cope with and regulate their emotions safely.

One thing we tell adolescents and families is that DBT offers a lot of options. It's a vast menu of skills. It is almost guaranteed that we'll be able to find some skills that can help most individuals in most situations. 

DBT-A in practice

There are four key components of DBT-A treatment. 

1) Skills group

The skills group teaches individuals effective skills to tolerate distress, regulate their emotions, and to navigate their social world. Co-leaders provide instruction and opportunities for in-session practice, as well as assign homework for completion prior to the next session. Typically, the groups are scheduled about once a week, two hours at a time. 

For adolescents, at least one caregiver must attend each group with their teen. This is designed to recognize that interactions are transactional; that an individual's environment impacts their functioning—just as much as they impact their environment—and to provide the family with the knowledge and language to cope effectively together.

2) Individual therapy

Individual therapy is designed to increase an adolescent’s motivation and teach them how to apply their learned skills to their own lives. Typically, sessions are once a week, although they can be increased to twice per week as needed and may be supplemented with family meetings. The adolescents are expected to keep a diary card to track their target behaviors, emotions, and skills effectiveness over the course of the week. This helps to generalize the treatment to real life situations.

3) Phone coaching

The focus of this component is on building skills and preventing crises. To support this effort, a clinician from the DBT team is available to patients and their parents or caregivers 24 hours a day, seven days a week.

4) Provider consultation

The DBT team meets weekly to focus on supporting providers as they work with individuals who exhibit risky or sometimes life-threatening behaviors. The consultation team serves as an important function in maintaining treatment adherence, but also in preventing burnout. 

If your adolescent is finding it difficult to manage their emotions, DBT may be a helpful treatment. You can learn more about the Mindful Teen DBT Program at Bradley Hospital on our website.

Karyn J. Horowitz, MD

Dr. Karyn Horowitz is chief medical officer at Bradley Hospital and director of child outpatient psychiatry for Lifespan.