Dialectical Behavior Therapy (DBT)

At Youth Care, our dedicated and experienced treatment team uses cutting-edge, evidence-based interventions, such as Dialectical Behavior Therapy (DBT), to help young people manage their mental health and behavioral symptoms.

“Evidence-based” or “empirically supported” are technical terms for scientifically tested and effective. One of the most rigorous ways to study a treatment is a randomized controlled trial (RCT), this type of study shows if medications are effective. RTC’s are the “gold standard” for confirming that a clinical intervention is effective. Dialectical Behavior Therapy (DBT) has about 20 RCT’s showing consistent reduction of suicidal and self-injurious behaviors, hospitalizations, and treatment drop out.

Created in the late 1980s by Marsha Linehan, Ph.D., DBT is commonly used to treat borderline personality disorder and other mental health disorders. The theory behind the DBT is that some individuals tend to have high sensitivity to emotional stimuli, react stronger and with greater emotional intensity to emotional situations, especially those involving close relationships. As a result, these individuals experience greater than average emotional arousal. Moreover, these individuals have a slower return to their emotional baseline and need help learning how to manage their emotional experiences. In practice, DBT focuses on four primary areas: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

Mindfulness is about maintaining awareness of the internal experiences of sensations, thoughts, emotions, and impulses as well as awareness of external experiences in terms of what is going on in the environment and in interactions with others. Mindfulness is about staying present in the moment on both the inside and outside to minimize interpretations, assumptions, abstractions, and judgments.

Distress tolerance is the ability to experience frustration and stress without engaging in problematic or destructive behaviors. The goal is to learn how to tolerate distress in a constructive manner. DBT builds distress tolerance by helping individuals learn strategies for dealing with suffering, such as distracting themselves, taking care of themselves (“self-soothing”), redirecting their thought processes, and assessing options for improving their situation.

Emotion regulation focuses on teaching students about their emotions; helping them to achieve a deeper understanding of their emotional life, and developing more skills and abilities to address painful or intense emotions.  When someone does not understand or know how to deal with their emotions, they may act out in various ways such as emotional outbursts, cutting, or isolating themselves from others.  DBT uses skills such as labeling emotions, describing emotions, and exploring the origins of emotions.

Interpersonal effectiveness is a collection of skills designed to help individuals express their needs and desires in relationships in a way that is healthy and assertive.  This core area of DBT focuses on teaching the students how to have functional relationships with others by teaching skills that help one to clearly ask for what one wants or say “no,” skillfully while tactfully negotiating using gentleness, and sticking to one’s values. One component of the interpersonal effectiveness component of DBT is the “DEARMAN” approach to making requests:

  • Describe the situation
  • Express why this is an issue and your feelings about it
  • Assert yourself and ask clearly for what you want
  • Reinforce your position
  • Be Mindful of the situation and your goal
  • Appear confident
  • Negotiate fairly

At Youth Care, DBT is central to our treatment approach. Throughout all levels of care, students complete diary cards and participate in DBT skills groups. In addition, DBT skills are encouraged in the milieu; staff members receive training in DBT and all clinical staff have in-depth (foundational or intensive) training in the DBT model. This experience with DBT gives all staff members and students a common language for describing and working through issues that come up during treatment in a healthy and positive manner.

Certain DBT skills are particularly useful for the students at Youth Care. For example, distress tolerance and emotional regulation help students learn to manage emotional situations and emotional extremes in effective ways. In addition, students have many opportunities to practice DBT principles and skills. For example, all students use the DEARMAN format (described above) when making formal requests.

By building Youth Care’s treatment program on a foundation of DBT principles, students learn to regulate their emotions, rates of self-harm decrease, and outcomes for all students improve.

If your child or a young person in your care might benefit from the high-quality interventions we provide, please do not hesitate to contact us. The sooner that young person is able to address his or her mental health and behavioral difficulties, the sooner he or she can begin building a foundation for lifelong health.

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