Dialectical Behavioral Treatment for Adolescents (DBT-A)
What is DBT-A?
Dialectical Behavioral Therapy for Adolescents (DBT-A) is a form of cognitive behavioral therapy that was initially developed to treat people who engage in (repeated) suicidal behaviors, self-injury, or other mental health problems that threaten their safety, relationships, functioning at work or in school, and emotional well-being. It has also been successfully adapted to treat people who have substance use disorders. DBT-A is highly structured so the youth can learn about why they behave the way they do (acceptance) and skills designed to change their behaviors.
Studies show that approximately 3% of adolescents engage in significantly disruptive, self-harm, or other concerning behaviors.
Why do we need DBT-A?
Many adolescents go through mood swings and changes in behavior, but it is problematic when their behaviors endanger their safety, wellness, and harm their relationships. Studies show that approximately 3% of adolescents engage in significantly disruptive, self-harm, or other concerning behaviors, including impulsivity, mood swings, multiple suicide attempts, or anger that doesn’t seem appropriate. Youth who engage in these behaviors often find that they push others away and harm their relationships, even though this is not what they want. Changing established behavior patterns is difficult, so Dialectic Behavioral Therapy is structured to support the youth and their caregivers to learn how to manage their overwhelming feelings and learn new skills for building satisfying relationships.
Who is DBT-A for?
Youth (ages 13-18) with a history of suicide attempts and other emotional and behavioral concerns that negatively impact their relationships (e.g., conflicts with peers, family, or loved ones) over an extended period may be good candidates to receive DBT-A treatment. You may hear the term borderline personality disorder when your clinician is considering DBT-A treatment. Some of those emotional and behavioral concerns include but are not limited to:
- Chronic feelings of emptiness.
- Frantic efforts to avoid real or imagined abandonment.
- Quick and intense mood changes.
- Unstable sense of self.
- Recurring suicidal behavior, threats, or self-harm.
- Harmful impulsivity (spending money, substance misuse, reckless driving, sex, binge eating, etc.)
- Intense and unstable relationships with others.
- Inappropriate anger or difficulty controlling anger.
You may hear the term borderline personality disorder when your clinician is considering DBT-A treatment. As with any treatment, only a trained clinician should diagnose and determine the appropriateness of DBT-A or any other mental health intervention.
Is DBT-A Effective?
Several studies using scientific methods such as randomized controlled trials have found that DBT-A effectively reduces adolescent self-harm, suicidal ideation, and other problematic behaviors that harm their ability to form health relationships.
What can I expect if I receive DBT-A?
Dialectical Behavior Therapy for Adolescents treatment is provided in individual therapy sessions, family therapy as needed, and a skills training group. It may also include homework and real-time access to coaching. Clinicians may support the individual and group sessions with tools and worksheets to reinforce new skills development and gauge progress.
Youth who are found appropriate for DBT-A are screened for suicide risk and then receive an orientation to the treatment process. The youth is then required to agree to the following:
- Willingness to work hard.
- Committed to active participation for sixteen weeks.
- Prepared to make difficult but healthy lifestyle changes.
- Willingness to sign a behavioral contract and have an adult in his/her life who is willing to participate as a support person.
Once the youth agree to participate, they will engage in weekly, individual treatment sessions designed to build specific skills in 4 areas:
- Mindfulness: is the practice of being fully aware and present in the moment.
- Distress Tolerance: How to tolerate pain in difficult situations, not change it.
- Interpersonal Effectiveness: How to ask for what you want and say no while maintaining self-respect and relationships with others.
- Emotion Regulation: How to decrease vulnerability to painful emotions and change emotions that you want to change.
Once engaged in this process, the clinician will help the youth focus on facing the sources of their emotional or behavioral concerns and work on self-respect, achieving individual goals, and addressing the typical challenges of everyday life.
Youth will also participate in weekly, two-hour education and skill-building group sessions to reinforce the skills they have learned in individual treatment. Additional services may include medication management and strategic case management, telephone consultation, and safety assessments.
Treatment typically lasts 16-24 weeks.
The treatment goals are to reduce self-harm behaviors, learn to tolerate painful emotions and “self-soothe,” reduce behaviors that interfere with developing positive relationships, and communicate more effectively with peers and adults.
Who provides DBT-A?
DBT-A is provided by clinicians who have completed training and received certification in the model.
- Most of New Hampshire’s community mental health centers have clinicians trained to provide DBT-A.
- Granite Recovery Centers provide DBT for individuals with substance use disorders.
- DBTeens provides an intensive 12-week intensive outpatient telemental health treatment program for youth ages 12-18.
Learn More About Dialectic Behavioral Therapy for Adolescents:
McLean Hospital provides in-depth information about DBT and Borderline Personality Disorder in Adolescents.
To find training in Dialectic Behavioral Therapy for Adolescents:
- The Mental Health Center of Greater Manchester provides training in DBT, including a module on treating adolescents.
- The Association for Psychological Therapies (APT) provides face-to-face and online DBT-A training.
Learn More:
Guilé, J. M., Boissel, L., Alaux-Cantin, S., & de La Rivière, S. G. (2018). Borderline personality disorder in adolescents: prevalence, diagnosis, and treatment strategies. Adolescent health, medicine and therapeutics, 9, 199–210. https://doi.org/10.2147/AHMT.S156565
Kothgassner, O.D., Goreis, A., Robinson, K., Huscsava, M.M., Schmahl, C., & Plener, P.L. (2021). Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis. Psychological Medicine, 51(7):1057-1067. doi: 10.1017/S0033291721001355.
Fleischhaker, C., Böhme, R., Sixt, B., Brück, C., Schneider, C., & Schulz, E. (2011). Dialectical Behavioral Therapy for Adolescents (DBT-A): a clinical Trial for Patients with suicidal and self-injurious Behavior and Borderline Symptoms with a one-year Follow-up. Child and adolescent psychiatry and mental health, 5(1), 3. https://doi.org/10.1186/1753-2000-5-3
Miller, A. L. (1999). Dialectical Behavior Therapy: A New Treatment Approach for Suicidal Adolescents. American Journal of Psychotherapy, 53(3), 413ñ417. https://doi.org/10.1176/appi.psychotherapy.1999.53.3.413
Rathus, J. H., & Miller, A. L. (2002). Dialectical Behavior Therapy Adapted for Suicidal Adolescents. Suicide and Life-Threatening Behavior, 32(2), 146ñ157. https://doi.org/10.1521/suli.32.2.146.24399