Dialectical Behavior Therapy (DBT) for Teens

Although dialectical behavioral therapy (DBT) was initially developed to treat suicidal thoughts in those living with borderline personality disorder (BPD), today it’s also used for several other mental health conditions — many of which are prevalent among teenagers. 

DBT can be beneficial in treating self-harm, suicidal thoughts and behavior, substance use disorder, depression, and some types of disordered eating, among other conditions. This type of therapy is effective for some people who have intense reactions to certain emotional situations. Thus, working to find emotional balance is a critical component of DBT treatment. 

DBT therapy for teens can address the emotional and behavioral issues that are common in this age group. Recent research found that an estimated 1 out of every 5 teens have symptoms of anxiety or depression. Teens today are under incredible stress and often face high-stakes issues that can be challenging to navigate on their own. 

Teaching coping skills to manage teen mental health is essential, and DBT for teenagers can be a lifeline. Keep reading to learn more about how and why dialectical behavioral therapy can be a valuable type of therapy for teens. 

What is DBT & How Does it Work for Teens?

DBT therapy for teens is a type of cognitive behavioral therapy (CBT) — also known as talk therapy. It teaches teens to dive into emotional chaos, use problem-solving, and find acceptance when dealing with crises. 

DBT is particularly productive for teenagers who find it hard to see multiple perspectives and rely on an all-or-nothing way of thinking.

DBT for teenagers can treat conditions like:

• Anxiety: DBT skills help teens learn to manage and overcome fear and anxious feelings. It provides coping skills for anxiety in teens.
• Depression: DBT teaches resilience techniques that help teens deal with depression.
• Borderline personality disorder (BPD): BPD involves intense emotions that feel impossible to manage. When you partake in DBT for borderline personality disorder, you’ll discover tools for emotional regulation and distress tolerance, which are common symptoms of BPD.
• Disordered eating: Eating disorders are about more than food — they’re about control and body image, too. Studies suggest that DBT can effectively treat disordered eating. For example, mindfulness exercises that DBT teaches can help teens regain a healthy relationship with food without engaging in self-harming behavior.
• Suicidal thinking: By addressing underlying issues and providing immediate coping mechanisms, DBT can help teens with suicidal thoughts.
• Attention deficit hyperactivity disorder (ADHD): With an emphasis on emotional regulation and control, DBT can be a beneficial addition to ADHD treatment plans.  

Benefits of DBT for Teens

DBT therapy for teens can be a game-changer, and several studies show positive outcomes in behavioral and other problems. The skills and strategies taught become a toolkit full of coping mechanisms that last throughout the teen years and into adulthood. 

DBT helps teens develop healthy social skills, learn emotional regulation, and use crisis management tools to cultivate and nurture healthy, rewarding relationships with peers, teachers, and family members.

Benefits of DBT for teens can reduce:

• Self-harm tendencies
• Anger  
• Depressive symptoms
• Days of in-patient hospitalization
• Alcohol and drug use or abuse

“DBT can be very effective for teens as it encompasses skills that help them navigate the intense feelings and challenges that can arise within themselves and others. DBT provides a framework to address negative thought patterns, regulate emotions, and shift behaviors. Given the skills within DBT, it can be very effective with a wide variety of concerns teens grapple with at this stage of life, for example, eating disorders, depression, self-harm, and ADHD, along with many other concerns.”

– Talkspace therapist Jill Daino, LCSW-R, BC-TMH

Core Components of DBT Adapted for Teens

Understanding the core components of DBT will help determine whether it might be a valuable option for treatment. This highly specialized form of therapy uses mindfulness, distress tolerance, emotion regulation, and interpersonal tolerance to achieve the ultimate goal of finding acceptance. 

Understanding mindfulness and present moment awareness

Mindfulness is about being in the moment. Research suggests it can have a positive impact on symptoms of BPD and other mental health conditions. 

Mindfulness is a skill that helps teens avoid dwelling on the past or worrying about the future. When mastered, mindfulness promotes calm and clarity. It makes it easier to focus on things that matter and can be controlled, so teens can stop wasting time and energy. 

Teens can use DBT and mindfulness to practice:

• Being in the moment: Teens learn to let go of past regrets and forget about future anxieties so they can be rooted firmly in the present. 
• Using breath as an anchor: Fast, shallow breathing is common in times of distress, but when teens focus on controlling their breath and breathing deeply and slowly, the effect is calming and grounding. Deep breathing signals the parasympathetic nervous system — also known as the fight-or-flight response — that it’s time to slow down. Research shows that breathing deeply can reduce anxiety, slow the heart rate, and calm racing thoughts. 
• Focusing on senses: The senses are pathways to the present. DBT teaches teens to focus on what they smell, hear, see, and feel so they can stay in the moment. 

