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Adolescence is an incredibly difficult period in one’s life. The mere physical maturation that a teenager endures during his or her adolescence is immense. One’s teenage years are filled with exponential physical, emotional, and mental growth, which can be confusing, difficult to manage and at times seemingly impossible to navigate. Many teens will attempt to manage the evolving changes they are experiencing with unhelpful coping mechanisms and/ or turn to self-medicating tactics (i.e. drugs and/ or alcohol) before seeking guidance from others. It is a rather challenging undertaking as a parent or guarding to distinguish the differences between typical teenage behaviors and those that should be considered red flags. If there is any concern that a teen may be exhibiting atypical behavior, it may be beneficial to consult a professional, so as to assure the teenager’s safety. There are a variety of therapeutic methods that can be helpful for teenagers to learn useful coping mechanisms, both for those with an identified mental health diagnosis as well as those without.

Dialectical Behavior Therapy

Dialectical behavior therapy (DBT) is a psychotherapy that is based off of the principals of cognitive-behavior therapy (CBT). In the late 1980, Psychologist Marsha Linehan developed DBT to help treat individuals with borderline personality disorder (BPD). It has since been rendered an effective method of treatment for many other mental health conditions. It is helpful in treating issues related to emotional dysregulation. Emotional dysregulation is a term used within the mental health field to denote irrational, poorly modulated emotional responses. DBT focuses on teaching four core skills: mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation. 

In order to successfully impart the core skills, dialectical behavior therapy is comprised of different therapeutic components, which include:

• Individual therapy sessions: one-on-on therapy sessions allow a teen to work in a co-creative fashion with his or her mental health clinician to identify prohibitive, damaging, and maladaptive thoughts and behaviors. Through positive reinforcement, individual therapy sessions motivate change and emphasize a teen’s strengths, which helps to repair and improve his or her sense of self. They are also focused on enhancing the teenager’s motivation and the practice of applying certain DBT skills learned to specific, relevant challenges.  
  • Diary cards: a diary card is a tool used as a means to track one’s emotions throughout the week, identify which DBT skills were used and determine if they were helpful. A teenager’s diary card will be reviewed in with his or her therapist during each individual therapy session. This can help to shed light on areas during the week that the teen struggled and how to better implement the DBT skills so as to prevent the reoccurrence of future, unnecessary pitfalls.
• Group skills therapy sessions: skills training provide teens with an opportunity to learn DBT skills alongside of other teens experiencing similar challenges. Group therapy sessions also provide a safe, controlled environment for the participants to practice implementing the newly learned DBT skills.
  • Homework: assigning homework is an integral component of group skills therapy, as it encourages teens to continue to practice the DBT skills in their everyday lives.
• Coaching: during the time between individual therapy sessions and group therapy sessions, a client may encounter difficult to navigate situations and/ or find him or herself in crises. Phone coaching is used during these times to offer in-the-moment support. A teenager can call his or her clinician for assistance with implementing DBT skills and/ or obtain support and guidance with managing difficult situations that arise in everyday life. 

Any mental health clinician that offers dialectical behavior therapy as a form of treatment is also obligated to participate in DBT consultation teams. These teams are made up of other mental health professionals. They are an essential resource for clinicians, as they offer outside insights, useful perspective and needed support for working with high-risk, difficult to treat clients. 

Worksheets

As was previously noted, homework is integral to the dialectical behavior therapy process. The full DBT course and skills curriculum typically runs approximately six months long. Around six of the twenty-four weeks is allocated to each of the four core skills, respectively. There are certain worksheets that are associated with each of the core skill modules. Although a mental health clinician will likely yield a more successful outcome, it is possible for an individual to do DBT on his or her own. This, however, is not recommended for adolescents. The worksheets used in DBT can be accessed online, or even purchased in a printed form. There is a reason mental health professionals are trained in delivering various therapeutic modalities, and in order to acquire the proper guidance regarding the worksheets, an individual must request help from a qualified mental health professional. 

