Anxiety In Teens joins Dr. Shari Manning, an expert in Dialectical Behavioral Therapy (DBT) and founder of Treatment Implementation Collaborative. Here, she shares more about exactly what DBT is and how dialectic behavioral therapy for teens could be helpful.
AIT: What exactly is DBT? How is it different from other therapies such as CBT? What is the goal?
SM: DBT is multi-modal comprehensive treatment for BPD and other multiple problem, severe clients with emotion dysregulation disorders. It has four stages that range from decreasing out of control behaviors to increasing clients’ capacities for joy and enriched
experiencing. DBT is a cognitive-behavioral therapy (the name of the manual is Cognitive Behavioral Treatment for Borderline Personality Disorder).
When DBT was originally written, CBT did not emphasize acceptance technologies. Now, however, CBT includes treatments that are mindfulness based such as Acceptance and Commitment Therapy and Mindfulness Based Cognitive Therapy for Depression. DBT has an emphasis on what is targeted and when it is targeted in the treatment.
AIT: Could you explain a bit about the 4 modules of skill training in DBT? What are they and why are they useful?
SM: It is important to remember that skills training alone is not DBT.
The first module is Core Mindfulness. A goal of DBT is for clients to fully experience their lives without self-consciousness. Mindfulness is how to know your experience, engage in it and not judge or invalidate.
The second module is distress tolerance. Like Core Mindfulness, Distress Tolerance is considered a set of acceptance skills. The distress tolerance skills are divided into two categories: Crisis Survival Skills (how to make it through difficult moments in life without doing things that make them worse) and Acceptance Skills (how to acknowledge painful situations and the emotions that those situations cause).
Interpersonal Effectiveness skills are assertiveness skills. They teach clients how to ask for what they want, say no to unwanted requests and state opinions in ways that keep the relationship with the other person and maintain or increase self-respect.
Finally, emotion regulation skills are how to know your emotions and their functions, decrease vulnerability to negative emotions, experience painful emotions when necessary, use emotions to help us when they are needed and change ineffective, unwanted emotions.
AIT: In what ways do you see DBT as being effective for your clients?
SM: I began training in DBT in 1993. I have used it in outpatient therapy, intensive outpatient, partial hospitalization, residential treatment, corrections and private practice. I have used DBT with adults and adolescents. DBT is extremely effective at curtailing impulsive behaviors including suicide, self-harm, substance abuse, eating disordered behaviors and avoidance behaviors. It is most effective with behaviors that are driven by emotion.
AIT: What clients would benefit the most from DBT therapy? Is it more useful for certain mood disorders more than others? Or how would dialectic behavioral therapy for teens be useful?
SM: Clients who benefit from DBT are those with emotion regulation and impulsive behaviors. I don’t recommend DBT for people with a single disorder for which another evidence based treatment has efficacy, e.g. a single anxiety disorder, panic disorder, PTSD or depressive disorder. It is for people who have complex problems in multiple areas. There is no randomized trial evidence that DBT is effective for a certain mood disorder. There was an RCT for DBT with geriatric depression and it was efficacious in the study. There are two studies going on with adolescents right now. The pilot data show that DBT is effective for adolescents with emotion regulation and behavioral dyscontrol.
AIT: How would you suggest going about finding a DBT therapist or group?
SM: DBTcertification of therapists is in its infancy. I am certified by the institute that will certify therapists but most people don’t yet have access to the certification. Until is more public, I would ask how much training the person has in DBT (it can’t be learned in one or two days), who is on their team (you are not doing DBT if you are not in a consultation team) and with whom they had supervision and if that supervisor is recognized as a DBT expert.
AIT: Any final thoughts about DBT for our readers?
SM: It is extremely problematic that people are doing things that they think are DBT and they are not. DBT is NEVER just a group. DBT is a comprehensive program that requires skills training plus other things. In outpatient therapy, those other things are DBT individual psychotherapy, telephone consultation and other environmental interventions. If someone says that they have a group and therefore are DBT, beware. They are not.
About Shari Manning, Ph.D:
“Dr. Manning is the former President/CEO of Behavioral Tech, LLC and Behavioral Tech Research, Inc, two companies that provide training, consultation and research in Dialectical Behavior Therapy She is also the founder of the South Carolina Center for Dialectical Behavior Therapy (now the SC Center for DBT, LLC), a private practice that offers standard outpatient and intensive DBT treatment for adults and adolescents. She has supervised therapists at the Behavioral Research and Therapy Clinics at the University of Washington and the University of South Carolina as well as training and supervising therapists and programs at the SC Department of Mental Health and SC Department of Corrections. Dr. Manning consults extensively to state and private mental health programs, domestically and internationally, at all levels of client care, including forensic and criminal justice settings. Her research includes investigations of the efficacy of DBT with incarcerated women with borderline personality disorder (BPD) and with adult women with co-morbid BPD and eating disorders. Dr. Manning has written several published chapters and articles on DBT and its implementation and her book for family members, Loving Someone with Borderline Personality Disorder: How to Keep Out-of-Control Emotions from Destroying Your Relationship.”
By: Kara Baumgardner, Anxiety In Teens Contributor