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

MY APPROACH

I am intensively trained in DBT and participated in Behavioral Tech’s weeklong foundational training with Dr. Adam Payne. I also received training under Dr. Charles Swenson.

I am also trained in DBT for Children (DBT-C) and participated in Behavioral Tech’s 6-day certification with Dr. Francheska Perepletchikova.

I currently use DBT to treat children, preadolescents, adolescents, young adults, 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, I 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, I 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 check with Dr. Hamlet about current group availability within her 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.