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.

“Effective” Parenting: More than Behavioral Control

By Gavi Hoffnung, PhD

Being a parent is incredibly rewarding, but also tremendously demanding. Our office receives hundreds of phone calls each year from parents seeking guidance in how to better manage their children’s behaviors. Above all, they are striving to become “effective” parents: They want to be more successful in shaping their children’s perspectives and behaviors. Here are some of the ideas and approaches that we use to help them get back on their feet.

A clinical approach to parenting suggests that there are two main operations at play when parents interact with children: One is behavioral-management, and the other is the parent-child relationship. Behavioral management involves, well, management of children’s behavior. When in this “mode” we ask questions like How can I get my child’s behavior to be in line with family? How can I get my kid to school on time? What can I do to make sure that homework gets done, and that bedtime is adhered to? These are fundamentally important questions since parents who struggle with behavioral management often feel a lack of control. By contrast, the parent-child relationship involves creating a secure attachment with children, and a sense of closeness and bonding. When in this “mode” parents do what they can to draw close and stay close to their children, and create a sense of love and connection. This too is fundamentally important, both for parents and kids.

Effective parents are masters of both the parent-child relationship and behavioral management. Many parents are good at one, or the other, and some parents struggle with both. But what separates effective parents from the rest of the pack is that they know when, where, and how to shift into behavioral management mode, and relationship mode.

Most ineffective parents mistakenly feel that behavioral management is synonymous with shaping children’s perspectives and behaviors. After all, if we can get our children to listen and comply with the rules, we have a sense that we are educating them and in control. For this reason, in many cases with ineffective parents, behavioral management takes up the majority of parent-child interactions and gets the most attention. Think: Endless negotiations (even arguments) about bedtime, nagging about putting toys away, etc. But often, children who struggle to comply are missing out even more on their parent-child relationship. In many cases, children are clear about what they need to do – they just don’t care to listen to their parents because their relationship isn’t close enough.

For this reason, when we consult with parents about their children, the first step almost always involves guiding them through a protracted period of building a stronger parent-child relationship. We help parents to establish bonds by paying more attention to children, listening to their interests and needs while refraining from shaping their behavior, and just enjoying time together. Only after several weeks of re-building a firm and secure attachment do we consider shifting focus to behavioral management. This is because the relationship and connection parents have with children is a very powerful potential motivator to helping children stay within the lines.

So, it turns out that the first step in being effective as a parent is to show lots of love, attention, and affection. Once those are firmly in place, we can effect change through establishing limits and regaining a sense of control. The result of this is not only an easier time for parents but the greatest and most rewarding outcome of all: Raising kids who thrive.

Holiday Self-Care

By Laura Vraney, PsyD

While the Spring holiday season ushers in nicer weather and rays of optimism, there is no question that it also brings about anxiety. At times, we may become so distracted by the to-do list, both leading up to and during the holiday time that we forget to appreciate and enjoy the festivities. Additionally, other stressors often surface preventing us from enjoying the holidays; for instance, many celebrate the holiday with family members who are hypercritical; others are reminded of loved ones who have passed away, and some are navigating transitions that do not allow for certain family members to be present. Well, you are in luck! Whether the holidays are usually a joyous time or a stressful one (or both!), here are three self-care strategies you can utilize to ensure a more cheerful and relaxing holiday.

  1. First and foremost, acknowledge and validate your feelings with minimal self-judgment. You may have anxiety or stress or sadness or anger or other feelings. If you pretend to be “fine,” especially to yourself, then either you will repress your feelings only to “explode” at a later time OR your feelings may manifest in disguised ways, for instance, a loss of appetite or passive-aggressive behavior. Neither of those routes is productive. While it may feel selfish, you need to be kind to yourself. Rule of thumb – support your own emotions just how you would support a friend or loved one when they are feeling anxiety and/or stress.
  2. In order to feel a greater sense of control, here are some basic behavioral strategies you can implement. Write a list of everything that needs to get done in the days to come – spend as much time as you need getting everything organized. Prioritize in a daily planner your responsibilities based on the day, required preparation time, and deadlines. If you are someone who struggles with other aspects of the holidays (e.g., family gatherings), know your warning signs when feeling overwhelmed. These may include a shift in your mood, increased heart rate, or loss of appetite. Whether the former and/or later, give yourself permission to take 10-15 minutes alone to refresh. Find things that are self-soothing, such as journaling, listening to music, or stepping outside for a short walk. Also, please make sure you are eating well-balanced meals and getting adequate sleep both during the holidays and in general. We are more vulnerable to stress and anxiety when we are “emotionally eating,” skipping meals, and/or sleep deprived.
  3. Let us not forget why holidays are so special! Research has found that taking the time for gratitude can facilitate neurobiological changes that protect us from stress, anxiety, and depression. Especially when one is preoccupied with planning or overwhelmed by other holiday activities, it is not abnormal to be disconnected from the meaning of the holidays. So, give yourself the freedom and space to appreciate the good in your life over the holidays. A way to do this is by slowing yourself down to acknowledge three wonderful things in your life and contemplating them for a full 60-seconds each. Whether in a state of distress or not, there is no better time to appreciate and adopt an attitude of gratitude!