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Teen DBT Programs Part Two: How DBT Helps Teens

Written by Evolve's Behavioral Health Content Team​:

Alyson Orcena, LMFT, Melissa Vallas, MD, Shikha Verma, MD, Ellen Bloch, LCSW, Lianne Tendler, LMFT, Megan Johnston, LMFT
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DBT Helps Teens Manage Emotions and Tolerate Distress

[seriesbox]DBT Residential Treatment For Teens
Teen DBT Programs Part One: What Is DBT?
DBT the Gold Standard for Treating Adolescent Self-Harm and Suicidal Ideation
How do Adolescent DBT Programs Help Depressed and Anxious Teens?
Family DBT at Evolve: How We Do It[/seriesbox]In our last article on DBT – Teen DBT Programs Part One: What Is DBT? – we presented an overview of DBT. We discussed the history of DBT, explained where you can find DBT treatment for your teen, and addressed what types of issues DBT helps, and why. This article moves from the why to the how. You’ll learn about the core modules of DBT, the two primary types of DBT programs, and how to enlist the help of a mental health professional to find a DBT program that’s appropriate for your teen.

Let’s jump right in, right now, with the how.

How DBT Helps Teens

Teens who participate in DBT-A programs learn skills they can apply immediately to improve their lives. DBT-A includes five core modules:

1. Mindfulness

This module helps teens learn mindfulness practices that help them get perspective on their thoughts and emotions. This perspective, in turn, helps them manage thoughts and emotions that degrade their wellbeing and mental health. Mindfulness teaches a unique skill: the ability to identify and experience emotions and thoughts without judging them or reacting to them. For instance, a teen feels an emotion they label as bad. Mindfulness teaches them to allow that emotion to exist on its own without labeling it as good or bad. Then, with this perspective, they can decide how they want to behave in response to that emotion. Do they choose a behavior that supports or degrades their wellbeing? A DBT therapist will help them self-direct toward the former and help them self-direct away from the latter.

2. Emotion Regulation

The practice of mindfulness leads directly into the Emotion Regulation module, which helps teens learn how to manage turbulent, difficult feelings. Adolescence is filled with ups and downs as it is, and an adolescent with a mental health disorder experiences disruption and disturbance on a level it’s difficult to understand. DBT skills help teens prevent emotions from dominating their thoughts and dictating their behaviors. With DBT, they learn they can control how they react to their emotions. This gives them agency. This empowers them to choose their behaviors, rather than their emotions choosing their behaviors for them.

3. Interpersonal Effectiveness

This module helps teens manage relationships with others. It starts by teaching teens to use the first two skill modules to look inside and identify their personal needs in terms of their relationships with their family, their friends, their peers, and other people in their lives, such as teachers, coaches, or mentors. Teens learn to respect themselves and others, create healthy boundaries, and learn to interact with people who push their buttons. Most importantly, teens can use the skills they learn in this module to help repair any relationships that may have been negatively impacted by their previous, mental health, symptom-influenced behavior.

4. Distress Tolerance

This module teaches teens skills that help them manage difficult emotions in a healthy, safe manner. Distress tolerance helps teens in crisis situations make decisions that improve, rather than exacerbate, any given crisis or problematic situation. Emotions can cause teens – or anyone, for that matter – to act rashly, or act on impulses guided by fear or desperation. For instance, a teen who feels an overwhelming, painful emotion may turn to alcohol or substances to reduce the pain in the moment. But that choice only works in the moment and can backfire. Distress tolerance skills – such as distraction or reality acceptance – teach teens how to make it through hard moments without acting on impulse. It takes time and effort, but over time, teens learn they can make wise, life-affirming choices in times of challenge and crisis.

5. The Middle Path

Dr. Linehan developed this model for adolescents. It involves what the name implies: finding the balance between two extremes. Teens with mental health disorders – including depression, anxiety, or borderline personality disorder – often engage in what therapists call all or nothing thinking or black and white thinking. For them, an event, a person, or a thing is either good or bad. There is no room in their thinking for in between. When they learn to walk the middle path, teens learn to replace a thought like “I’m right and you’re wrong” with a thought “We can both be right.” This allows them to see the gray areas in life. Seeing the potential for and validity of different perspectives allows them to compromise, collaborate, and become more flexible in their thinking and approach to problem-solving.

Now that you know what DBT is and how it works, it’s time to learn more. We’ll start by telling you that there are two primary types of DBT programs available. There are DBT-informed programs and comprehensive DBT programs. The main difference between DBT-informed and DBT-comprehensive is how the programs implement the four core components of DBT – which are not the same as the five core modules of DBT.

We’ll explain.

What is a Comprehensive DBT Program?

A comprehensive DBT program includes all four of the standard DBT treatment components, whereas a DBT-informed program includes one or more of the standard treatment components, but not all. During a comprehensive DBT program, teens participate in a structured therapeutic sequence designed for maximum treatment success. Therapists scaffold tools and help teens build competency with essential DBT skills over time. The step-wise manner of a comprehensive DBT program ensures teens have the tools they need to manage their disorder and prevents gaps in their knowledge and experience that can derail their progress.

The Four Core Components of DBT

  1. Individual therapy: In one-on-one sessions, DBT is the primary therapeutic approach. Therapists teach teens to track their own emotions and behavior in between sessions using one of the DBT techniques from the five DBT skill modules.
  2. Skills training: Teens learn the five skill modules of DBT alongside peers. Group DBT sessions focus on one of the core modules. After each session, counselors or therapists assign therapy homework. This typically involves practicing and applying the DBT skill covered in group, but independently, before the next class.
  3. Skills coaching: If a teen needs emergency support, they can contact their DBT therapist and receive in-the-moment coaching. This is valuable when a teen feels the impulse to engage in negative behaviors and needs help applying the appropriate coping skill. In these situations, therapists help the teen problem-solve using DBT techniques they’ve covered in individual and group therapy sessions.
  4. Consultation teams: This component is about the therapists, rather than the teens, but ultimately leads to the best possible support for the teens. DBT consultation teams meet weekly – at a minimum – to evaluate their application of DBT with teens and discuss the progress their teens make or discuss the obstacle their teens face. The purpose of a consultation team is to enhance and improve both the motivation, capabilities, and effectiveness of DBT therapists.

Now you know what DBT is. You also know the two primary types of DBT programs available. But how do you decide which DBT program is right for your teen?

DBT Programs: Making the Best Choice for Your Teen

Every teen is different, and the course of every mental health disorder is unique to the individual. Therefore, it’s impossible for an article like this to tell you exactly what kind of DBT program your teen needs. However, if your teen has tried outpatient treatment, intensive outpatient treatment, or partial hospitalization treatment without success, it may be time to consider an immersive program at a residential treatment center that offers a comprehensive DBT program.

However, you need to make that choice in collaboration with your teen’s therapist, because they know you and your teen better than anyone else. If your teen doesn’t have a therapist yet – and they experience extreme, reactive emotions and display severe mental health symptoms – then your first step should be to arrange a full biopsychosocial assessment administered by a licensed mental health professional experienced in working with adolescents. They have the knowledge to diagnose your teen and make a recommendation or referral to a treatment center that meets your needs.

The sooner you get your teen evaluated – or get your teen into a DBT program, if their therapist recommends it – the better. Evidence shows that when a teen with a mental health disorder gets the treatment they need, outcomes improve.

Your teen can learn to manage their symptoms and live a full and productive life. DBT helps them choose what that life looks like. In the words of DBT therapists worldwide, DBT helps teens create “a life worth living.”

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