DBT for Adolescents

For decades, psychologists have said that adolescence is a tumultuous time. Until recently, we blamed it on puberty and hormonal changes. However, new research bears out that hormones may only be a small part of the equation. Thanks to the work of people such as Dr. Dan Siegel, we now know that the adolescent brain undergoes extensive changes and growth from the onset of puberty until about age twenty-five.

How does this knowledge change the way we think about adolescents?

Some teens are more biologically prone to emotional sensitivity. This means they experience their emotions more intensely, more frequently and for longer periods of time than many of their peers. If there is a biological predisposition to anxiety or a mood disorder, the emotional dysregulation can sometimes trigger a major depressive disorder or anxiety disorder.

Thanks to a better understanding of how dopamine works in the brain, we know why thrill-seeking behaviors and intense sensation-seeking can become addictive, and even dangerous, for emotionally sensitive teens. Because the frontal cortex is the last part of the brain to fully mature at approximately twenty-five years of age, adolescents are often unable to effectively navigate the consequences of their actions. The brain is primed at this age for learning. 

What does the research tell us about the importance of treating depression and emotion dysregulation in teens?

According to the National Comorbidity Survey-Adolescent Supplement, about 11 percent of adolescents have a depressive disorder by age 18. Girls are more likely than boys to experience depression. According to the World Health Organization, major depressive disorder is the leading cause of disability among Americans age 15 to 44.

According to a 2007 study funded by National Institute of Mental Health, suicide was the third leading cause of death for youth ages 15 to 24. The Treatment of SSRI-resistant depression in adolescents (TORDIA) study found that teens who did not respond to a first antidepressant medication are more likely to get better if they switch to a treatment that includes both psychotherapy and medication.

How does DBT address the needs of adolescents struggling with emotion dysregulation, self-harm, and other ineffective coping mechanisms?

In 2007, Marsha Linehan, Ph.D., Alec Miller, Psy. D. and Jill Rathus, Ph.D. published their research in Treating Suicidal Adolescents Using Dialectical Behavior Therapy. (Guildford Press) Their evidence-based protocol for treating adolescents is the model by which clinicians apply DBT for this population. 

DBT addresses the challenges listed above by teaching teens and their parents about current brain science. DBT teen classes for both high school and middle school ages involve a consistent parent/guardian or significant adult who attends class as a student along with the child. This allows young people to learn from adults other than their parents and for parents to see their own child in a more normalized way. This kind of reassurance helps parents regulate their own emotions as they "let go" to allow teens to make choices. Having a parent learn and use skills also helps ensure continued use of skills in the home where teens need to feel both support and structure as they navigate their entrance into adulthood.

How does a DBT skills class for adolescents work?

• The length of time to complete all modules is 20 weeks.

• New members enter and leave as individual modules are completed.

• A teen’s individual therapist must be willing and capable of providing skills coaching according to the DBT Adolescent protocol.

• At times parents and teens meet separately in order to give parents and teens role-specific coaching and general parenting/teen support. During these times, the non-participating parent may join the class.