It is normal for an individual to occasionally experience doubts and/ or fears that lead to certain behaviors. These are generally fleeting occurrences that are not uncommonly experienced by neurotypical individuals. OCD is a debilitating condition that greatly affects an individual’s quality of life as the symptoms of this condition make completing everyday tasks extremely challenging, if not impossible. Obsessive-compulsive disorder (OCD) is a mental health disorder that is characterized by intrusive, unreasonable thoughts and/ or fears (obsessions) that commonly lead to compulsive, repetitive behaviors. OCD can manifest and affect people of all ages. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) provides clear criteria for mental health professionals when diagnosing obsessive-compulsive disorder. 

Risk Factors

The precise cause as to why an individual may develop obsessive-compulsive disorder remains unknown. There are, however several risk factors that can indicate one’s predisposition for potentially developing OCD, including:

• Presence of other mental health disorder (i.e. depression, anxiety, posttraumatic stress disorder…etc.)
• Family history of OCD (i.e. parent, child, and/ or sibling diagnosed with OCD)
• Differences in the makeup of one’s brain
• History of child abuse (physical, verbal, and/ or sexual)
• Experience with trauma

It is also possible for OCD to develop in children as a result of a streptococcal infection. This is referred to as PANDAS (pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections). 

OCD Categories

Obsessive-compulsive disorder can manifest if a variety of different ways. As such, several OCD categories have been established. The most common OCD categories individuals fall into include the following: 

• Checkers: repeatedly looking at and checking things such as alarm systems, lights, locks…etc.
• Washers: fearing contamination, compulsively engaging in personal hygiene rituals (i.e. washing hands, showering, washing feet…etc.)
• Hoarders: collecting things for fear that something bad may occur directly as a result of throwing items away. 
• Doubters: continuously afraid that if something is not done perfectly the individual will be punished and/ or it will result in something terrible occurring.
• Counters: the need to compulsively count things (i.e. steps, bottles, letters…etc.) and/ or have irrational superstitions connected to certain numbers.
• Arrangers: must have everything arranged to perfectly reflect order and symmetry. 

Some individuals may exhibit symptoms related to multiple categories, although it is most common for an individual to experience symptoms as they primarily relate to one of the above categories. 

Signs And Symptoms

Every individual is different and may exhibit a unique set of OCD symptoms. As provided by the National Institute of Mental Health, examples of common symptoms related to OCD can include any of the following:

• Compulsive counting
• Arranging and/ or ordering items in the same, symmetrical, precise way
• Excessive cleaning and/ or hand washing
• Repeatedly checking on things
• Irrational fear of oneself or others getting hurt
• Religiously preoccupied
• Avoiding touching things for fear of contamination 

While some individuals may only experience one component of OCD (obsession or compulsions) many individuals with OCD to have both obsessions and compulsions. Research has indicated that stress itself does not induce OCD, it can, however, lead to the worsening of symptoms.

How OCD Is Diagnosed

The diagnosis process for obsessive-compulsive disorder typically includes several components. The initial steps generally include a thorough physical exam as well as conducting various blood tests to ensure symptoms aren’t being caused by something else. A psychological evaluation occurs to enable the clinician to gain insights into an individual’s behavior patterns, symptoms, thoughts, and feelings. This can help the evaluating clinician determine if the individual’s obsessions and/ or compulsions are actively interfering with his or her ability to function and quality of life. Many mental health professionals that are capable of diagnosing OCD closely adhere to the criteria provided by the American Psychiatric Association published in the DSM-5 listed under the category Obsessive-Compulsive and Related Disorders. The current diagnostic criteria for OCD include:

1. The presence of obsessions, compulsions, or both
2. Obsessions and/ or compulsions are time-consuming (at least an hour per day) and/ or result in clinically significant distress and/ or impairment in occupational, social, and/ or other areas of functioning
3. OCD symptoms are not attributable to physiological effects of another mental condition (i.e. side effects of medication, substance use disorder…etc.)
4. The obsessive-compulsive disturbances are not better explained as symptoms of another mental disorder

Any mental health disorder diagnosis should be established through a proper evaluation conducted by a qualified mental health professional. If there is any concern that a loved one may be struggling with OCD, it is best to seek the guidance of a mental health professional as soon as possible. Treatment for OCD can help an individual learn tools to effectively manage his or her symptoms and go on to lead a healthy and fulfilling life.

