Dialectical Behavioral Therapy

Dialectical Behavior Therapy (DBT) is an intensive, highly structured intervention, which was originally developed by American Psychologist Dr. Marsha Linehan to treat adult borderline personality disorder – a mental illness that afflicts individuals with a range of symptoms from chronic suicidal thoughts and/or self-harming behaviors to anxiety and depression. From her work, Dr. Linehan reconceptualised the disorder as a specific dysregulation of the emotion system. Her findings parallel with the clinical presentation of individuals suffering from borderline personality disorder as they predominantly have difficulty regulating their moods, consequently bringing about impulsivity in their actions and interpersonal conflicts. From reviewing the effectiveness of therapeutic methods, specifically Cognitive Behavioral Therapy (CBT) and Mindfulness, to ameliorate these symptoms, Dr. Linehan successfully moulded the acceptance techniques of mindfulness with the change strategies of CBT to create DBT.

Since its emergence, DBT has been adapted specifically for adolescents with extreme emotional instability, including self-harm and suicidality. DBT is designed to aid severe emotional dysregulation – the inability to manage intense emotions adaptively and appropriately. Dysregulation of emotions typically then results in impulsive, self-destructive and potentially self-harming behaviors as methods of maladaptive coping. Therefore, the purpose of DBT is to enable adolescents with techniques to understand their intense emotions without judgement (the mindfulness component) while supporting them with strategies to effectively manage those emotions and change behaviors toward adaptive functioning and better quality of life.

DBT for adolescents actively involves both individual therapy and group skills training for the family. As mentioned above, it is a highly structured program and incorporates five components:

  1. Mindfulness skills: learning to be present in the moment and non-judgemental when understanding the signs of un- regulated emotions
  2. Emotion regulation skills: Coping with distressing situations by harnessing positive, self-soothing experiences to buffer against intense emotional triggers
  3. Interpersonal skills: Teaching adolescents how to interact effectively with others and enable them to feel supported within their social network.
  4. Distress tolerance skills: Building awareness and recognition of urges to act and behave in ineffective ways, such as self-harming behaviors, and moving toward consciously controlling them.
  5. ‘Walking the middle path’ skills: Adolescents and their parents learn how to validate one another, how to compromise and negotiate and how to perspective take. These skills mainly focus on understanding and acknowledging the existence of multiple truths between children and parents.