Adolescent Mental Health in 2024: DBT-A Efficacy and How it Helps
We have been specializing in working with adolescents since we began practicing psychotherapy, and it’s one of our main clinical interests. Throughout this time, we’ve observed consistent, remarkable outcomes in utilizing DBT-A for teens and families. Our adolescent patients typically present in treatment with a range of concerns, including depression, anxiety, OCD, eating disorders, difficulties with life transitions and shifting identity into early adulthood, substance abuse and PTSD. We also have significant clinical experience with teens who engage in self-harm, experience suicidal ideation, exhibit high risk-behaviors and school avoidance, and report ongoing conflict in interpersonal relationships or within their families.
In recent years, we’ve seen our teen patients struggling more than ever, and we’re deeply concerned and invested in both the causes and solutions as mental health providers and parents. From experiencing formative developmental years during Covid, to the various pressures of living in high-achieving areas like Northern New Jersey and NYC, to managing a myriad of current concerns, like navigating social media, there are so many factors that are currently exacerbating mental health symptoms and related issues. Current research estimates that approximately 1 in 5 teens are experiencing symptoms of depression and/or anxiety that is causing functional impairment in some capacity.
So, where does the acronym-loving treatment known as DBT come in?
DBT-A is DBT adapted for adolescents by Alec Miller, PhD and Jill H Rathus, PhD from Marsha Linehan’s original treatment and research. DBT-A, strongly committed to research just as DBT is, has been extremely and extensively studied since, with consistently promising and clear outcomes. Here's just one study showing the efficacy of DBT-A. There are hundreds of studies and articles that reinforce the same.
This therapy approach combines cognitive-behavioral techniques with mindfulness practices to help individuals develop core coping skills and regulate their emotions, while also focusing on building a strong, collaborative therapeutic alliance. The therapist approaches each individual with a commitment to maintaining a dialectical balance of acceptance and change. What exactly does this mean? DBT highly prioritizes creating a validating, non-judgmental environment, while also identifying the function or cause of various target behaviors that we are addressing in treatment to assess which pieces we can collaboratively build on working and changing session-to-session. Through interventions like behavioral chain analyses, we help our adolescent patients gain insight into their own thoughts, emotions, and actions/action urges, while being able to understand and validate where these distressing symptoms may be coming from, and why. This process lets us build new skills, and approach or respond to thoughts, emotions, and action urges in a way that aligns with the individual’s values and wants and needs, not their emotion-minded wants and needs.
How Comprehensive DBT-A Treatment Benefits Teens:
Improved emotional regulation: One of the key components of DBT is learning how to effectively regulate unwanted emotions. Teens do experience more intense and fluctuating emotions, and DBT provides them with strategies to manage emotions in a more effective way, which helps build confidence and resiliency, and reduces the likelihood of behaviors like self-harm. These emotion regulation skills provide the tools to experience emotions without engaging in avoidant or maladaptive behaviors, while still being able to experience emotions and get comfortable feeling uncomfortable. The goal is to “get better at feeling” rather than always trying to “feel better” (or numb oneself out). Unfortunately, these types of skills are rarely taught to children, though we all need these skills to be effective as adults. We also work with our teens to identify what their life worth living looks like, what values and priorities are important to them, and how to work toward avoiding avoiding, reducing overall emotional vulnerabilities, and understanding their emotional experiences and what information emotions may be providing.
Interpersonal skills: Adolescence is a time of significant social and emotional development, and teens (like the rest of us, just more acutely!) struggle to navigate relationships with their peers and family members while trying to figure out who they are and what they want. DBT focuses on navigating and utilizing effective communication skills, assertiveness, conflict resolution interventions, how to set boundaries, building healthier relationships, challenging interpersonal myths, and improving overall social relationships. In adolescence, self-perception is deeply linked to others’ perceptions, which is further influenced by social media, and the comparisons and pressures it brings. While this completely makes sense, as adolescents are burgeoning adults and learning how to function within a community and seek acceptance, it can become quite complicated. As such, we also focus heavily on teaching how to self-validate, and recover from invalidation when it does occur, while staying true to oneself and ones’ own values.
