Dialectical Behavior Therapy (DBT) is an evidence-based therapeutic modality designed to help those with emotion dysregulation. The original model has been adapted for use with a variety of populations, including adolescents. (If you’d like a broader overview of how DBT supports teens struggling with depression, you can read our parent blog on DBT for Adolescent Depression.) Adolescents are especially vulnerable to emotion dysregulation due to a variety of factors including changes in biology, brain development, social and societal pressures, and developing self-identity. (If you’ve noticed signs of sadness or withdrawal in your child, our blog “Why Is My 13-Year-Old Depressed?” explores this topic in more depth.) In this blog, I will dive deeper into emotion regulation information specifically as it pertains to adolescents.
What is DBT emotional regulation for adolescents?
DBT emotion regulation is a therapeutic approach designed to help adolescents manage intense emotions, develop healthier coping strategies, and improve their relationships. The skills training portion of the program teaches teens how to do this through mindfulness skills, emotion regulation skills, interpersonal effectiveness skills, and distress tolerance skills. The skills training group at Cincinnati Center for DBT is a multifamily group, meaning that teens join the group with an adult, typically a parent or guardian. The group teaches the teen and their guardian skills in these 4 areas to help teens and their adults build awareness of their emotional states, regulate their emotions and build emotional resilience, improve interpersonal skills, and tolerate distress more effectively.
What are the 5 areas of dysregulation in DBT?
The 5 areas of dysregulation in DBT are:
- Emotion dysregulation includes emotional vulnerability, reactivity, and liability. Emotion dysregulation can lead to experiencing more persistent negative emotional states (i.e. shame, guilt, depression, anxiety) and having difficulty experiencing more positive emotional states (i.e. happiness, contentment). DBT addresses these concerns largely in the Emotion Regulation module.
- Interpersonal dysregulation can look like: unstable relationships, interpersonal conflicts, chronic family disturbance, social isolation, efforts to avoid abandonment, and difficulties getting wants and needs met in relationships and maintaining one’s self-respect in relationships. DBT teaches skills to improve these areas in the Interpersonal Effectiveness module.
- Cognitive dysregulation and family conflict can look like nondialectical thinking (i.e. extreme, polarized, black-and-white thinking), difficulties in taking perspective, difficulties with conflict resolution, invalidation of self and others, and difficulty effectively influencing own and others’ behaviors (i.e. obtaining desired changes). These concerns are largely addressed in the Walking the Middle Path module.
- Behavioral dysregulation includes impulsive behaviors such as skipping school, cutting classes, blurting out in class, spending money, risky sexual behaviors, binging and/or purging, drug and alcohol abuse, aggressive behaviors, suicide, and non-suicidal self-injurious behaviors. (If your teen has been engaging in self-harming behaviors, our blog “Why Is My Daughter Cutting Herself?” may provide helpful insights and next steps.) DBT works to help clients decrease these behaviors in the Distress Tolerance module.
- Self-dysregulation looks like lacking awareness of emotions, thoughts, and action urges. This can include poor attentional control, unable to reduce one’s suffering while also having difficulty accessing pleasure, identity confusion, sense of emptiness, and dissociation. The Core Mindfulness skills in DBT are helpful in reducing suffering in these areas.
How do you teach adolescents emotional regulation?
Okay, this is a big question to answer. I’ll first address this as a clinician who provides DBT therapy. In DBT, we seek to teach adolescents emotional regulation through learning the skills in the skills training group and through coming to individual sessions where the adolescent and their individual therapist can work together to target the teen’s specific goals with the 5 areas of emotion dysregulation noted above in mind. The teen will be asked to track various emotions and behaviors in their diary card daily to gain more awareness of them, to notice patterns, and to track progress over time. Phone coaching is provided so that your teen can have 24/7 access to their clinician to gain insight into how to actually use the skills they’re learning in the moment they’re feeling distressed. Finally, the clinician takes part in a consultation team to receive support and consultation as needed so that your teen has a team of therapists serving them.
If you’re asking this question from the parent’s perspective on how you can teach your adolescent emotion regulation, there’s a lot that can be done from this perspective as well. For one, at least in our program, you (or another adult in your teen’s life) can have the opportunity to take part in our skills training group and you’ll learn, right alongside your teen, the skills to help build emotion regulation. It’s my long-held belief that every single human should take a DBT skills training group at least once in their life. I truly believe it’s the blueprint for solid mental health for just about everyone. You can help your teen learn emotion regulation by practicing the skills and modeling them for yourself. This will help you feel better and then respond more effectively to your teen, which of course will help them respond better and feel more connected to you. They’ll also get the chance to see you “practice what you preach” so to speak which can help them see how to practice the skills, understand better how they work, have more buy-in because they see the skills work for you, and feel more connected to you by the sheer effort you’re putting in.
You can also engage with your teen’s therapist and work together to address the systems in place contributing to emotion dysregulation in your teen. Forming a plan with your teen, their therapist, and other members of the family can really help provide the most effective, well-rounded care for the teen. Teens are in such a unique position: they’re getting older, wanting to experience new things, and forming their identity, but they also have so little control over their lives, they’re told what to do at school and at home. Addressing ineffective behavioral patterns within the family unit can really make this process easier and smoother not just for the teen, but for the family as well.
How to control emotions in adolescence?
Ah, I’m going to reframe this one, I don’t love the wording. “Controlling” emotions in teens is not exactly the most effective framework to view emotion dysregulation. Don’t get me wrong, I can only imagine how scary, upsetting, frustrating, etc. it must be to be in your shoes trying to raise a teen with high emotion dysregulation. “Controlling” the emotions, though, can have a negative connotation because, more often than not, it’s not necessarily the emotion that’s ‘bad’ but rather the behaviors that come with it. For example, the problem isn’t necessarily that your teen gets angry. Anger isn’t ‘bad’! Anger can be so effective for people to be assertive, protect themselves, and get their needs met. If that anger causes your teen to hurt their siblings, now that’s different. It’s not that we have to control the anger, it’s that your teen needs to learn what to do when they get angry and how they can express that anger effectively. So, if that teen can learn to talk to their sibling using a DEARMAN (a skill taught in the Interpersonal effectiveness module), they can learn that their anger was a cue to them that they did not like what their sibling did. Instead of hitting their sibling, they can learn to talk to them and, in doing so, they’ll learn they can get their needs met more effectively and they don’t end up in trouble.
Helping teens identify what they’re feeling, understand what that means for them and their environment, and then get their needs met in a safe and effective way is what DBT is all about. (To learn more about how DBT for adolescents works in our Cincinnati practice, visit our comprehensive guide on DBT for Adolescent Depression.) Teens and their families can learn together how to identify their emotions and use their emotions to inform them about what’s going on and what that means. While emotions can come with problematic behaviors that you don’t like, the emotions themselves aren’t the “problem”, your teen (and honestly most of us at least in some way) needs to learn how to regulate their emotion and act on it effectively. That’s where we come in! Give us a call and we can help you and your family learn these skills and develop your life worth living, together!