The Center for Integrated Behavioral Health  offers a full-model comprehensive Adult and Adolescent Dialectical Behavior Therapy (DBT). Our DBT team is intensively trained by Marsha Linehan’s, Ph.D., ABPP group at Behavioral Tech.

Dialectical Behavior Therapy (DBT) is an evidence-based form of Cognitive Behavioral Therapy (CBT) that was developed by Dr. Marsha Linehan, Ph.D., for the treatment of suicidal and self-harm behaviors, and has been adapted to meet the needs of multi-problem clients.

The United States Substance Abuse and Mental Health Services Administration (SAMHSA) has described DBT as “one of the best, if not the best, treatment” for chronically suicidal and self-injurious individuals (SAMHSA, 2011).

Dialectical Behavior Therapy for Adolescents (DBT-A)

Center for Integrated Behavioral Health is proud to announce we are expanding our comprehensive Dialectal Behavior Therapy program to now include DBT for Adolescents (DBT-A). Dialectical Behavior Therapy for Adolescents (DBT-A) is an evidence-based therapy for teens who struggle with multiple problems associated with emotion dysregulation. Adolescents with high risk behaviors such as suicidal thoughts or attempts, self-injurious behaviors, sexual impulsivity, and substance misuse have  been shown to benefit from the treatment.

Our program is adherent to the research protocols that established evidence for the treatment’s effectiveness and includes the following components:

Weekly multi-family skills training class (24 sessions)

The class meets for two hours each week in the evening and includes 4-6 teens along with their caregiver(s). Each family learns skills, and parents learn to understand and respond to certain adolescent behaviors, to encourage use of the skills at home, and to receive support from each other within a DBT framework. The class lasts for 24 sessions and is led by two skills trainers who combine lecture, discussion, and practice exercises in order to teach the following skill modules:

  • Core mindfulness: teaches participants how to focus the mind, direct attention, and how to non judgmentally observe and describe what they are feeling and thinking in the moment. These skills can help teens develop a more stable sense of who they are, and can help reduce reactivity to painful thoughts and emotions.
  • Distress tolerance: targets impulsivity by teaching teens how to effectively distract and soothe themselves while considering pros and cons of their actions. These skills typically replace problem behaviors such as cutting classes, self-inflicted cutting, physical fights, and using alcohol or drugs.
  • Emotion regulation: addresses extreme emotional sensitivity, rapid mood changes, and other unregulated moods such as chronic depression, anxiety, or hostility. Examples of specific skills include learning to identify and label emotions, learning how to increase positive moods, and learning how to make yourself less vulnerable to negative moods.
  • Interpersonal Effectiveness: addresses difficulties in maintaining consistent and rewarding relationships by teaching skills such as how to ask for what you want, how to say no in a gentle yet effective manner, and how to maintain your sense of self-respect and independence in the face of peer pressure.
  • Walking the Middle Path: targets extreme, rigid, or non-balanced thinking and behaviors among young adults and their roommates and/or family members. These skills involve learning about common areas of conflict and polarization in relationships, and reducing the conflict by learning methods of behavior change as well as methods of validation and acceptance.

Inter-session telephone coaching for the teen and the parents.  Phone coaching is designed to promote skills use where it matters most–in the real world. When adolescents feel “stuck” and unsure what to do, they are encouraged to contact their individual therapist for help in using DBT skills. In addition, parents are able to contact one of the skills trainers for coaching in how to apply skills with their teens while they are participating in the skills group.

Specialized Parenting Sessions. Parents often benefit from an (unspecified) number of additional sessions with a parenting coach (who is typically one of the multi-family skills group leaders so the parents are already familiar with this person).  The coach offers specialized parenting strategies to assist parents reaching their goals in a planful and proactive manner rather than relying on a reactive crisis-oriented approach.

Family therapy.  Family therapy occurs on an as-needed basis to increase behavioral skill use within the family system, improve communication between family members, and to reduce family interactions that interfere with either the adolescent’s or the family’s quality of life.

(Weekly therapist-only consultation team).  The 1.5 hour therapist-only consultation meeting is for DBT practitioners at CIBH. The DBT treatment team meets weekly to assist each other in providing effective, efficient, and compassionate treatment. We spend time problem-solving difficulties that interfere with client progress in treatment and help keep each other practicing within a dialectical framework.

Who can benefit from Dialectical Behavior Therapy (DBT)?

Individuals who:

  • Have suicidal thoughts (chronically) or past suicide attempts
  • Injure themselves (e.g., cutting, scratching, burning)
  • Have a diagnosis of Borderline Personality Disorder
  • Have difficulty regulating their emotions
  • Have difficulty managing relationships with others
  • Use ineffective coping and problem-solving skills
  • Act impulsively
  • Abuse substances
  • Have disordered patterns of eating

Adult Dialectical Behavior Therapy (DBT)

Individual Therapy (~1 session per week)

  • Create a life for the client that is worth living
  • Eliminate life-threatening behaviors (e.g., suicidal and self-injurious behavior)
  • Eliminate therapy-interfering behaviors (e.g., late or missed attendance, non-completion of homework)
  • Decrease quality-of-life-interfering behaviors (e.g., depression, anxiety, anger, relationship problems, impulsive behavior, risky behavior, missed school or work, disordered eating, substance abuse)
  • Apply problem-solving and new coping skills to recent and current difficulties

Skills Training Group (~2 hours per week) teaches participants to:

  • Be fully aware of the present moment without judgment and to participate in life more fully (i.e., Mindfulness)
  • Make it through crises without making things worse (i.e., Distress Tolerance)
  •  Effectively manage emotions in ways that don’t cause additional problems (i.e., Emotion Regulation)
  •  Effectively manage relationships with others, accomplish goals, and maintain self-respect (i.e., Interpersonal Effectiveness)
  •  Apply validation and behavioral principles to oneself and others (i.e., Walking the Middle Path)

Between Session Consultation Calls with Therapist  (~as needed to implement skills learned)

Adult DBT Program Requirements

Please note that DBT is an intensive treatment requiring a considerable commitment on the part of participants.

In order to be admitted to our DBT program, participates must commit to the following:

  • Attend both individual therapy (~53 minutes) and skills training group (~120 minutes) weekly for 14 months
  • Attend both individual therapy and skills training group weekly for approximately 14 months; the research supporting DBT’s effectiveness is based on the data from participants who took part in both individual therapy and skills training group for at least one year
  • Actively work to decrease suicidal and self-injurious behavior and/or other problem behaviors (e.g., disordered eating, substance abuse)
  • Practice DBT skills and complete homework assignments taught between sessions