How dialectical behavior therapy can help your teen

DBT for Teens

(855) 506-1906

What is DBT for teens?

Dialectical behavior therapy (DBT) is an evidence-based therapeutic approach that combines cognitive behavioral therapy (CBT) with mindfulness. “Dialectic” is a philosophical term that means reconciling an apparent contradiction. In DBT, the seemingly conflicting elements are acceptance and change.

Acceptance means surrendering to the present moment, no matter how challenging circumstances might be. Change is the process of discarding old, worn-out habits for healthier, more empowering ones. Combine these two apparent opposites, and you get DBT’s core philosophy. 

What conditions can DBT treat?

DBT for kids can improve the following conditions:

  • Substance use
  • Impulsive/disruptive behaviors
  • Mood swings
  • Self-harm
  • Suicidal thoughts
  • Depression
  • Anxiety
  • Family conflict
  • Anger issues  
  • Eating disorders 

The 4 DBT modules for teens

The fundamental skills of DBT are imparted through four modules.

1. Mindfulness

Mindfulness is among the most effective DBT skills for depression. It involves total immersion in the present instead of worrying about the future or fixating on the past. Once this is achieved through meditation or by mindfully observing the world, we can watch our thoughts without labeling them as good or bad. Cultivating such awareness prevents us from identifying with our thoughts.

The problem with attaching to a thought is that we can think it’s real, failing to see it as a fleeting mental formation—or as Buddhists describe it, the boundless sky of our awareness. Identification gives thoughts power they shouldn’t have.

For example, let’s say a teen thinks, “I’m not good enough.” Though it’s not a fact, this adolescent might buy into the thought hook, line, and sinker. The thought may even feel like an unchangeable truth, prompting them to act as if it were. Over time, such unobserved thoughts can do great damage to a teen’s self-esteem and confidence. With DBT, however, they would learn to view such thoughts from the perspective of a detached observer, helping them recognize mere opinions.

2. Emotion regulation

Emotion regulation is all about understanding and managing emotions over the long term.

It helps teens identify their feelings, the reasons they feel as they do, and potential triggers of those emotions. 

The skill includes strategies for handling difficult emotions to avoid overwhelm. The goal of this module is to help teens increase positive feelings while reducing the intensity of negative ones. By building this skill, teens learn to stay more balanced and in control, even when life throws challenges their way.

3. Distress tolerance

Distress tolerance is a set of strategies for handling the intense feelings that arise in upsetting situations. They include distraction, self-soothing, and radical acceptance. These techniques help teens tolerate emotional pain instead of acting it out. In this way, teens can reduce impulsive reactions and self-destructive choices when things feel out of control.

Distraction

Distraction involves a teen temporarily shifting focus away from distressing thoughts or feelings by engaging in activities that absorb their attention, such as watching a favorite show, playing a game, or taking a walk. After a set time, they can return to the situation with a clearer, calmer mindset, making it easier to handle without succumbing to self-sabotaging behaviors.

Self-soothing

Self-soothing, one of the DBT techniques for anxiety, helps teens remain calm during stressful times. It involves learning and practicing actions that help them feel more grounded, such as wrapping themselves in a soft blanket or chilling out to music.

Radical acceptance

It’s difficult for a teen to make changes without first accepting what they’re trying to change because resistance creates internal conflict. Change is achieved more effectively from a calm state, which is what DBT is all about. 

When a teen’s mind is split between wanting to move forward and rejecting where they are, it’s like trying to drive with the brakes on—they won’t get far. Internal conflict drains their energy and focus, making it harder to achieve their goals.

Many people think acceptance means giving up, but that’s not true. It merely means that one has removed this internal conflict from the equation. Without this unnecessary stress, a teen can see circumstances more clearly, which helps them make better decisions.  

DBT acceptance includes everything, from circumstances and situations to thoughts and emotions. Take feelings, for instance. When teens try to resist or deny them, their pain often intensifies. Surrendering to emotions by fully feeling them, by contrast, allows them to pass more quickly. 

Acceptance is about being okay with wherever you are on your life journey. Teens who are upset because they’re progressing more slowly than they’d like often blame themselves. 

But such self-criticism not only creates stress and anxiety but also drains them of energy and keeps them mired in negativity. This makes it challenging to stay motivated and focused.

DBT acceptance also applies to past events, such as trauma, mistakes, and regrets. This doesn’t mean that a teen must be happy about all that has happened, but they must acknowledge such experiences as unchangeable parts of their history. Accepting the past is necessary to prevent it from dictating the present. Acceptance also requires a teen to acknowledge that not everything is within their control. They must learn to tolerate ambiguity without becoming overwhelmed by anxiety or fear.

4. Interpersonal effectiveness

When a teen is struggling with intense emotions, it can be challenging to refrain from saying or doing things that can cause irreparable harm to their relationships. Thankfully, the DBT framework includes several DBT skills for adolescents that can help prevent this.