Substance use disorder (SUD), also known as addiction, is a serious mental condition that affects one’s brain and leads an individual to compulsively engaging in harmful behaviors. Addiction is characterized when an individual habitually abuses drugs and/ or alcohol without regard for the ensuing negative physical, mental, social, emotional, financial and/ or legal consequences. For decades, addiction was not recognized as a mental illness, but rather something that was brought on solely by the struggling individual as the result of weakness in the form of a lack of control and/ or poor judgment surrounding his or her use of drugs and/ or alcohol. After significant research, addiction is now accurately identified as the mental disorder that it is and is listed as such in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). 

There are a myriad of different therapeutic approaches when it comes to creating a treatment plan for an individual in recovery for substance abuse and/ or addiction. Every individual is different and will respond distinctly to the various therapeutic methods offered. It is highly common for substance abuse and/ or addiction treatment plans to include an array of different therapy strategies. Addiction often requires a customized treatment plan that considers and addresses the symptoms, the underlying causes of the disease, as well as work with the individual to repair the damage that occurred in the various areas of his or her life as a direct result of his or her substance abuse. 

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy (CBT) is a multi-dimensional form of psychotherapy that helps an individual learn to shift damaging belief systems and behaviors. It focuses on one’s thoughts, beliefs, images and attitudes that contribute to his or her distorted sense of self. Through CBT an individual is able to identify, cope, and correct how these aspects influence the way he or she navigates the challenges in his or her life. 

Dialectical Behavior Therapy

Dialectical behavior therapy (DBT) is based on the principals of CBT with a greater emphasis placed on social and emotional aspects, such as regulating emotions and mindfulness. DBT was developed in the late 1980s to help treat individuals with borderline personality disorder (BPD). It is now a common form of psychotherapeutic treatment for individuals struggling with extreme and/ or unstable emotions and/ or harmful behaviors. DBT can help to reduce one’s drug cravings, help individuals learn to navigate triggering situations, and learn healthy coping skills.

Rational Emotive Behavior Therapy

The core of rational emotive behavior therapy (REBT) is the notion that rational thinking comes from within and that positive and negative feelings do not manifest as a result of external stimuli, but rather are derived from one’s internal thoughts. REBT helps to teach individuals how to understand their own thoughts and subsequently develop rational thinking habits that promote positivity. 

Family Behavior Therapy

An addiction does not only affect the individual engaging in substance abusing behaviors, but also can have a significant impact on his or her loved ones. It is common for individuals in treatment for substance abuse and/ or addiction to participate in some form of family therapy. Family behavior therapy (FTB) can teach a family unit helpful tools and strategies for navigating family conflict, improving communication methods, and reduce risk factors for addiction. 

Aftercare

Any type of formalized substance abuse and/ or addiction treatment an individual completes will provide an individual with an aftercare plan. This can be invaluable for an individual in recovery, as it can provide a detailed relapse prevention plan and helpful guidance for maintaining one’s sobriety. As a result of one’s addiction, an individual often drops healthy habits (that were established prior to his or her substance abuse) and develops many unhealthy habits and patterns in order to accommodate his or her addiction. In addition to closely adhering to one’s therapeutic treatment plan, it is beneficial to one’s recovery to implement healthy life-style habits. Part of an effective recovery plan from substance abuse and/ or addiction is for an individual to foster a reliable support network. This, for example, can be accomplished by regularly attending support group meetings such as Alcoholic Anonymous (AA) and/ or Narcotics Anonymous (NA). Furthermore, assuring an individual maintains a healthy diet, establishes a consistent exercise routine, obtains adequate rest and nightly sleep are all important self-care practices that can help an individual maintain continued success regarding his or her sobriety. 

If there is concern that a loved one may be struggling with substance abuse and/ or addiction, it is essential to obtain professional help as soon as possible. If left untreated, addiction can result in severe short and long-term consequences, and in some cases death. The sooner an individual obtains treatment for his or her addiction, the sooner he or she will learn the tools needed to go on to live a sober, healthy, and meaningful life. 