Distress tolerance skills for emotional crises

Distress tolerance skills are powerful coping strategies teens can use when navigating crisis mode and trying to overcome challenges. Managing emotional pain in healthy ways can be difficult — especially for teens who rely on destructive, unhealthy, or unhelpful habits — so distress tolerance can be crucial in managing difficult times.

Teens learn distress tolerance skills like:

• Evaluating the pros and cons of a situation
• Using self-soothing techniques
• Finding things to distract them from their current state of mind
• Implementing acceptance into their life
• Stopping themselves from engaging in destructive or impulsive behaviors
• Using the idea of TIPP (temperature, intense exercise, paced breathing, paired muscle relaxation)

Emotion regulation to manage intense feelings

Emotion regulation teaches teens to manage intense feelings. They’ll learn to recognize emotions, understand where they come from, and decide how to respond rather than using an impulsive reaction. 

Teenagers who participate in DBT therapy learn to regulate their emotions by:

• Acknowledging feelings: This means allowing a feeling to surface without reacting.
• Distinguishing between fact and feeling: It can be hard to determine what’s real vs what’s just a reaction to a situation or person. Learning to separate facts from feelings helps teens see things clearly so they can assess the best way to move forward.
• Picking battles: While in the moment, an intense emotion can feel like it needs to be dealt with immediately, they don’t always require an instant reaction. Sitting with discomfort teaches the young person how to respond in healthy ways instead of using avoidance or engaging in destructive responses.

Interpersonal effectiveness for healthier relationships

Relationships are often complex and confusing — especially during the teen years — so learning to navigate them in healthy ways is important. DBT therapy for teens can be pivotal in helping young people foster deep bonds that result in productive and mutually rewarding relationships.

DBT treatment helps teens develop healthy interpersonal relationships by teaching the importance of:

• Saying what you mean: Learning to ask for what you need clearly and assertively is a life skill everyone should know. 
• Learning to deal with “no”: Hearing no without falling apart can be challenging for teens or young adults. Acceptance is pivotal in keeping doors open for future interactions, opportunities, and conversations.
• Setting boundaries: Prioritizing healthy boundaries and knowing how to enforce them helps the teen or young adult become better at demanding self-respect and teaching people how to treat them.

Walking the middle path: balancing acceptance and change

Balance and acceptance are skills all teens should master. Finding that equilibrium is easier when a teenager has the coping skills and tools to help them make sense of their world. DBT can effectively help teenagers learn to accept difficult emotions and work to change their behaviors.

Find a Teen Therapist Specializing in DBT

Dialectical behavioral therapy is an evidence-based form of therapy that helps teens manage their emotions and find success in relationships. It’s not always an easy road, but with the proper guidance and resources, teens can access powerful coping tools so they can overcome virtually anything they’re struggling with. DBT therapy for teens teaches teenagers to identify and accept how they think and feel so they can make positive life changes. 

Talkspace is an online therapy platform that simplifies the therapy process, with convenient, affordable sessions that are easy for teens to fit into their busy lives. Talkspace mental health providers are skilled, experienced, and qualified to use DBT for teens seeking help. 

If you’re interested in learning more about online therapy for teens, reach out to Talkspace today to get started. If you’re a teen living in New York City, you may qualify for free online therapy through Talkspace.

Sources:

1. Roughly 1 in 5 adolescents report experiencing symptoms of anxiety or depression. KFF. February 6, 2024. Accessed March 15, 2024. https://www.kff.org/coronavirus-covid-19/press-release/roughly-1-in-5-adolescents-report-experiencing-symptoms-of-anxiety-or-depression. 

2. Wisniewski L, Ben-Porath DD. Dialectical behavior therapy and eating disorders: The use of contingency management procedures to manage dialectical dilemmas. American Journal of Psychotherapy. 2015;69(2):129-140. doi:10.1176/appi.psychotherapy.2015.69.2.129. https://pubmed.ncbi.nlm.nih.gov/26160619/. Accessed March 15, 2024.

3. Pardo ES, Rivas AF, Barnier PO, et al. A qualitative research of adolescents with behavioral problems about their experience in a dialectical behavior therapy skills training group. BMC Psychiatry. 2020;20(1). doi:10.1186/s12888-020-02649-2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7238612/. Accessed March 15, 2024.

4. Eeles J, Walker D. Mindfulness as taught in dialectical behaviour therapy: A scoping review. Clinical Psychology & Psychotherapy. 2022;29(6):1843-1853. doi:10.1002/cpp.2764. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10084181/. Accessed March 15, 2024. 

5. Russo MA, Santarelli DM, O’Rourke D. The physiological effects of slow breathing in the healthy human. Breathe. 2017;13(4):298-309. doi:10.1183/20734735.009817. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5709795/. Accessed March 15, 2024.