Dialectical behavior therapy (DBT) is an evidence-based psychotherapy. DBT stems from and includes many components of the cognitive behavioral therapy (CBT) approach. DBT differs from CBT in that dialectical behavior therapy prioritizes focusing on the psychosocial aspect of therapy. It was developed by Marsha M. Linehan in the late 1980s, intended to be used as a means to treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD). In addition to DBT currently being recognized as the gold standard treatment method for BPD it has also become known as an effective treatment method for other mental health conditions (e.g. bulimia, binge-eating disorder, substance use disorder, depression, bipolar disorder, attention-deficit hyperactivity disorder, and more). Further, standard DBT has been adapted and DBT for children (DBT-C) is used to treat pre-adolescent children.

Standard DBT

Dialectical behavior therapy is comprised of three components: weekly individual psychotherapy, weekly DBT group skills training sessions, and optional phone coaching. One-on-one therapy sessions offer individualized support to go over any confusion surrounding DBT skills, address personal challenges and discuss successes that occurred during the pervious week. The DBT group skills training sessions focus on four behavioral skill modules, two of which are acceptance-oriented and two of which are change-oriented:

• Core mindfulness (acceptance-oriented): learning to be present and fully aware in the moment
• Distress tolerance (acceptance-oriented): learning to tolerate pain in difficult situation, instead of attempting to change it
• Emotion regulation (change-oriented): learning to honor boundaries, and advocate for one’s wants and needs in relationships in a way that is both self-respecting and non-damaging 
• Interpersonal effectiveness (change-oriented): learning to manage and deal with primary emotional reactions before they have a chance to turn into distressing secondary reactions

As additional support, phone coaching is available between sessions and can be used at the individual’s discretion. The entire DBT program (assuming skills modules are not repeated) typically lasts about six months long, as approximately six weeks are allocated for each of the four skills module. 

Adaptations

According to Behavioral Tech, DBT for children (DBT-C) was developed to “address treatment needs of pre-adolescent children with severe emotional dysregulation and corresponding behavioral discontrol.” DBT-C relies on the same principals, theoretical model and therapeutic strategies of standard DBT. However, the DBT-C curriculum is re-framed in a way that considers and accommodates the developmental and cognitive levels of pre-adolescent children and provides age-appropriate services. DBT-C is comprised of three main categories, which are subdivided into the following subcategories, as provided by Behavioral Tech: 

1. Decrease risk of psychopathology in the future
   1. Life-threatening behaviors of a child
   2. Therapy-destroying behaviors of a child
   3. Therapy-interfering behavior of a child
   4. Parental emotion regulation
   5. Effective parenting techniques
2. Target parent-child relationship
   1. Improve parent-child relationship
3. Target child’s presenting problems
   1. Risky, unsafe, and aggressive behaviors
   2. Quality-of-life-interfering problems
   3. Skills training
   4. Therapy-interfering behaviors of a child

As is articulated in Behavioral Tech, the goal of DBT-C is to eliminate the “harmful transaction between a child and an environment and replace it with an adaptive pattern of responding to ameliorate presenting problems, as well as to reduce the risk of associated psychopathology in the future.” Through DBT-C a young person will learn a variety of adaptive coping skills and effective problem-solving strategies. Further, DBT-C helps the parents of the pre-adolescent learn how to create a supportive, validating and stabilizing environment. 

Disclaimer: 

The information above is provided for the use of informational purposes only. The above content is not to be substituted for professional advice, diagnosis, or treatment, as in no way is it intended as an attempt to practice medicine, give specific medical advice, including, without limitation, advice concerning the topic of mental health.  As such, please do not use any material provided above as a means to disregard professional advice or delay seeking treatment.