Dialectical behavior therapy (DBT) is a form of psychotherapy that is based on cognitive behavioral therapy (CBT). Psychologist, Marsha Linehan developed DBT in the late 1980s to help treat borderline personality disorder (BPD). It has since been adapted and is applied as an effective therapeutic modality for treating several other mental health ailments, including individuals struggling with severe suicidal thoughts. DBT is a multidimensional and comprehensive therapeutic approach. It utilizes several strategies to help an individual learn coping mechanisms for regulating and managing extreme and/ or unstable emotions and/ or harmful behaviors. DBT can be useful to one’s treatment plan for individuals recovering from substance abuse and/ or addiction. There are several components that make up DBT, and as such it can be conducted a variety of settings. 

Substance Abuse

Substance abuse occurs when an individual misuses drugs and/ or alcohol. Individuals that are prescribed medications and take more than the prescribed dose, take it in a method other than prescribed (i.e. crushing up pills and subsequently snorting the powder), mix the medication with additional substances (i.e. alcohol), take it for a longer duration than prescribed, and/ or take it more frequently than prescribed are all forms of substance abuse. Individuals that take illicit substances, and/ or medications that were not prescribed to them are engaging in a form of substance abuse. Consuming excessive amounts of alcohol is also a form of substance abuse. 

Substance abuse is different from addiction, also referred to as substance use disorder (SUD) in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). However, if left untreated, engaging in substance abusing behaviors can lead to addiction. Addiction can wreck havoc in all areas of one’s life. Addiction is a mental disorder that is characterized by compulsively and habitually abusing drugs and/ or alcohol, regardless of the ensuing negative consequences. An individual with SUD is physically unable to stop abusing drugs and/ or alcohol even when it causes harm to his or herself and/ or others. According to the National Institute on Drug Abuse, the most common abused substances in America include the following:

• Alcohol
• Marijuana
• Painkillers (i.e. codeine, OxyContin, Vicodin…etc.)
• Heroin
• Inhalants 
• Benzodiazepines (i.e. Xanax, Diazepam, Klonopin, Valium…etc.)
• Stimulants (i.e. Adderall, Ritalin, Vyvanse… etc.)
• Barbiturates (sedatives)

There are a number of other substances that are commonly abused by individuals in the United States. Any type of foreign substance or substances that are regularly present in one’s system will affect the way one’s body and mind function. 

Substance Abuse Treatment and DBT

Every individual is different and for optimal results will require a customized substance abuse and/ or addiction treatment plan that considers the individual’s nuanced needs. Many substance abuse and/ or addiction treatment plans integrate a variety of therapeutic modalities. The combination of therapeutic approaches utilized will depend on several contributing factors. Any individual that struggles with substance abuse and/ or addiction and also has suicidal ideation, can likely benefit from DBT. Individuals that have a co-occurring disorder (also known as a dual diagnosis), substance use disorder in addition to another mental health disorder, can benefit from DBT. 

There are a variety of treatment options for individuals struggling with substance abuse and/ or addiction. Inpatient treatment programs can offer DBT services as well as outpatient treatment programs. DBT is carried out in three distinct methods, each providing unique benefits, which include the following:

1. Individual therapy sessions: one-on-one therapy sessions allow an individual personalized support as it relates to emotional regulation, and shifting damaging thinking and behavior patterns, through teaching new skills and developing coping mechanisms to address navigating challenges in a healthy fashion.  
2. Group therapy skills sessions: group therapy sessions provide an individual with a safe and controlled environment to practice implementing DBT social skills. It also allows individuals to connect with peers experiencing similar life challenges. Group therapy sessions offer a platform for clients to share insights into their personal recovery experiences and learn from others. 
3. Coaching: phone coaching is offered for additional support during the times between individual and group therapy sessions. The client is able to reach out to his or her clinician for in-the-moment guidance, encouragement, and/ or assistance with applying various learned DBT skills.

Any person that has struggled with substance abuse and/ or addiction has modified areas of his or her life to accommodate his or her substance use behaviors. This can not only have grave affects to one’s physical and emotional health, but can also lead to financial difficulties, legal challenges in addition to damaged relationships. Learning tools to foster, repair, and/ or sustain healthy relationships are essential components of DBT. 

