When Leah was 16, she couldn’t think of a single reason to live. Leah was diagnosed with type 1 diabetes the previous summer, and since then, she and her parents had been constantly fighting about what she ate, her diabetes care, and how she spent her time. Leah started cutting herself to cope with the stress of her diagnosis and her relationship with her parents. Things only seemed to get worse. She felt like she couldn’t really trust the few friends that she had, and she seemed to always be fighting with her peers and teachers. When her girlfriend broke up with her, she decided she was “done.” Leah was hospitalized after an overdose, but during her inpatient stay, she was introduced to a psychologist from Nemours Children’s Hospital, Delaware. This psychologist suggested that Leah might benefit from participating in Dialectical Behavior Therapy, one of the few interventions proven helpful for teenagers with self-harm and lethal behaviors.
For some teens, life can feel overwhelming, and they may struggle to manage the big emotions that they experience each day, leading to risky behaviors, self-harm, and suicidal ideation. Dialectical Behavior Therapy (DBT), originally developed for adults with severe interpersonal and emotional difficulties, has proven to be a safe and helpful therapy for teens struggling with these issues. Nemours Children’s Hospital, Delaware offers one of only two Comprehensive DBT Programs in the State.
So, what is Dialectical Behavior Therapy? DBT is a type of cognitive-behavioral therapy (CBT) that emphasizes teaching skills to manage emotions, deal with emotional crises, solve problems, and engage in better relationships. The term “dialectical” refers to the integration of opposites—in this case, the acceptance of one’s experiences and the need for change. DBT is particularly effective for individuals who experience intense emotions and engage in self-destructive behaviors. As DBT creator Marsha Linehan would say, DBT recognizes that youth who are struggling need a balance of support and validation, along with the skills and encouragement to make changes toward a “life worth living.”
DBT for teens involves several key components:
- Individual Therapy: Teens meet one-on-one with a therapist to discuss their specific challenges, strengths, and areas of progress. This setting allows for personalized guidance and support.
- Group Skills Training: Teens participate in group sessions where they learn and practice DBT skills. These sessions are typically divided into four modules:
- Mindfulness: Developing awareness of the present moment and understanding thoughts, feelings, and sensations without judgment.
- Distress Tolerance: Learning techniques to tolerate and survive crises without making them worse, such as self-soothing and distraction.
- Emotion Regulation: Identifying and managing intense emotions to reduce vulnerability and increase positive experiences.
- Interpersonal Effectiveness: Building skills to communicate effectively, set boundaries, and maintain healthy relationships.
- Phone Coaching: Teens can reach out to their therapist between sessions for guidance on applying DBT skills in real-life situations. This support ensures they have the tools to handle crises as they arise.
- Therapist Consultation Team: DBT therapists meet regularly to support each other, ensuring they provide the best care possible. This team approach helps maintain therapist effectiveness and adherence to DBT principles.
DBT has been shown to have the following benefits:
- Reduced Self-Harm and Suicidal Behaviors: DBT equips teens with coping strategies to manage distress, reducing the need for self-destructive behaviors.
- Improved Distress Tolerance and Emotional Regulation: Teens learn to understand and manage their waves of emotions.
- Enhanced Relationships: By developing effective communication skills, teens can build and maintain healthier relationships with family, friends, and peers.
Leah completed DBT group last fall and still works with her therapist every few weeks. She still has strong emotions, but she now has the skills from group that she uses instead of self-harm. And even though she and her parents still have arguments, she and her mom feel the communication skills they learned helped them take time to understand each other better and take breaks when their emotions run hot. Today, she is preparing for her senior year of high school and is even thinking about college.
Dialectical Behavior Therapy offers a lifeline for teens struggling with emotional dysregulation and self-destructive behaviors. If you or someone you love is between the ages of 12 and 17 and might benefit from DBT, please reach out to the Delaware Valley department of Behavioral Health at 302-651-4500. We offer in-person and telehealth consultations, and skills groups are held virtually.
Christina Cammarata, PhD, ABPP is the Clinical Director of Clinical Child and Community Psychology for Nemours Children’s Health in the Delaware Valley.
