What is Dialectical Behavior Therapy (DBT)?
Dialectical Behavior Therapy (DBT) is a type of cognitive-behavioral psychotherapy originally designed to help more effectively treat chronically suicidal individuals and those who have borderline personality disorder. Over time, DBT has been adapted and found effective in treating various mental illnesses, such as PTSD and depression.
Characteristics of DBT:
Dialectical Behavior Therapy (DBT) has been found to be effective for teens in crisis due to several key characteristics that make it particularly suitable for this population. Here are some of the characteristics that contribute to the effectiveness of DBT for teens in crisis:
- Emphasis on validation: DBT recognizes the importance of validating the experiences and emotions of individuals, including teens in crisis. Validation helps to establish a trusting therapeutic relationship and validates the struggles and difficulties they are going through. For teens who may feel misunderstood or invalidated, this approach can be particularly beneficial in fostering engagement and motivation to participate in therapy.
- Skill-building approach: DBT provides practical skills that can be learned and practiced by teens. This approach is essential for adolescents who may not have developed effective coping strategies or emotional regulation skills. By teaching specific skills in mindfulness, interpersonal effectiveness, distress tolerance, and emotional regulation, DBT equips teens with the tools they need to navigate crises and manage their emotions in healthier ways.
- Focus on emotion regulation: Adolescence is a time of heightened emotional intensity, and teens in crisis often struggle with regulating their emotions. DBT specifically targets emotion regulation skills, helping teens understand and manage their emotions effectively. By learning to identify triggers, label emotions, and apply appropriate coping mechanisms, teens can gain a greater sense of control over their emotional experiences, reducing impulsive and self-destructive behaviors.
- Adaptive coping strategies: DBT emphasizes the development of adaptive coping strategies to replace maladaptive behaviors. Teens in crisis often resort to self-destructive behaviors such as self-harm, substance abuse, or impulsive actions. DBT provides alternative coping skills and strategies, such as distraction techniques, self-soothing methods, and problem-solving approaches, to help teens manage distressing situations and navigate crises in healthier ways.
- Family involvement: DBT recognizes the importance of involving families in the therapeutic process. Teens in crisis often benefit from support and guidance from their families. DBT includes a family component, such as family therapy sessions or skills training for parents, to improve communication, increase understanding, and strengthen the support system around the teen. This involvement can enhance the effectiveness of treatment and promote better outcomes for the teen.
- Non-judgmental and collaborative approach: DBT therapists approach teens in crisis with empathy, non-judgment, and collaboration. This creates a safe and supportive environment where teens can openly express their thoughts and emotions without fear of criticism or punishment. The collaborative nature of DBT allows teens to actively participate in their treatment, giving them a sense of empowerment and ownership over their progress.
DBT utilizes individual psychotherapy sessions and group therapy sessions to help individuals come to terms with and accept and deal with uncomfortable emotions, thoughts, and reactions rather than struggling with them. DBT helps students to learn to regulate their emotions and address problems head-on, rather than engaging in problematic behavior and unhealthy coping mechanisms, such as self-injury, self-deprecation, and substance use/abuse.
By addressing their unique needs and challenges, DBT can help adolescents develop resilience, enhance emotional well-being, and build a foundation for healthier and more fulfilling lives.
The Four Modules of DBT:
DBT consists of four main modules, each focusing on a specific set of skills that help teens develop more adaptive coping strategies and improve their overall well-being. The four modules of DBT are:
Mindfulness is a core component of DBT and serves as the foundation for the other modules. It involves cultivating present-moment awareness without judgment. In the context of DBT, mindfulness helps individuals observe and describe their internal experiences, such as thoughts, emotions, and bodily sensations, with acceptance and without getting caught up in them. By practicing mindfulness, individuals can develop a greater capacity to stay present, regulate their emotions, and make more deliberate choices rather than reacting impulsively.
Interpersonal effectiveness focuses on enhancing communication and relationship skills. This module teaches individuals how to express their needs and wants effectively, set boundaries, and navigate challenging interpersonal situations. It also helps individuals develop skills for building and maintaining healthy relationships, assertiveness, and problem-solving. Interpersonal effectiveness training aims to improve communication patterns, increase self-respect, and foster positive interactions with others.
Distress tolerance is about learning to tolerate and manage distressing situations and emotions without resorting to destructive or impulsive behaviors. This module provides individuals with tools and techniques to endure difficult emotions, tolerate distress, and avoid engaging in self-destructive behaviors, such as self-harm or substance abuse. Distress tolerance skills include distraction techniques, self-soothing strategies, improving the moment, and accepting reality. By building distress tolerance skills, individuals can navigate crises and maintain stability in the face of adversity.
Emotional regulation focuses on developing skills to better understand, manage, and regulate emotions. This module helps individuals identify and label emotions accurately, understand the functions of emotions, and learn strategies for changing unwanted or intense emotions. Emotional regulation skills include recognizing triggers, reducing emotional vulnerability, increasing positive emotional experiences, and applying healthy coping mechanisms. By improving emotional regulation, individuals can enhance their ability to cope with challenging emotions and reduce emotional reactivity.
These four modules in DBT work together to provide a comprehensive approach to help individuals build a life worth living. By incorporating mindfulness, interpersonal effectiveness, distress tolerance, and emotional regulation skills, individuals can develop a greater sense of self-awareness, improve their relationships, effectively manage distress, and regulate their emotions more effectively. DBT aims to empower individuals to create a balanced and fulfilling life while addressing the challenges they face in their mental health and well-being.