Dialectical behavior therapy (DBT) is an evidence-based psychotherapy treatment that was originally developed by Marsha Linehan, in the late 1980s, to help treat individuals diagnosed with borderline personality disorder (BPD). Research has shown that since its inception it has become an effective form of treatment for individuals with other mental health disorders. The DBT approach is now frequently implemented in treatment plans for individuals (both adolescents and adults) struggling with any single or combination of the following ailments, as listed by the Child Mind Institute: 

• Drugs and/ or alcohol abuse 
• Substance use disorder
• Anxiety/ generalized anxiety disorder (GAD)
• Impulsive and/ or disruptive behaviors
• Attention-deficit/ hyperactivity disorder (ADHD)
• Frequent mood swings
• Bipolar disorder
• Self-injuring behaviors
• Depression/ major depressive disorder (including treatment-resistant major depression and/ or chronic depression)
• Suicidal behaviors
• Poor coping skills
• Anger outbursts
• Eating disorder behaviors/ bulimia/ binge-eating disorder/ anorexia 
• Family and/ or peer conflict
• Post-traumatic stress disorder (PTSD)

DBT is based on the cognitive behavioral therapy (CBT) approach that relies on talk therapy and emphasizes the psychosocial aspects of treatment. Dialectical behavior therapy helps teach individuals healthy coping mechanisms and useful techniques for managing stress, regulating emotions, and improving relationships with others. 

Therapeutic Settings

Dialectical behavior therapy is conducted three therapeutic settings, which include individual therapy sessions, group skills therapy sessions, and coaching. Individual therapy sessions provide a client and his or her clinician the opportunity to co-create behavior plans that incorporate long and short-term goals as well as delve deeper into and process the client’s life journey while also learning skills to improve self-worth, establish self-compassion, acceptance and a positive self-identity. These sessions are empowering in teaching a client skills, many of which will serve them for the rest of their lives. Group therapy sessions provide clients to learn DBT skills and a safe environment to practice implementing skills learned in both group and individual therapy sessions. The structure of group therapy sessions enable an individual to learn important behavioral skills from peers as well as encourage new, healthy ways of interacting with others. Coaching is a component of DBT that provides the client access to his or her clinician between individual and group therapy sessions. An individual can call his or her clinician to receive support and guidance for coping with challenging in-the-moment situations.

DBT Skills Training

DBT utilizes four main strategies for teaching individuals skills that help with effectively changing their behaviors. They include the following: 

1. Mindfulness: the practice of remaining present and fully in the moment at any given time
2. Distress Tolerance: learning to tolerate pain in challenging situations, without changing it or escalating it
3. Interpersonal Effectiveness: increasing one’s self-awareness through learning to effectively advocate for one’s own wants and/ or needs by saying no and/ or expressing one’s desires while maintaining self-respect and without feeling that relationships will be compromised 
4. Emotion Regulation: learning how to shift and/ or change unwanted emotions

DBT helps individuals transform negative thoughts and behaviors into an understanding of one’s life journey and ultimately helps to establish mindfulness and self-compassions, which are beneficial and can be useful throughout one’s entire lifetime. 

DBT Adolescent Skills Groups

Adolescents, typically between the ages of twelve to nineteen years old, must attend group therapy sessions as a component of DBT.  Adolescent DBT group therapy generally extends to parents and/ or caregivers. By attending group sessions together, the adolescent and his or her support system can learn DBT skills together. In DBT group skills sessions, adolescents learn and practice implementing DBT skills used to help communication, regulate emotions, improve relationships, enhance moods, and practice effective problem solving skills. These group sessions are helpful for parents’ and/ or caregivers as the sessions allows them to learn effective methods of communication and gain an understanding for how to better empower their adolescent to employ the DBT skills to deal with problems and navigate challenges. 

