Demystifying Dialectical Behavior Therapy (DBT)
Written by Pardis Khosravi, PsyD, Clinical Director and Licensed Psychologist, CHC Clinical Services and Patrice Crisostomo, PhD, Clinical Program Manager and Licensed Psychologist, CHC Clinical Services
Suicide rates among ages 10-24, while stable from 2000 to 2007, jumped nearly 60 percent by 2018, according to the Centers for Disease Control and Prevention. By 2019, 1 in 5 youths had contemplated attempting suicide. And more than 25% of girls reported that they had seriously contemplated attempting suicide during the pandemic, twice the rate of boys.
Despite its increasing prevalence, finding out that your teen is experiencing suicidal thoughts or engaging in self-harm can be shocking, terrifying, surreal and stressful. You may feel completely overwhelmed and confused about next steps. It’s important to remember that you are not alone, and to reach out for help.
In speaking with your child’s pediatrician, school counselor or current therapist, you may hear about Dialectical Therapy or “DBT.” Individuals are commonly referred to DBT due to concerns about suicidal thoughts and/or actions, self-injurious thoughts and/or actions, or engaging in risky behaviors.
What is DBT?
DBT is the only evidence-based treatment for decreasing suicidal thoughts or self-harming behaviors in youth. The main focus is to help individuals build a “life worth living.”
DBT comes in two main forms: comprehensive/standard DBT and DBT-informed treatment.
What is comprehensive DBT?
For treatment to be considered “comprehensive DBT,” it must include four components:
- Individual therapy from a DBT-trained therapist
- DBT skills group
- In-vivo (in the moment) phone coaching to assist clients in utilizing the skills in real life situations
- DBT consultation team (for DBT therapist)
Note that if a client does not receive all four treatment components at a given time, it is not considered a “comprehensive” DBT program.
Comprehensive DBT can be offered at an outpatient and intensive outpatient level of care. CHC’s RISE Intensive Outpatient Program is a comprehensive DBT program in partnership with Stanford Children’s Health.
What is DBT-informed treatment?
DBT-informed treatment incorporates some components and principles of DBT but does not include all of the features necessary for a comprehensive DBT program. For instance, DBT skills groups are great opportunities for youth to learn and practice DBT skills to target emotion regulation, managing times of high stress, and improved communication and quality of relationships. As an adjunct to individual therapy, these sessions allow youth to learn and practice additional coping strategies in a group setting.
CHC offers two types of DBT skills groups. The first is a “multifamily group” for middle school students and their parents/caregivers, facilitated by two DBT therapists. Parents/caregivers are required to attend to support the developmental needs of pre- and early adolescents and learn skills they can apply to their own lives. Our high school groups offer skills training with a DBT therapist and without parents or caregivers. Participants in both groups must be seeing an outpatient therapist on a regular basis outside of the group setting.
When should I consider “Comprehensive DBT” or “DBT-informed treatment” for my child?
You might be wondering whether your child needs comprehensive DBT or DBT-informed treatment. Comprehensive DBT is more frequently recommended when there are multiple areas of concern, including concerns about safety. These can include:
- experiencing frequent suicidal ideation (i.e., thoughts of not wanting to be around),
- suicidal behaviors (including intent to kill oneself, creating plans for suicide, preparatory action towards a suicide attempt, suicide attempts, attempts that were interrupted)
- a pattern of self-injurious behaviors (frequent urges, and/or actions)
DBT-informed treatment may be more appropriate when someone is beginning to experience suicidal ideation or is beginning to have urges for self-injurious behaviors. DBT-informed treatment may also be appropriate in the absence of suicidality or self-injurious behaviors if a child is experiencing significant depression and/or anxiety and needs additional support to develop coping strategies to tolerate distress and regulate emotions.
Once you decide which type of DBT treatment is the best fit for your child, it’s time to consider levels of care.
What is “Outpatient” level of care?
“Outpatient” means that individuals are not living at the program or clinic where they are receiving services. Outpatient mental health care can typically look like one or two treatment appointments per week. Your child may be receiving weekly individual therapy, attending a weekly skills group, and have regular medication management appointments.
Comprehensive DBT offered on an outpatient basis typically involves weekly individual DBT therapy sessions, attending a weekly DBT skills group, and having access to your therapist via phone coaching between sessions.
What is IOP level of care?
IOP refers to “intensive outpatient program,” targeted to treat mental health or substance use and addiction. IOPs are designed for individuals who are suffering from significant mental health difficulties that impact their functioning in their family and/or peer relationships, school, and/or community.
IOP offers individuals more structured supports than outpatient therapy, while still maintaining the flexibility of being able to attend school and work and practice skills in those environments. IOP is offered multiple times per week and follows a specific schedule and routine to help individuals build and practice specific skills. A typical IOP program includes individual therapy, group therapy, and may include meetings with a psychiatrist and/or nurse practitioner for medication consultation and management. Typically, IOP treatment lasts for 8-12 weeks and requires 6-12 hours per week of participation.
Comprehensive DBT offered at an IOP level of care, like the RISE Program, typically involves twice weekly individual DBT therapy sessions, twice weekly DBT skills groups, 24/7 access to the therapist for phone coaching between sessions, and several other therapy groups throughout the week focused on mindfulness and skill building.
Learn more about DBT
This short video from the UC San Francisco (UCSF) provides a good explanation of dialectical behavior therapy for adolescents.
CHC has created an easy-to-read infographic to explain what DBT is and how it works.
Still have questions? We know this can be a scary time and you just want your child to be safely on the road to healing. Our Care Team is here to help you navigate this journey and figure out what level of care is best for your teen. Reach out to firstname.lastname@example.org or call us at 650.688.3625 to schedule a free 30-minute consultation with an expert clinician who can provide guidance around the type of supports and services that would be most helpful for your child and family.
For immediate assistance, the following resources are available 24/7 unless otherwise noted:
- Dial 911 or go to your nearest emergency room or urgent care
- Santa Clara Crisis Line: 855.278.4204
- San Francisco Crisis Line: 415.781.0500
- Star Vista’s Crisis Hotline: 650.579.0350
- National Suicide Prevention Hotline: 800.273.8255
- Uplift Mobile Crisis Team: 408.379.9085 / toll-free 877.412.7474
- Alum Rock Mobile Crisis: 408.294.0579
- Lifeline Crisis Chat: suicidepreventionlifeline.org
- OnYourMind Teen Chat (M-Th, 4:30-9:30 pm): sanmateocrisis.org/