What is DBT?
Dialectical Behavioral Therapy (DBT) is a comprehensive and evidenced-based intervention that has been shown to help teens and adults manage intense emotions more effectively by learning and applying adaptive coping behaviors rather than reacting in ways that can cause conflictual, impulsive, harmful and/or problematic behaviors or by avoiding in ways that can limit functioning. DBT teaches the practice of mindfulness- how to be fully present in the moment without judgment and focus on one thing at a time. When mindful awareness is combined with effective coping and problem-solving skills, it allows clients and family members to tolerate distress and respond more flexibly to stressful and painful life experiences while communicating their needs with others more effectively.
“Dialectical” refers to the existence of two opposing truths that are accepted and addressed at the same time. The fundamental “dialectic” in DBT is the concept that we are both accepting what is happening now and working to change it. DBT is a behavioral intervention that also helps change thinking patterns and increase insight into coping and relational patterns.
DBT was developed by Marsha Linehan in the 1980s. The intervention’s efficacy was initially studied in people with borderline personality disorder, who tend to exhibit high emotional sensitivity and reactivity, and thus suffer repeated crises and resulting conflictual relationships. Since then, the evidence-based intervention's efficacy has been demonstrated much more generally. DBT is now utilized with a wide variety of ages and clinical populations who tend to experience high emotional sensitivity and reactivity and need ways to be more effective in managing their emotions and relationships. DBT has been found to work well with both adolescent and adult groups and there are skills curriculums designed for each. Considerable research has been conducted on DBT use with adolescents and adults. Multiple randomized, controlled research trials have demonstrated its effectiveness in treating a wide variety of behaviors and mental health conditions including:
Frequent mood swings
Self-injurious and suicidal thoughts and behaviors
Depression and anxiety
Family and peer conflict
Substance use as a means of coping
Eating disordered behaviors
Poor coping skills
Using substances to cope with distress
Avoidance behaviors affecting functioning
High functioning autism
Raising children who experience their emotions intensely can be very challenging. Typical parenting strategies tend not to work very well with this population, who require more thoughtful, deliberate, and directed approaches. Parents may also feel their feelings intensely, particularly when experiencing their children struggling or feeling unsafe. For these reasons, it is as important for parents to learn DBT skills as it is for their teens/young adults.
When parents learn DBT skills alongside their teen or young adult, they are able to both “speak the same coping language” with their kids and model those adaptive skills. When families adopt a DBT skills coping framework, it allows the environment to become a more safe and validating space for the experience and expression of authentic emotions, in ways which can significantly improve functioning and relationships within the family.
What will comprehensive DBT look like if my family chooses this treatment?
There will be pre-treatment first.
Before beginning skills training, clients engage in 4-6 sessions of pre-treatment. During this time the therapist establishes a relationship with the client and conducts a thorough assessment (including a parent interview session), establishes goals, orients the client to the process and tools of DBT, and addresses any barriers that may interfere with the client engaging successfully in the treatment.
Clients are asked to demonstrate a willingness and commitment to the DBT process and tasks and to give the intervention an honest chance by agreeing to maintain safety and commit to creating a life worth living.
What Skills Will Be Taught in DBT?
There are essential DBT components.
In order for DBT to be adherent to the evidence-based model it must have the following:
Skills Training Group
DBT Consultation Team
How does the "DBT Skills Group" work?
Core Mindfulness: Skills to live in the present moment by accepting what is, not judging things and exhibiting compassion.
Emotion Regulation: Skills to understand emotions, how they serve us, and ways to take care of ourselves regularly to limit vulnerabilities that can make us more susceptible to intense emotions.
Distress Tolerance: Skills to tolerate difficult and uncomfortable emotions and body sensations associated with intense emotions without acting on them in ways that can make things worse.
Interpersonal Effectiveness: Skills to communicate effectively that help to develop and maintain relationships and get needs met skillfully rather than in ways that can cause conflict or hurt relationships.
Walk the Middle Path: Skills that move us away from all or nothing patterns of thinking acting and allow for greater flexibility, behavior choices, compromise, and consideration of others’ perspectives.
Each module is taught in 5 weeks with core mindfulness taught for 1 week in between each of the other modules. There are 4 modules plus the core mindfulness sessions = 24 sessions per cycle. Parent skills groups may meet for fewer total sessions though cover all the same skills. A full round of skills training takes approximately 24 weeks (give or take). It is common for clients to repeat a second cycle or more of skills training if skills are not yet integrated and goals not yet met. The team will consult with clients and families on progress toward treatment goals and the recommendation for continued skills group training beyond one cycle.
It has been our experience that due to the focus on safety and stability for most clients during the first cycle, this is a time when skills are introduced though are not yet absorbed. Once greater stabilization has been achieved, a second cycle helps to integrate and apply the skills with greater awareness and thoughtful deliberation. DBT can take anywhere from 6-24 months to achieve best and lasting results.
Due to the intense nature of this intervention there are very few weeks that are cancelled for holidays or vacations. Please see our attendance policy.
Once skills training is complete, a graduate DBT group is available to help clients continue to utilize skills in their daily lives and access support and coaching in session from peers. Parents do not attend a parent group once their adolescent is in graduate group.