DBT Adult Skills Groups

Much like the adolescent DBT skill groups, adult skills groups are an integral component of one’s DBT treatment. Adult skills groups are comprised of other individuals experiencing similar concerns. The skills addressed in the group sessions reflect the four main pillars of DBT (mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation). The associated skills are also worked on in a group setting. This provides a client the opportunity to implement the skills, tools, and coping mechanisms learned with peers in a safe and controlled environment. The work that occurs during the skills groups continues, as homework that corresponds to the DBT skills taught or visited during each DBT group session are regularly assigned. 

Adolescence is an incredibly challenging time in one’s live. There are rapid and exponential psychological, physical, emotional and developmental maturation processes that occur simultaneously as a result adolescence. Hormones are surging through teenagers’ bodies and navigating how to regulate the emotional and physical impact of them is difficult. Often teenagers employ a trial and error method for coping as a means to manage the intense changes they are experiencing. Every teen is different and will experience and process the stressors related to adolescence distinctly.

Self Harm In Teens

Adolescents that inflict self-harm and/ or self-mutilation can do so in a variety of different ways. This can occur on any area of one’s body, but it is most frequently seen on the arms, legs, and/ or front of the torso. The Mayo Clinic provides a comprehensive list of reported self-harming methods, some of which include the following examples: 

• Scratching
• Carving and/ or branding one’s skin
• Hitting oneself
• Burning
• Ingesting poison
• Cutting
• Inserting foreign objects under the skin and/ or into one’s body
• Head banging
• Pulling hair out
• Getting excessive body piercings
• Picking scabs to prevent wounds from healing
• Jumping in front of vehicles and/ or from high places
• Overdosing on drugs and/ or medication

It is normal and should be expected that the majority of teenagers are likely to experience an array of pain in during their teenage years. However, it is abnormal for a teenager to purposefully engage in self-mutilation and/ or self-harm and must obtain professional help immediately. 

Warning Signs

Teenagers are notorious for exhibiting moody behavior and remaining exceedingly private. There a plethora of potential reasons for the impetus behind why a teenager acts the way he or she does, but the reality is those reasons are rarely, if not ever, revealed to a parent and/ or caregiver. There are specific warning signs for which to be on the lookout regarding self-harming behaviors in teens. Examples of these warning signs can include, but are not limited to the following:

• Missing patches of hair (from head, eyebrows and/ or eyelashes)
• Spending time with people that harm themselves
• Only wearing long sleeved clothes, regardless of the outside temperature
• The presence of cuts, bruises, scratches, burns, and/ or carvings on one’s body
• Self-isolation
• Noticing sharp objects hidden in his or her belongings

Many warning signs that are indicative of a teen inflicting self-harming behaviors are similar to typical behaviors exhibited by any teenager. It is important to note, that not all adolescents that present with any combination of the above examples is undoubtedly causing self-harm. However, if concern arises it is best to seek the guidance of a qualified mental health professional as soon as possible to assure the safety of the teenager. 

Treatment Options

There is an array of treatment options available for a teen struggling with self-harm and/ or self-mutilation. The first step is to have a calm conversation with the teenager expressing concern and offering support. The next step is to set up an appointment for the teenager to get evaluated by a mental health professional. This will illuminate the presence of any underlying mental health issues that may be driving the teen to engage in self-harming behaviors. The mental health evaluator will also be able to provide guidance as to subsequent steps to help the teen obtain the needed support to stop the self-destructive behavior. 

It is highly common for some form of formalized treatment to be recommended by the evaluating mental health professional. A teen may benefit from individualized therapy as a means to treat his or her self-mutilating and/ or self-harming behaviors. There are formalized outpatient mental health programs that require the teen to participate in the treatment program for a certain number of hours, daily. Depending on the severity of the situation, there are also acute inpatient mental health treatment programs that offer twenty-four-hour care and support throughout the duration of the program. In severe cases, hospitalization may be necessary. 

The treatment approaches vary, as they are contingent upon the specific needs of the teenager. A customized treatment plan is developed to accommodate the nuanced needs of the teenager. Generally the treatment protocol for teens that engage in self-harm will include some combination of different psychotherapy approaches. Certain psychotherapy modalities that are commonly integrated into treatment plans for teens that self-harm include cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), psychodynamic psychotherapy, mindfulness-based therapy, creative arts therapies, and/ or family therapy. Treatment plans may also include medication. Some medications can be helpful in decreasing uncomfortable symptoms associated with other underlying mental health issues, which in turn can reduce the urge to self-harm. 

