Treatment Spotlight: Dialectical Behavioral Therapy (DBT) at Evolve

Here in the Parenting Tips and Advice section of our website, we share articles designed to increase awareness and understanding of issues relevant to parents of adolescents experiencing behavioral challenges or emotional distress. We focus on topics related to treatment of and recovery from significant mental health issues such as substance use and mood disorders, but we also include general resource articles on a wide variety of topics. From education trends to new mindfulness techniques to self-care tips that help keep you balanced while your teen is in treatment, our goal is to offer resources in an open, honest, and direct manner you won’t find anywhere else online.

We strive to give you the best information available, supported by the latest research in our field. We shy away from using this part of our site as an endless serialized commercial for our treatment centers. You can tell by the fact we don’t redirect you to a registration page every other paragraph, hard sell our programs under the guise of news articles, or draw you in with clickbait headlines.

We’re going to break that trend in this article, however, and talk about ourselves. Don’t worry – no clickbait and no hard sells – just solid information about a topic relevant to anyone connected to Evolve. We’re inspired by a lecture our Clinical Director, Dr. Lauren Kerwin, presented at a recent conference for mental health professionals. Her presentation was so well-received we thought you might like to spend a few minutes getting a deeper understanding of how we apply Dialectical Behavioral Therapy (DBT) at Evolve, and more specifically, how we use it to help teens in our residential programs.

How We Do It

Evolve Treatment programs focus on changing behavior. Our primary therapeutic mode is Dialectical Behavioral Therapy – DBT for short. DBT is the backbone of our treatment process because we’ve found it works for a wide range of issues. We’re not the only ones who recognize its value and versatility: decades of clinical research prove the effectiveness of DBT. When applied properly, DBT can help adolescents struggling with mood disorders, self-harming behaviors, out-of-control behavior, and alcohol/substance abuse disorders, and more.

Here’s a concise summary of why we use DBT at Evolve:

DBT helps our teens change ineffective behavior patterns into effective ones. DBT treats issues such as impulsivity and overwhelming emotion, which are recurring themes among adolescents with mental health and substance abuse disorders. DBT works to achieve four primary goals: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

While changing behavior is the primary goal of DBT, the core principle we apply to achieve that behavioral change is awareness: we teach our teenagers to recognize and accept reality as it is without the desire to change it. We help them see themselves, other people, and the world objectively. We teach them to look inward, so they can recognize and accept their relative strengths and challenge areas. We also teach them to look outward, and see the actions of others – peers, parents, and authority figures – without creating meaning that’s not there or assigning motivation they can’t possibly verify.

In that way, our core DBT principle of awareness is synonymous with the concept of mindfulness, which, according to mindfulness expert Thich Nhat Hanh, simply means “…the ability to be aware of what’s going on both inside us and around us. It is the continuous awareness of our bodies, emotions, and thoughts.”

In the world at large, people use mindfulness techniques to reduce stress and find balance in their lives. In residential treatment at Evolve, we use mindfulness for those same purposes, but first, we use mindful awareness to help our teenagers see reality as it is, not as they wish it would be. This perspective helps them recognize the nature and scope of their behaviors, which is the first step toward changing them.

What We Teach: Practical Skills

There are many variations of DBT currently in use in inpatient and outpatient treatment centers around the world. Each therapist develops their own way of applying fundamental DBT principles, and no one way is superior to any other. The only true measure is the outcome: did DBT help the individual change the behavior they wanted to change?

We understand most teens struggle to change unwanted behavior because they lack the skills to do so. That’s why we take a skills-based approach to DBT: everything we do is based on equipping our teens with techniques they can use to manage whatever condition stands between them and the life they want to lead.

The Five Skills of DBT

  1. Mindfulness. It all starts with mindfulness. Cultivating a mindful awareness gets our teens out of a reactive space, into a neutral space, and allows them to move toward a proactive space. We break mindfulness down into What and How skills. What skills help our teens to observe, describe, and feel their emotions. How skills help our teens see and feel their emotions non-judgmentally, then process them in productive ways. We also teach our teens how to gauge the intensity of an emotion on a scale of 1-10, where 1 is mild emotion and 10 is extreme emotion. Once our teens learn to identify the intensity of an emotion, they can decide which DBT skill they can use to manage it.
  2. Distress Tolerance. The purpose of this skill is essential: we teach our teens how to survive emotional crises without making them worse. Our teens use distress tolerance skills to handle extreme emotions that fall in the 7-10 intensity range. The goal of distress tolerance is to change the moment, reorient the mind, and shift the attention away from distressing stimuli and focus on something else until the crisis has passed. We make sure each of our teens has at least ten effective distress tolerance skills before they leave treatment. We practice them through role play while they’re here, so when they face a crisis out in the world, they’re ready to apply tools they know work for them.
  3. Emotional Regulation. We often find our teenagers honestly don’t know what they’re feeling when they’re feeling it. When asked about their emotional state, they often reply, “I don’t know – it’s like looking into a thick fog.” To teach them how to regulate their emotions, we start at the beginning and take them through a three-step process: we help them understand what an emotion is, help them identify the different types of emotion, then teach them how to change their emotional state if they want to. They learn use these emotional regulation skills for feelings that fall in the 4-7 intensity range – emotions that need processing, but are neither incredibly intense nor typical, run-of-the-mill feelings.
  4. Interpersonal Effectiveness. Teens need interpersonal skills just like we all do: the difference between teens struggling with emotional, behavioral, and/or substance use disorders and the rest of us is that their condition interferes with their ability to communicate in circumstances most people find relatively easy. Interpersonal skills apply when emotional intensity falls in the 1-3 range, which is where most of us spend most of our time – typical daily life. Skills many of us take for granted can be challenging for teens seeking treatment. They need basic lessons in how to set appropriate boundaries, how and when to say yes or no, and how to ask for what they need on physical, emotional, and psychological levels. These skills form the bedrock of their return home after treatment: when an individual understands how to successfully navigate low-stress situations and advocate for their basic needs when emotions aren’t challenging or overwhelming, they’re often able to stop problems before they start and avoid emotional crises altogether.
  5. Changing Behaviors. This is the last skill on our list, but it’s the skill all the others lead to. When our teens integrate the first four skills into daily life, those skills gradually become default coping mechanisms. They replace the old ineffective coping mechanisms that made their lives unmanageable with new skills and mechanisms that allow them to live a life of their choosing. A course of DBT equips a teenager with the skills needed to analyze behavior, identify emotions, then deploy effective techniques to process those emotions. They learn to change their thinking and manage triggers – i.e. exposure to environmental cues that previously led to life-interrupting behaviors – without reverting to their previous, life-interrupting behaviors. They understand the negative consequences of those behaviors, and know their health, happiness, and long-term well-being depends on making wise choices from a place of balance, perspective, and emotional maturity.

DBT in Residential Treatment:  Theory to Practice

DBT is an effective treatment for our teens because there’s no mystery to the goal: behavioral change. This means judging outcomes is simple, because behavior either changes or it does not. The DBT approach allows our teenagers to learn new strategies, practice them, and decide whether they’re going to work out in the world. It implies a collaboration between therapist and patient, where the therapist leads the patient to new knowledge, the patient applies this new knowledge both internally and externally, then judges the practicality of the new knowledge based on real experiences rather than speculation. The core tenet of DBT – mindful awareness – endures long past the time a teenager spends in treatment. It’s a skill that not only helps them recover from addiction and mental health disorders, but also equips them to handle the emotional challenges they’ll inevitably face as they transition from adolescence to early adulthood and beyond.