Why is Dialectical Behavior Therapy (DBT) Recommended for Teens with Self-Harm Tendencies?

The teenage years are a challenging time. Teens are almost adults, but still live at home. Their bodies are growing and changing, but they still have a curfew. They’re supposed to decide what they want to do for the rest of their lives, but they still have homework.

In addition to these responsibilities, many teens also deal with serious mental health issues like depression, borderline personality disorder, anxiety and bipolar disorder. People with these mental health conditions often have difficulty regulating their emotions and may make split-second decisions triggered by these emotions. Since teens are already more impulsive, this can be particularly dangerous. 

According to the Minnesota Department of Health, “From 2016 through 2020, there were more than 10,000 hospital visits for self-harm injuries (i.e., suicide attempts) in Minnesota, and those were mostly among people ages 10-24, predominantly females. Each year about 75-80% of suicide deaths are among males.” 

But recent research has shown that dialectical behavior therapy (DBT) is effective for treating teens with self-harming and suicidal tendencies.

What is DBT?

In the 1970s, psychologist Marsha Linehan developed a new kind of therapy — dialectical behavior therapy (DBT) — specifically to treat people with borderline personality disorder. The therapy combines elements of cognitive behavior therapy (CBT) and mindfulness teachings. It includes individual therapy, group therapy, skills training and sometimes, phone therapy.

Psychotherapy Academy states, “DBT is based on a continuous oscillation between change and acceptance. [It seeks] a balance between changing and accepting beliefs and behaviors.” DBT acknowledges that people have big, difficult emotions, but they can learn to manage these feelings and not necessarily act on them.

Why is it important for teens with suicidal feelings?

For teens who experience suicidal feelings, DBT can make a big difference. The New York Times states, “In a 2018 study in the Journal of the American Medical Association, Dr. Berk and her colleagues found that D.B.T. led to sharper drops in suicidal attempts and self-harm among adolescents than a more generalized therapy did.”

Though Fraser Mental Health Professional Sarah Davis isn’t formally trained in DBT, she did complete her internship under a DBT-trained therapist and uses some DBT techniques in her therapy. One thing she says DBT focuses on is urge control.

A person experiencing big feelings may have an urge to hurt themselves through self-harm or suicide. However, just because an individual has that urge doesn’t mean they actually want to go through it or wouldn’t regret it later. People who are experiencing this urge are feeling overwhelmed and aren’t sure how to handle it. Again, for teens who are impulsive, this is particularly dangerous.

DBT helps identify triggers and emotions

This is where DBT is helpful. During this therapy, teens learn to be present in the moment and recognize these big emotions when they experience them. Maybe the feeling starts with tension in the shoulders, a clenched jaw or a quickening of the heartbeat. After they learn to recognize these feelings, they can express them. According to the New York Times, “‘It is vital to ‘put language’ to a physical and emotional experience; this engages parts of the brain, like the prefrontal cortex, that help regulate emotions.”

DBT teaches people how to self-soothe

Then through therapy, they can learn how to regulate their emotions and self-soothe, rather than acting on impulses, like hurting themselves or acting out in a destructive manner.

“People in DBT learn how to be gentle with themselves, to sit in their emotions and to experience big emotions without acting on them,” says Davis. “DBT essentially teaches people about balance: even though there are hard things in the world, you can feel them and not react negatively to these things.”

Self-soothing can include breathing exercises, journaling, physical activity and even putting an ice pack on your eyes.  For teens, especially, it’s important to take care of their bodies, since physical health and mental health are tightly linked. The Child Mind Institute states, “There’s a big focus on the physical body: eating properly, getting enough sleep, taking their medicine and avoiding drug use.” This too, helps teens manage emotions.

Parents and teens learn to communicate in DBT

In DBT, people also learn how to interact with others better, since interactions can often trigger these negative emotions and impulses. For teens, that also means parents are included in the DBT process. Working together in DBT teaches teens and parents to communicate more effectively.

Since the adolescent brain isn’t fully developed, teens have a hard time responding to new information and “the brain just goes into overload, flooded with high emotional arousal,” so teens “can’t learn anything new, can’t process incoming information and so suggestions of what to do or to try just bounce right off” them. That’s why teens will ignore parents’ attempts to help them.

And even great parents may be dismissive of teenagers’ feelings because they may think teens are overreacting or being hormonal. But during DBT, the New York Times states, “Parents are trained to validate the feelings of their teenagers, as irrational as those feelings may seem.” Since there are so many communication barriers, learning how to talk and listen to each other is so important.

“Teenagers are a part of a family dynamic, so it’s important for parents to be included in the process and learn those skills themselves,” says Davis. “With DBT, families learn how to talk about these things, support each other and address these issues in a different way.”