Is Dialectical Behaviour Therapy (DBT) Effective for Teens?

If you’re a teenager or a parent of a teenager who is experiencing some challenges, you might be recommended Dialectical Behaviour Therapy (DBT). With all the different support options out there, it’s natural to wonder what actually works. While there is no one-size-fits-all answer to this, DBT might be a promising option. DBT was designed to help people manage strong emotions and maintain stable relationships—difficulties which are commonly experienced by teenagers.

Why would teens benefit from therapy?

Adolescence is a time of considerable change—physically, sexually, emotionally, and psychologically. Brain and hormonal changes bring about rapid developments in how young people relate to others and themselves.

In the teen years, we typically see great strides in logical reasoning abilities, depth of emotional experience and social connection, independence, and identity—this is largely a time of exploring who we are and our place in the world. However, adolescence can be a time of confusion, self-consciousness, conflict, and emotional turmoil. New and strong emotional experiences can be overwhelming for teenagers as well as those around them.

It’s common for teenagers to face some challenges, and many of these can be managed with support from family and friends. However, some teens and their families struggle more than others and can benefit from extra guidance, particularly when parents are also feeling overwhelmed.

For teens and families with more challenging experiences—such as violent conflict, self-harm, excessive drug use, unsafe sex, or any behaviours that may be dangerous—support from a qualified mental health professional is highly recommended.

How can DBT help?

While the name might sound somewhat technical, DBT is a form of talk therapy that is intended to be relatable and engaging, and to help individuals build skills that they can use in daily life. DBT usually consists of a structured program that spans over several weeks or months and often involves multiple components, typically including both group and individual sessions. The format might differ slightly depending on the concerns being addressed. Read more on how DBT can help with anxiety.

The word dialectical was used to describe this therapy as it refers to the integration of different perspectives. DBT centres around the understanding that there are many ways to view a situation and that seemingly opposing ideas can be true at the same time. For instance, the idea that emotions can be valid and they can be unhelpful, or that one is doing the best they can and they can do better.

DBT includes elements from Cognitive Behavioural Therapy, such as finding more helpful ways of thinking and encouraging constructive behaviours. These skills are combined with techniques from eastern practices, such as mindfulness, self-reflection, and acceptance.

DBT integrates methods that are otherwise considered to be contradictory (e.g., acceptance and change), which allows for multiple challenges to be addressed at once. This approach is different from many therapies which focus on one challenge at a time.

The specific areas that DBT addresses include:

• Emotion management: DBT includes activities specifically designed to help with naming emotions, understanding their function, and how they affect our bodies and actions. Through this understanding, DBT helps individuals to experience emotions and allow them to pass, rather than pushing them away or becoming “stuck” in an emotion. DBT also focuses on how to increase positive experiences and emotions in our daily lives. 

• Impulsive behaviour: Difficulties managing emotions can often result in actions that are emotion-driven and not well thought out. DBT includes a focus on managing high levels of distress by learning calming techniques and practicing acceptance. These skills can help to reduce impulsivity and risk-taking.

• Relationship challenges: DBT aims to improve the quality of the various relationships in people’s lives. This is addressed by incorporating activities which help to build effective communication skills, including showing empathy and perspective taking, being honest, understanding personal boundaries (of others and our own), and being assertive.

• Confusions about identity: By building mindfulness skills, DBT helps individuals gain more awareness and sense of control over their own thoughts and actions. DBT also focuses on finding balance between emotional and logical reasoning. These skills allow for a deeper understanding of oneself and our place in the world.

DBT for teens

A version of DBT has been developed with the goal of being more relatable and appropriate for teenagers and the specific types of challenges that teens and their families often experience. This adapted DBT includes practical changes like a shorter duration of therapy and more suitable language, as well as some additional content specifically tailored to teens.

DBT also includes a protocol to encourage individuals to stick with therapy—teens can sometimes struggle to stay engaged in other types of therapy.

In addition to the areas addressed in DBT described above, some of the specific focuses of DBT for teens include:

The teen-parent relationship

One of the main topics of focus in DBT for teens is on improving the teen-parent relationship. The therapy identifies common points of conflict in these relationships and teaches skills for managing these conflicts.

Sometimes tensions can arise between teenagers and parents as teens begin to assert more independence.

Teens might sometimes feel like they are not being allowed the level of autonomy they crave, and parents can feel like teens are not respecting their role in keeping them safe. DBT not only helps teens to improve their communication skills, but also works on building the skills of parents, with the aim of finding a sense of mutual respect.

Distinguishing between typical and not-so-typical teen challenges

As some degree of identity confusion and emotional difficulties are typical during adolescence, it can be tricky for individuals and families to know what experiences are “normal” and what might be especially concerning. DBT for teens helps to tease apart experiences that are common from the less common—reducing the perception that typical behaviours are “wrong”, while also decreasing tendencies to normalise problematic behaviours.

All-or-nothing thinking

As teenagers’ abilities to think through complex problems and consider various perspectives are still developing, teens are especially prone to perceiving the world in black and white.

DBT for teens has introduced a specialised module called walking the middle path. This set of activities dives deeper into the dialectical concept and focuses on helping teens to balance their thought processes, rather than thinking in extremes. For instance, teens can benefit from replacing “either-or” terms with “both-and” terms (e.g., instead of “I can either be independent or do everything my parents say” it could be “I can be independent and find compromises with my parents”).

Walking the middle path also helps teens to appreciate the notion that there is no absolute truth, and that differing opinions can be equally valid, even those you don’t agree with. This approach can help teens to reduce their reactivity, improve their perspective taking skills, and solve problems in more constructive ways.

Choosing DBT

Above all, DBT aims to empower teenagers to take charge of their own journeys by encouraging both acceptance of themselves and motivation to grow.

Teens can often feel that the world is against them, and DBT acknowledges these feelings while helping them to realise that, even if they have not caused the difficulties they face, they have ultimate responsibility for their actions and reactions.

That said, the central motto of DBT is that everyone is doing their best at any given time and emphasises that teens and their families cannot fail DBT.

Research shows that the teenage adaptation of DBT has been effective for improving the quality of life for many teens and their families.

If you are a teen considering therapy, or a parent seeking therapy for your teen, you may like to consider finding therapists who use DBT in their practice. DBT programs might be offered at community mental health centres. You can also try some DBT techniques in Mind Ease—an app which offers a range of short activities for managing anxiety, including activities derived from DBT.