Dialectical Behavior Therapy (DBT) for Children, Preadolescents, Adolescents, and Young Adults: A Treatment for Undercontrolled Copers
Dialectical Behavior Therapy (DBT) is an evidence-based treatment for individuals who struggle with regulating and tolerating their emotions. Individuals who benefit from this comprehensive treatment tend to feel their emotions intensely and react to their urges impulsively. The behaviors that individuals exhibit when they react are often ineffective and can grow negative emotions even more. Ultimately, this undercontrolled (UC) style of coping can create impairments in functioning, especially with respect to relationships, work, and school.
An undercontrolled (UC) coper who may benefit from DBT can exhibit the following:
Impulsive behaviors that are often disruptive
Signs of inattention
Emotional lability, or mood swings
Self-injurious and suicidal behaviors
Conflict with family and peers, or in romantic relationships
Outbursts that appear angry
Inconsistent/disordered behaviors in areas such as:
Sleep
Eating
Self-care
Work/School
Substance use
Screen use
Anxious and/or depressed mood
Changes in mood and behavior in the 7-10 days prior to menstruation
Consistent use of poor coping skills to manage emotions
OUR APPROACH
We are intensively trained in DBT and participated in blah blah training with senior DBT clinicians including Adam Payne, André Ivanoff, and Charles Swenson. Dr. Hamlet is also formally trained in DBT for Children
We currently use DBT to treat clients of all ages and their families who struggle to regulate and tolerate their emotions. Treatment for teens and young adults consists of:
A consultation or evaluation to determine goodness of fit for the treatment
Individual treatment, usually 45 minutes weekly where patients work on specific problem behaviors and apply techniques learned in group therapy to their goals.
DBT Skills Group, where UC copers learn healthier ways of approaching their stressors. Parents of teens learn the content alongside their child in group, while young adults learn content with peers.
Coaching, where the patient (and where appropriate, parents) can reach out to their therapist for in the moment crisis-based support outside of the therapy appointment time
Consultation for the therapist, which consists of a group of practitioners who are trained in DBT. Here, we seek support and share knowledge to best support our patients and their families.
Separate parent consultation as needed for parents of young adults, or parents who need support beyond learning skills with their teens
In individual therapy, we work with patients on adaptive coping and emotional control by targeting the following general areas:
Increasing mindfulness capacity (of thoughts, feelings, actions). Increased awareness provides us with greater chances of being able to respond to a stressor adaptively
Teaching the concept of dialectics, or how to move away from extreme/black and white approaches to thought and behavior
Increasing validation, or acknowledgment of patients’ pain and life struggles with the goal of enhancing trust, connection, and eventual behavior change
Addressing and altering life threatening, therapy interfering, and quality of life interfering behaviors that are getting in the way of achieving goals and living by individuals’ values. We address these target areas through:
Practicing and using DBT Skills
Enacting stimulus modification or control- removing or altering elements of one’s life to decrease risk of emotional reactivity
Teaching cognitive modification- a movement towards adaptive/healthy ways of thinking
Implementing contingency management strategies- practicing and reinforcing adaptive behaviors in line with patients’ values and goals
Utilizing exposure therapy to help patients approach and work through their emotional pain
In Skills Group, we teach UC copers (and when appropriate, their families):
Mindfulness, to increase awareness of thoughts, feelings, body sensations with the goal of adopting new behaviors in response to stressors
Dialectical theory, and how to practice thinking and behaving dialectically
Ways of changing behavior through principles like:
Shaping
Reinforcement
Altering what may be causing problematic behaviors
Interpersonal skills aimed at helping individuals to:
Be appropriately assertive
Build and maintain relationships
Live according to their values
Distress Tolerance Skills aimed at teaching patients how to get through hard moments/times that cannot be changed
Emotion Regulation Skills aimed at teaching patients how to alter their emotional presentation if context allows
Groups are 20 weeks for one cycle and occurs weekly for 90 minutes. Patients may choose to repeat a cycle to deepen their skills proficiency. Skills class is generally available for teens and young adults.*
Treatment is usually most effective with all components working in tandem, however the model can be flexible.
*Skills class is currently being held on Zoom. Please contact Hamlet Therapy about current group availability within the practice.
Preadolescent and Child-Focused DBT (DBT-C)
DBT Treatment structure for preadolescents and children differs slightly from teen and young adult focused DBT.
With younger patients, the goal is to ensure that parents are trained in DBT and work to create a change ready environment so that children have a safe, supportive space to change behavior. There is an increased focus on parent involvement and behavioral parent training strategies.
There are two overall models of treating children with DBT:
Individually focused parent sessions, with eventual involvement of the child
Individual therapy for children, along with a group component (the child learns in one group, and parents learn in a separate group)
Phone coaching and consultation for the therapist is available in both models
The determination for which model is most appropriate is at the clinician’s discretion and involves considering the individual needs of each family based on several criteria.
For more information on DBT, click here, or here.