Increased mindfulness: Mindfulness is a core component of DBT and involves being present in the moment without judgment. Teens are often juggling so many responsibilities between schoolwork, family time, extracurricular activities, preparing for college, and social relationships, and it’s nearly impossible to engage in any sort of ongoing mindfulness practice. In fact, their lives are programmed and structured to essentially not engage in any sort of mindfulness practice, and it’s not their fault! Many of our teens report they are excellent multitaskers, though experience significant anxiety trying to get everything done, in the way they want to get it done. Unfortunately, this leads this age group to get lost in the future and not be focused on the present.
This poses a significant issue. Simply put, lack of mindfulness often makes it impossible to see reality ‘as it is’ and conversely makes it easy to get wrapped up in things that may not be an accurate depiction of reality (that test score is going to ruin my life). It also makes it difficult to see what one truly wants because there’s not a clear idea of what is actually happening and what may it may “mean” in the greater context of ones’ life.
Practicing mindfulness scientifically reduces stress, anxiety, and rumination, and allows us to engage in our lives intentionally and with purpose that allows us to stay grounded. By learning to be more present and aware of thoughts, feelings, action urges, and values, teens can significantly enhance their self-awareness, emotional well-being, and focus on their priorities in a more balanced and constructive way.
“Coping skills”/Distress Tolerance and Radical Acceptance: DBT-A equips teens with a toolbox of what many may identify as stereotypical “coping skills” to manage high distress, anxiety, depression, and other mental health symptoms while in extremely challenging situations. Distress tolerance skills focus on getting through short-term, emotionally-activating experiences without engaging in behaviors that will make ones’ life worse or cause additional suffering, even if an individual can’t immediately make something “better.” This set of skills tends to be many of our teen patient’s favorite skills, as they are able to find many easily accessible things to re-regulate, even in times of severe dysregulation. These skills also build a strong sense of mastery over how they respond to their own emotions and distress, and feeling in control despite external things feeling out of control. Distress tolerance skills are designed to be alternative behaviors to utilize when in a crisis.
Additionally, we focus on reality acceptance skills, and differentiate that while we all must deal with pain (because life is painful and not often easy!), we do not have to suffer. Reality acceptance focuses on working with what we have right now, even if we don’t want it for very valid and genuine reasons.
Reduced risk of self-harm and suicidal ideation: Research has shown that DBT is an extremely effective treatment for reducing self-harming behaviors and suicidal ideation in teens. In fact, it’s the gold standard!
To quote NIH, “In DBT, NSSI and suicidal behaviors are viewed as responses to unbearable emotional suffering, and though they may be dysfunctional, they are highly effective emotion regulation strategies. Indeed, they dramatically reduce emotion intensity and immediately relieve from intense suffering.” Through individual DBT therapy and DBT skills training, we are able to teach much more effective emotion regulation and distress tolerance strategies to replace the aforementioned, while also really focusing on how to help each individual build the life they want, while decreasing overall emotional dysregulation.
Comprehensive, accurately-provided DBT is one of the very few evidence-based practices that research shows reduces suicide risk. As DBT therapists, we’re trained to address suicidal thoughts and self-harm behaviors directly, engage in thorough assessment, engage in ongoing monitoring and evaluation of these thoughts and behaviors session-to-session, reduce the use of psychiatric hospitalization and provide skills-based interventions to reduce suicide risk, identify and work toward long-term solutions to reduce suicidal ideation, and are available between sessions for skills coaching and support.
We know through all of this extensive research and practice experience that DBT-A is a truly life-changing treatment. We also know that it’s extremely important to receive comprehensive and adherent DBT through specialized DBT-trained providers. Unfortunately, many providers may teach the skills in the workbook, though have never received training in the complexities and principles interwoven throughout the treatment, and are providing “DBT-Informed” care. This type of treatment does not have the same outcomes that DBT, as it was originally researched and intended to be provided, does. We are firm believers in providing all modes of treatment (individual, multi-family skills group, skills coaching- i.e. teens can reach out to their therapist for skill generalization and support, parents can reach out to their parent coach for assistance in utilizing skills when parenting, and our DBT consultation team where individual cases are discussed and collaborated on to ensure fidelity to treatment and best care principles), and have an extremely high standard for training for all of our clinicians. Each therapist has been trained through the treatment developer’s training company, Behavioral Tech, and has collective decades of experience in treating teens and families utilizing DBT. When you work with us, you work with our entire team!