Anxiety, Depression, Mindfulness, Teens

Teen Mental Health: What Dialectical Behavior Therapy (DBT) Can Offer

By Thanos Nioplias, MA

Anxiety and depression are clearly on the rise among teenagers. And it’s not only psychologists and educators who are concerned. Everyday conversations among teens focus on how stressed and anxious they feel, and the press has recently written extensively about mental health struggles that young people face. Time magazine, citing compelling clinical research and personal accounts, recently described the modern teenager as “fragile, less resilient and overwhelmed”.

What is wrong with our teens?

The modern teenager has been impacted by technological advances unlike any previous generations. At any given time, our teenagers are glued to their screens. As a result, they are exposed to plenty of negative information, some of which is genuinely terrifying and even horrifying. They are also constantly comparing themselves to others on social media where they are exposed to images of idealized bodies and lifestyles, which leave them feeling excluded, lonely, and dissatisfied with their own abilities and accomplishments. But perhaps the most insidious negative impact of screen-time is that teens are less focused and less present-minded than ever. As a result, they are less likely to naturally recognize and regulate their basic needs and emotions. All the bright lights and limitless scrolling are so distracting that many have no clue what they need themselves to maintain emotional wellness. The worst part about the above is that it has become completely normal for kids to use technology for hours on end each day.

As a result, we have a serious crisis. It is almost expected that teens today are moody, lacking in confidence, insecure about their appearance, filled with worry and concern about their future, and that they have been exposed one way or another to alcohol and illicit substances when interacting with peers. It is also very common for teenagers today to experience significant depressive symptoms including pervasive sadness, apathy, complaining about life being “hard and overwhelming” and even thoughts about suicide. Equally common are bouts of anger, which are frequently followed by apathy and seclusion, as well as failure to complete academic work and/or maintaining meaningful hobbies and interests (aside from scrolling on their phones). Also common are possession and frequent use of alcohol and drugs, and frequenting places where these substances can pose a threat to wellbeing. Worse, a staggering number of teenagers engage in self-injury and have significant, active suicidal ideation. The majority of the above symptoms – while common – are clear red flags that warrant professional intervention and care.

Can therapy help our teenagers become more resilient?

Dialectical behavior therapy (DBT) is a comprehensive, evidence-based psychotherapy originally developed to treat self-injury, suicidality and other high-risk behaviors among individuals with Borderline Personality Disorder. More recently, DBT skills groups have been modified to help troubled teenagers reduce depression, irritability, anger, impulsivity, self esteem issues and overall social adjustment, in addition to self harm and suicidal ideation. A DBT skills group is like a classroom. Teenagers (or adults) come to a 90-minute session each week for approximately six months to learn and practice skills in four core areas.

First, DBT participants learn how to practice Mindfulness, which helps them to slow down, be present in the moment, and simply identify and be aware of their thoughts, emotions, and urges.

Second, they focus on Emotion Regulation, which involves learning how to change their feelings such as anxiety, depression, anger, etc.

Third, they learn Distress Tolerance skills to manage impulsive and other problematic behaviors that can be damaging to themselves and others.

And finally, they learn strategies to build and maintain Interpersonal Effectiveness in order to improve and enhance social relationships through assertiveness and reducing hostility.

For teens, a fifth component of treatment focuses on Middle Path skills to let go of “black-and-white” thinking and embrace a balanced perspective in their relationships and in their life.

Among other therapies that have been showed to effectively improve teenagers’ mental health, DBT is especially promising in keeping teenagers safe and helping them build a life worth living. Even in our fast-paced and uncertain times, we have evidence to believe that our troubled teenagers can learn life skills, get better, and thrive in their lives.

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