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Dialectical Behavior Therapy

Created on August 5, 2017. Last updated on March 6th, 2024 at 04:46 pm

What is Dialectical Behavior Therapy?

Alec L. Miller, PsyD & Jessica Passman, PsyM

Dialectical behavior therapy (DBT) for adolescents is an evidence-based treatment originally developed for suicidal, multi-problem adolescents.  It has since been adapted for a broader range of adolescents who present with emotional and behavioral regulation challenges.  Moreover, while DBT started as an outpatient psychotherapy intervention, it has been utilized in a range of other clinical and non-clinical settings such as schools.

DBT synthesizes a variety of theoretical perspectives, including cognitive-behavioral, mindfulness/acceptance, biosocial, and a dialectical philosophy.  The biosocial theory of emotional dysregulation posits that a teens’ “5 problem areas” (i.e., 1) reduced focus/awareness, 2) impulsivity, 3) emotion dysregulation, 4) interpersonal problems, and 5) teen-family challenges) evolve from a transaction between a biological vulnerability and an invalidating environment.  The DBT treatment improves emotion regulation and reduces invalidating behaviors in the environment, and it offers 33 skills that map onto the 5 problem areas, including a) mindfulness skills, b) distress tolerance skills, c) emotion regulation skills, d) interpersonal effectiveness skills, and) walking the middle path skills.

Comprehensive DBT includes 5 modalities intended to address 5 functions:

  • Weekly multi-family skills group for 24 weeks to increase the teen and caregivers’ capabilities by teaching DBT skills.
  • Weekly individual DBT therapy to build and maintain motivation to remain in treatment, reduce target behaviors, all while helping the teen identify and reach his or her goals.  The DBT therapist uses a variety of acceptance and change strategies (including exposure, cognitive modification, contingency management, and skills training) to help the teen develop more effective coping strategies and overall functioning.
  • Inter-session coaching via telephone/text:  Teens and caregivers are encouraged to use such coaching from DBT providers in order to a) generalize the skills being taught in the skills group, b) share good news, and c) repair the relationship if needed.
  • Family therapy sessions/parenting sessions are offered on an as-needed basis to target family communication deficits, parenting skills deficits, and to provide a forum to put into practice the DBT skills with a DBT provider coaching all the while.
  • Therapist consultation team: All DBT therapists (individual and skills trainers) participate in a weekly consultation team in order to enhance DBT providers capabilities and to ensure adherence to the DBT model. Some refer to this as “therapy for the therapists,” which when working with a multi-problem population is extremely important to help keep the therapists balanced and supported.

Source(s): Mehlum, L., Tormoen, A., Ramberg, M., Haga, E., Diep, L., Laberg, S., Larsson, B., Stanley, B., Miller, A.L., Sund, A., Groholt, B. (2014). Dialectical behavior therapy for adolescents with repeated suicidal and self-harming behavior: A randomized trial. Journal of the American Academy of Child and Adolescent Psychiatry, 53(10), 1082-1091. DOI:

Miller, A.L., Gerardi, N., Grayling, K., Mazza, J.J., Dexter-Mazza, E.T., & Rathus, J.H. (under review). Delivering Comprehensive School-Based DBT (CSB-DBT)

Miller, A. L., Rathus, J. H., & Linehan, M. M. (2007). Dialectical behavior therapy with suicidal adolescents. New York, NY: Guilford Press.

Rathus, J. H. & Miller, A. L. (2015). DBT skills manual for adolescents. New York, NY: Guilford Press.

Rathus, J.H., Miller, A.L., Berk, M.S., & Halpert, R. (2020). DBT with adolescents: A review of the research. Handbook of Research on Dialectical Behavior Therapy. Bedics, J (Ed). Elsevier.

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Evidence-based Services Committee of Hawaii