Combing Nature Therapy With Dialectical Behavior Therapy for Teens
Nature therapy allows students to interact with others, build on strengths, and practice what they have learned. This is because DBT coincides perfectly with a lot of the principles of nature therapy.
Nature therapy utilizes overwhelming mastery experiences to build on an individual’s strengths and increase self-efficacy. While during outpatient DBT, individuals are expected to go home and practice the techniques, individuals are faced with new challenges, unpleasant emotions, and unfamiliar experiences daily. This allows students to practice their new learned coping skills daily, but in the unfamiliar surroundings of nature with an experienced guide to help them along their way.
In addition, therapeutic group living offers an excellent opportunity for young ladies to engage in group therapy with others who are overcoming similar obstacles and learning the same coping techniques. This offers even more opportunities for them to practice the “interpersonal effectiveness” techniques learned during DBT.
Dialectical behavior therapy addresses problematic behavior rather than treating a diagnosis; nature therapy helps to reinforce the strength building and the confrontation of negative emotions while teaching teens healthy coping strategies. If your teenager is struggling, a combination of nature therapy and DBT may be the answer your family has been searching for.
Benefits of a Nature-Based Short-Term Residential Treatment Program
Being immersed in nature can have a profound impact on a teenager. It improves their mental, emotional, and physical health. Combined with a proven clinical approach, a therapeutic experience helps teens heal. Here are specific benefits your family can expect to see while your teen is in nature-based short-term residential treatment.
The first stage of effective short-term residential treatment focuses on assessment and stabilization.
By observing your teen in a novel environment, our experienced therapists gain a deep understanding of what is really happening with your child. Research indicates accurate mental health assessments can lead to a 20% reduction in the number of days in treatment.
Mental health stabilization provides a safe environment to deescalate your teen’s level of distress and/or reduce their acute symptoms of mental illness. Until teens feel genuinely safe, they cannot begin to heal. One therapeutic modality emphasizes that “Cues of safety are the treatment” and “safety is defined by feeling safe and not simply by the removal of threat.” It is not enough to merely tell a teen in crisis that they are mentally and emotionally safe, they must actually feel and believe it.
Once your teen feels safe, our wilderness-based residential treatment program provides a novel and challenging environment that disrupts their unhealthy patterns and behaviors. Behaviors that either:
- cause your teen's mental & emotional health struggles
- or that your teen has developed as a negative way of coping with their struggles.
The second stage of an effective residential treatment program focuses on engaging teens in the therapeutic process and empowering them with the skills needed to thrive.
1. Engaging Teens in Therapy (even if they’ve been resistant to it before)
The ThreePeaks Ascent treatment program is designed to re-engage teens in healthy adolescent development. When your teen attends a short-term residential program, they are taken away from negative distractions they may have at home. They engage in treatment in a way that would not be possible in any other setting.
Your teen will participate in individual, group, and family therapy sessions while in treatment. This allows them to process their behavior as well as make changes in their personal life and family relationships. They are also able to learn from their peers, realize they are not alone in their struggles, and gain motivation to make changes.
We've found that by the time of discharge, 90% of teens were actively engaged in treatment. When contacted six months after treatment, most of these teens maintained the motivational progress they made during treatment.
2. Empowering Teens Through Skill Development
As your teen engages in the therapeutic process, they’ll start to see huge progress. But for long-term healing, it is not enough to only alleviate your teen’s struggles, we must also empower them with the skills needed to thrive in life. These skills include:
- Self-awareness skills like a growth mindset, identifying one's feelings, developing interests & sense of purpose
- Self-management skills like emotional regulation, self-motivation, resilience, setting & achieving goals, planning & time management
- Responsible decision-making skills like showing curiosity & open-mindedness, anticipating & evaluating the consequences of one’s actions, internal locus of control
- Relationship skills like communicating effectively, seeking & offering support, resolving conflicts constructively
- Social awareness skills like showing empathy & compassion for others, taking others’ perspective, recognizing strengths in others
Your teen is powerful, intelligent, and capable. They are among the leaders of tomorrow. That is why the third stage of our short-term residential treatment program focuses on helping teens redirect their previously misused potential toward developing mastery in life.
Philosopher Friedrich Nietzsche observed years ago, “Happiness is the feeling that power is increasing—that resistance is being overcome.” When teens develop competence and mastery they:
- gain self-reliance and self-confidence
- become more resilient
- have a greater sense of meaning and purpose
- and better resist negative emotions.
Overall, building mastery helps teens develop a positive mindset. Because they feel competent and in control, they go from feeling, “I’m not capable” to “I can do this!”
About the Author
Steven DeMille, Ph.D. LCMHC
Steven DeMille is the Executive Director of ThreePeaks Ascent. He is a Licensed Mental Health Counselor. His educational experience includes an MA in Mental Health Counseling and a Ph.D. in Counselor Education and Supervision. His research focus is on Nature-Based Short-Term Residential Treatment, nature, adolescent development, and counseling ethics. He is actively involved in the counseling and psychology profession and holds regional and national leadership positions. He publishes and presents on Nature-Based Short-Term Residential Treatment and the use of the outdoors. This is done around the world at the national and international conference levels.