DBT skills for teens

DEAR MAN

DEAR MAN is an acronym that outlines a step-by-step guide for getting needs met respectfully. It also helps teens say “no” without feeling guilty. Here’s what each letter stands for:

  • Describe: State the facts clearly so everyone knows exactly what you mean. Example: “I won’t be able to meet up after school today because I have a big test tomorrow.”
  • Express: Share how you feel so others understand how the situation affects you. Don’t expect them to guess. Use phrases like, “I feel ___ because ___.” Example: “I feel stressed because I’m worried about failing this test.”
  • Assert: Be direct about what you need. Say it clearly and simply. Example: “I need some quiet time tonight to study, so can we hang out another day?”
  • Reinforce: Reward positive responses. This can be as simple as a smile, a “thank you,” or a compliment. Example: “Thanks for understanding! I really appreciate you being cool about this.”
  • Mindfulness is vital: It’s easy to get sidetracked by distractions, so keep your attention on what you’re trying to achieve.
  • Appear confident: Show confidence in how you speak and hold yourself. Even if you don’t feel confident, “fake it ’til you make it” by standing tall, speaking calmly, and making eye contact.
  • Negotiate: Be open to finding a compromise because no one always gets what they want. Example: “How about we meet up after my test is over? I’ll be able to focus better then, and we’ll have more fun.”

GIVE

Teens can easily damage relationships when struggling with out-of-control emotions. The GIVE technique outlines practical communication features that prevent relationships from suffering this fate. Here’s what it entails: 

  • Gentleness: Be kind and gentle. Avoid harsh, sarcastic, or mean responses, even if you feel frustrated or upset. Use a calm tone of voice, don’t interrupt, and try not to be defensive. This prevents anger from escalating and shows that you care about the other person’s feelings.
  • Interest: Show genuine interest in the other person’s point of view. Listen actively, hold eye contact, and give them full attention, which makes them feel understood and appreciated, making it easier to come to an understanding. 
  • Validation: Acknowledge the others’ feelings, thoughts, and opinions, even if you disagree. Say things like, “I understand why you feel that way” or “I see where you’re coming from.” 
  • Easy manner: Use a friendly, easygoing manner. Smile, use humor appropriately, and keep the conversation light when possible. This can help diffuse tension and make interactions more pleasant, even when the topic is serious.

FAST

The FAST technique helps a teen stand their ground, stay true to their values, and avoid compromising their self-respect. Here’s what it stands for: 

  • Fairness: Treat yourself and others with respect. Acknowledge your own needs but find balance by also considering the feelings of others.
  • Apologies: Genuinely apologize for mistakes, but don’t over-apologize, particularly for appropriate behaviors like setting boundaries or expressing feelings. While refusing to apologize for errors shows a lack of accountability, over-apologizing can undermine your confidence.
  • Sticking to values: Don’t compromise your values to make someone else happy or avoid conflict. It’s easy to succumb to such pressures, but this will only undermine your self-respect. 
  • Truthfulness: Be straightforward and clear about your needs, feelings, and expectations. When you’re honest, you show others that you respect them enough to be authentic and not hide behind falsehoods or games.

How DBT therapy for kids works

Individual teen DBT therapy involves one-on-one sessions, during which the clinician works with the teen to identify the underlying causes of their difficulties and develop a DBT treatment plan, including strategies for managing challenging situations. The therapist takes on a coaching role, guiding the teen in practicing DBT skills and offering personalized feedback and support to help them achieve their goals.

Each session starts by reviewing the teen’s diary card, which the teen uses to track their emotions whenever they feel like engaging in self-destructive behaviors. Then the therapist helps the teen evaluate and address the most pressing behaviors.

DBT therapists review behaviors according to a hierarchy. Target 1 behaviors are life-threatening, such as suicidal thoughts or actions, and are prioritized to ensure the teen’s safety. Target 2 behaviors are those that get in the way of therapy, such as skipping sessions. Target 3 behaviors are those that negatively impact the teen’s quality of life, such as ongoing conflicts at home or school.

After six to twelve months of intensive DBT, teens may continue with individual or family therapy for ongoing support. DBT groups are also common, as they allow teens to work on skills with peers struggling with similar problems. 

Get help for your struggling teen at Avery’s House

If your child is struggling with overwhelming emotions or has difficulty managing their behaviors, consider adolescent therapy that incudes DBT. Studies have shown that DBT for depression and other mental health challenges can significantly improve emotional regulation, helping teens find healthier ways to cope with their feelings.

At Avery’s House in Phoenix and Boise, we have a proven track record of helping teens overcome the mental health challenges holding them back from forging a fulfilling life. DBT for OCD, depression, anxiety, and other mental health conditions is just one of the many evidence-based treatments we offer. Here are some others: 

Contact us today to learn more about how we can help your struggling teen.