When Lady Gaga famously told Oprah Winfrey (and the world) that she had suffered a psychotic break, she also revealed that she relies on Dialectical Behavior Therapy (DBT). “DBT is a wonderful, wonderful way to deal with mental health issues,” she said. Selena Gomez publicly praised this therapeutic modality as well, claiming in a Vogue interview that “DBT has completely changed my life.”
Despite being recently endorsed by two of today’s leading pop stars, DBT isn’t new. In fact, it’s been around since the late 1980s.
Why is this modality becoming so popular now? And exactly what is DBT? And how does DBT work? To understand how DBT can help teens, young adults, and families, let’s take a look at the history of DBT and how this therapy was developed.
The History of DBT
DBT is a branch of psychotherapy that was originally developed by Marsha Linehan, PhD, as a way to treat individuals with suicidal thoughts who were diagnosed with Borderline Personality Disorder (BPD). People with BPD often experience extremely intense emotions that can be difficult to manage and cause a great deal of chaos and conflict in their lives. They typically react with bursts of anger, crying, and passive-aggressive behaviors.
Borderline Personality Disorder can also manifest as poor self-image, disordered eating, substance use, instability in interpersonal relationships, lack of impulse control, and suicidal ideation—all issues that commonly occur in teens and young adults. Therefore, DBT has evolved to become a common treatment modality for teens and young adults today.
How Does DBT Work?
DBT research has shown that DBT is effective in treating many disorders, including substance dependence, depression, post-traumatic stress disorder (PTSD), and eating disorders. DBT is known for helping people cope with and regulate their emotions.
While DBT shares many concepts with Cognitive Behavioral Therapy, the main objective of DBT is to first stop a destructive behavior, then work on the negative thinking patterns that lead to that behavior. The goal of DBT is to teach people the skills they need to cope with and change these unhealthy behaviors.
The term “dialectical” comes from the idea that bringing together two opposites in therapy—acceptance and change—will produce better results than either one does alone. One unique aspect of DBT is the focus on acceptance of a person’s experience as the first step in the process of changing negative behaviors.
DBT typically has two main components: individual psychotherapy sessions and group therapy sessions. Individual sessions with teens emphasize problem-solving behavior for any issues or troubles that may have arisen since the previous session. They also focus on decreasing and dealing with post-traumatic stress responses from previous trauma in the teen’s life and improving their self-confidence and self-esteem. In group therapy sessions, which are led by a trained DBT therapist, teens learn skills from one of four different DBT modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.
Mindfulness is an ancient practice that revolves around being aware, without judgment, of what’s happening in the present moment, both inside and around you. Over the past decade, mindfulness has become a key part of mental health treatment because of its many benefits to mental health and emotional well-being. Studies suggest that mindfulness can reduce anxiety and depression, improve memory and focus, help people manage stress, and lead to greater satisfaction in relationships.
The mindfulness skills used in DBT can help teens learn how to be more aware of, and eventually accept, their emotions. The goal isn’t for teens to try to clear their mind or stop thinking, but rather to become aware of their feelings instead of getting lost in them. They also learn to observe and acknowledge their emotions without self-judgment. For example, if they feel anxious, they might simply state to themselves, I notice that I am feeling anxious, without judging or trying to change the feeling.
Adolescents sometimes feel that their problems are simply out of their control. It’s common for a teen to think, This isn’t fair or I shouldn’t have this problem, although it often makes them feel worse.
Radical acceptance is a term used to describe a healthier way of thinking in stressful situations. Instead of focusing on how much they want something to be different, teens learn through DBT to recognize and accept the problem or situation as it is. When they learn to accept what is out of their control, they feel less anxiety, anger, and sadness when dealing with the situation.
When a teen experiences an emotion, a behavior usually comes with it. If they are angry, they might fight or argue. If they are sad, they might withdraw from friends and family. Some of these behaviors are instinctive, while others might be conscious choices.
DBT teaches teens how choosing a different action in these situations can help regulate their emotions. For example, if they usually yell when they’re angry, they can try talking quietly and calmly instead. If they tend to withdraw when they are sad, they can call or visit a friend. DBT also encourages them to focus on the positive aspects of an experience, rather than the negative.
The last of the DBT modules is interpersonal effectiveness. Interpersonal effectiveness skills help teens understand how their behavior affects their relationships, so they can make positive changes. Learning how to balance our own needs with the needs of others can be challenging at any age. DBT includes three different skills that can help teens achieve this goal: objective effectiveness, relationship effectiveness, and self-respect effectiveness.
Objective effectiveness focuses on how to clearly express your own needs or desires. Relationship effectiveness teaches how to foster positive interactions with others. Self-respect effectiveness supports teens in ensuring that they don’t betray their own values and beliefs for approval or to get what they want.
In summary, DBT is an essential part of an integrated approach to teen treatment. At Newport Academy, we use DBT and other evidence-based approaches to treat the underlying causes of maladaptive and high-risk behavior.
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