There are a variety of treatment options that can include an array of different therapeutic methods that are available for an individual seeking treatment for an eating disorder. The principals of dialectical behavior therapy (DBT) are based on those of cognitive behavioral therapy (CBT). The CBT method works to help an individual learn how his or her feelings, thoughts, and behaviors influence each other. DBT is more keenly focused on the social and emotional aspects, as it helps individuals learn to cope with extreme, unstable and/ or harmful behaviors. Dialectical behavior therapy has evolved into an evidence based psychotherapy approach that is utilized as treatment for an assortment of mental health conditions. 

Eating Disorders

Eating disorders are serious mental illnesses that are characterized by persistent, damaging eating behaviors. They can have grave affects on one’s emotions, health, and capacity to adequately function in important areas of one’s life. There are a number of different manifestations of eating disorders. The various types are listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) under the Disorder Class: Feeding and Eating Disorders. The three most common eating disorders are anorexia nervosa, bulimia nervosa and binge-eating disorder. If left untreated, eating disorders can result in severe short and long-term consequences. While eating disorders are life-long conditions, with treatment, ample support, and steadfast commitment, an individual can learn the tools and skills needed to go on to live a successful, meaningful, and healthy life. 

Dialectical Behavior Therapy

Psychologist Marsha Linehan developed dialectical behavior therapy in the late 1980s. It was initially developed as a means to help treat individuals with borderline personality disorder (BPD) and/ or with chronic suicidal ideations. As time has progressed it has become evident that DBT can be helpful in treating individuals with other mental health conditions and/ or mood disorders. Research has shown that DBT can be advantageous when integrated into one’s treatment plan for mental disorders such as depression, substance use disorder, post-traumatic stress disorder (PTSD), and eating disorders. 

DBT can benefit an individual diagnosed with an eating disorder by helping to foster self-management skills, lower stress, reduce anxiety, and learn to control destructive eating behaviors. The goals of DBT are to help a client learn to establish healthy coping mechanisms that can be applied to environments that would have otherwise provoked engaging in destructive eating behaviors and/ or patterns. It helps clients learn how to reduce emotional reactivity and improve their interactions with others. DBT promotes acceptance and teaches skills to enable an individual to live in the moment and cope with emotional triggers that may otherwise perpetuate eating disorder symptoms and behaviors. 

How Does It Work?

DBT includes a combination of individual therapy sessions, group therapy sessions as well as coaching support. Every individual is different and will require some form of customized treatment plan when it comes to eating disorders. Therefore, the individual therapy sessions are essential in creating a forum for the client to work on his or her own nuanced issues with one-on-one guidance from his or her clinician. Creating personalized behavioral plans and goals surrounding mindful eating are established in individual therapy sessions. These sessions are beneficial in empowering a client as they help to establish and nurture self-compassion, increase one’s sense of self-worth, and develop a positive self-image. 

Group therapy sessions enable a client to practice the skills learned in individual therapy sessions. They can offer a safe environment to connect with other individuals experiencing similar life challenges. Furthermore, they allow individuals in recovery to engage in healthy interpersonal connections, while simultaneously cultivating a support network. Individuals have an opportunity to share their experience as it relates to their personal recovery process as well as offer support and insights to others in the group. Group therapy sessions also teach individuals important self-management life skills while creating an opportunity for the individuals to implement these skills in a group setting (i.e. mindful eating in a group environment). 

While group therapy sessions and individual therapy sessions can provide enormous support, it is not uncommon for a client to experience moments of distress between sessions. During those moments between individual therapy sessions and group therapy sessions, DBT offers coaching guidance. Clients can request clarification for and discuss how to implement certain management skills and/ or self-soothing techniques. If a client is struggling and/ or is in crisis he or she can reach out to and speak with his or her clinician for support over the phone, at any time. The coaching component of DBT is extremely helpful for an individual, as he or she knows that support is available during times of need.

Dialectical behavior therapy, DBT, is a type of therapeutic treatment that falls under the larger umbrella of CBT (cognitive behavioral therapy). DBT was developed in the late 1980s by Marsha Linehan, Ph.D., as a means to specifically treat individuals with borderline personality disorder (BPD). As time has progressed, it has proven to be an effective method in the treatment of individuals that suffer from other types of mental health disorders. While DBT utilizes a cognitive behavioral approach, it predominantly emphasizes the psychosocial aspects of treatment. The theory behind the DBT approach takes into consideration the notion that some individuals are prone to react in a more intense manner when it comes to certain emotional situations. The biological response manifests as an exponential increase in one’s arousal level (different from an average person’s), elevating one’s emotional stimulation, which in turn takes an individual a longer duration of time for the individual to return to his or her baseline arousal level. In order to adequately regulate one’s emotions an individual with borderline personality disorder must integrate specialized coping techniques. 

Borderline Personality Disorder

Borderline personality disorder is a mental health disorder that impacts the way an individual thinks about him or herself and others. As is described by the National Institute of Mental Health, it is characterized by an ongoing pattern of varying moods, behaviors, and self-image. The precise cause for developing borderline personality disorder remains unknown. There are, however, certain risk factors that research has suggested that may increase one’s susceptibility. Contributing risk factors include: genetics, one’s brain structure, family history, as well as environmental, social, and cultural factors. The symptoms of borderline personality disorder typically result in impulsive actions and relationship problems. The Mayo Clinic provides examples of signs and symptoms that are commonly exhibited in individuals with borderline personality disorder. They include the following:

• Engaging in risky and/ or impulsive behaviors (i.e. reckless driving, excessive gambling, binge eating, substance abuse, unsafe sex…etc.)
• Intense fear of abandonment
• Suicidal ideations
• Self-injury
• Severe mood swings (i.e. elation, irritability, shame, anxiety…etc.)
• Pattern of unstable relationships
• Irrational displays of anger
• Distorted self image
• Feelings of emptiness
• Stress related paranoia

Every person is different and an individual with borderline personality disorder has the propensity to experience any combination of the above symptoms. Borderline personality disorder is notorious for being an incredibly challenging mental health disorder to both diagnose and treat. The article, Why Psychiatrists are Reluctant to Diagnose Borderline Personality Disorder, pinpoint several challenges psychiatrist’s face when diagnosing borderline personality disorder. Borderline personality disorder is a mental health disorder that is treated by teaching an individual how to manage his or her symptoms. Hence, there is no known treatment for borderline personality disorder that fully eliminates or cures an individual from its diagnosis. 

Dialectical Behavior Therapy

Individuals who are diagnosed with borderline personality disorder tend to view things in extremes (i.e. all good or all bad). This can greatly impact the way one subsequently behaves which can make it challenging to function in one’s everyday life. The American Psychological Association assert that individuals who have undergone DBT as a component of treatment for borderline personality disorder have displayed notable improvements in the following areas:

• Shorter hospitalizations
• Reduced anger
• Less frequent and/ or less severe suicidal ideations
• Improved social functioning
• More likely to remain in treatment

It is highly common for individuals with borderline personality disorder to be unable to adequately cope with the sudden experience of surging of emotions, which is a typical symptom of the disorder. DBT helps teach clients learn and integrate coping mechanisms to help with changing unhealthy behaviors. DBT is made up of four modules. The modules are intended to shed light on situations where the objective is to change something (i.e. asking someone to do something) or to resist changes someone else is attempting to make (i.e. saying no). The four modules of dialectical behavior therapy treatment are:

1. Mindfulness: active practice of being fully aware and present in the moment
2. Interpersonal effectiveness: learning to advocate for one’s wants as well as say “no” while maintaining self-respect and outside relationships
3. Distress tolerance: learning to tolerate (not change) pain in challenging situations
4. Emotional regulation: learning to decrease vulnerability to painful emotions and change unwanted emotions

It is important to note that many individuals with borderline personality disorder have substantial interpersonal skill, but they are unable to properly apply their skills within the appropriate context. Obtaining treatment is essential in providing an individual with borderline personality disorder the needed tools to manage his or her disorder.