DBT for Teens: A Practical Guide to Skills, Benefits, and Support

Key Takeaways

• DBT for teens teaches practical skills for mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.
• Research suggests DBT-A can help reduce self-harm and suicidal ideation among adolescents while building healthier coping skills.
• Parents can support treatment by finding a provider with DBT training and experience working with adolescents.

Teen years bring big emotions, changing relationships, school pressure, and new expectations, and it isn't always easy to know how to respond. When emotions feel overwhelming, it can be difficult for teens to pause, understand what they're feeling, and choose how to respond. Dialectical behavior therapy, or DBT, for teens teaches practical skills that can help young people manage intense emotions, cope with distress, and navigate relationships in healthier ways.

DBT is a type of therapy that's considered for concerns including self-harm, suicidal ideation, depression, and some eating-related disorders in adolescents. Learning how to stay present, tolerate difficult emotions, regulate feelings, and communicate effectively gives teenagers tools they can draw on during challenging moments and carry with them beyond their teen years.

What Is DBT & Why Do Teens Need It?

DBT therapy for teens is a type of cognitive behavioral therapy (CBT), also known as talk therapy. It teaches teens to use problem-solving skills, tolerate distress, and find acceptance while working through difficult emotions and situations. DBT was originally developed for adults with borderline personality disorder (BPD) who experienced severe emotion dysregulation and suicidal behavior. The approach was adapted for adolescents as dialectical behavior therapy for adolescents (DBT-A), with treatment incorporating developmentally appropriate skills and, in many programs, family or caregiver involvement.

DBT is particularly useful for teenagers who find it hard to see multiple perspectives or tend to rely on all-or-nothing ways of thinking. The approach helps them consider that two things can be true at once, such as accepting how they feel while also working toward a different response. Recent KFF research found that an estimated 1 in 5 teens have symptoms of anxiety or depression. Teens today are under incredible stress and often face high-stakes issues that can be challenging to navigate on their own.

DBT for teen mental health may be used as part of treatment for concerns such as:

1. Anxiety: DBT skills can help teens learn to manage fear and anxious feelings. They can provide coping strategies alongside treatment for anxiety in teens.
2. Depression: DBT teaches skills that can help teens recognize emotions and respond to distress while receiving treatment for depression.
3. Borderline personality disorder (BPD): BPD involves intense emotions that feel impossible to manage. When you partake in DBT for borderline personality disorder, you’ll discover tools for emotional regulation and distress tolerance, which are common symptoms of BPD.
4. Disordered eating: DBT-based approaches have been studied for eating disorders, particularly when difficulty regulating emotions is part of the clinical picture. Research in the American Journal of Psychotherapy suggests that DBT may be considered as part of a broader treatment approach to help teens regain a healthy relationship with food without engaging in self-harming behavior.
5. Suicidal thinking and self-harm: DBT-A can help teens with suicidal ideation or thoughts of self-harm. Research in Psychological Medicine suggests it can reduce these behaviors and thoughts for some adolescents.
6. Attention deficit hyperactivity disorder (ADHD): DBT isn't a primary treatment for ADHD, but its skills may complement treatment when a teen also has difficulty managing emotions or responding to distress.

Note: While DBT and CBT share some similarities, they differ in their approaches and the skills they emphasize.

How Does DBT Help Teens Manage Emotions?

DBT therapy for teens transforms how teenagers understand and respond to intense feelings. Several studies, such as those in BMC Psychiatry, show positive outcomes in behavioral challenges and emotional regulation. The skills and strategies taught become a toolkit full of coping mechanisms that last throughout the teen years and into adulthood.

Through structured practice, teens learn to recognize emotional triggers before they escalate, and they develop the ability to pause between feeling and reacting. This creates space for healthier responses. DBT for teenagers helps teens develop healthy social skills, learn emotional regulation, and use crisis management tools to cultivate and nurture healthy, rewarding relationships with peers, teachers, and family members.

Benefits of DBT for teens can reduce:

• Self-harm tendencies
• Anger
• Depressive symptoms
• Days of inpatient hospitalization
• Alcohol and drug use or abuse

"DBT for teens can be very effective for teens, as it encompasses skills that help them navigate the intense feelings and challenges that can arise within themselves and others. DBT for teens provides a framework to address negative thought patterns, regulate emotions, and shift behaviors. Given the skills within DBT for teens, it can be very effective with a wide variety of concerns teens grapple with at this stage of life, for example, eating disorders, depression, self-harm, and ADHD, along with many other concerns."

– Talkspace therapist Jill Daino, LCSW-R, BC-TMH

What Core DBT Skills Should Teens Learn?

Understanding the core techniques of DBT for teens will help determine whether it might be a valuable option for treatment. This highly specialized form of therapy uses mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness to achieve the ultimate goal of finding acceptance.

Understanding mindfulness and present moment awareness

Mindfulness is about being in the moment. Research in Clinical Psychology & Psychotherapy suggests it can have a positive impact on symptoms of BPD and other mental health conditions. Mindfulness is a skill that helps teens avoid dwelling on the past or worrying about the future. When mastered, mindfulness promotes calm and clarity. It makes it easier to focus on things that matter and can be controlled, so teens can stop wasting time and energy.

Teens can use DBT and mindfulness to practice:

• Being in the moment: Teens learn to let go of past regrets and forget about future anxieties so they can be rooted firmly in the present.
• Using breath as an anchor: Fast, shallow breathing is common in times of distress, but when teens focus on controlling their breath and breathing deeply and slowly, the effect is calming and grounding. Deep breathing signals the parasympathetic nervous system, also known as the fight-or-flight response, that it's time to slow down. Research in Breathe shows that breathing deeply can reduce anxiety, slow the heart rate, and calm racing thoughts.
• Focusing on senses: The senses are pathways to the present. DBT teaches teens to focus on what they smell, hear, see, and feel so they can stay in the moment.

Distress tolerance skills for emotional crises

Distress tolerance skills are powerful coping strategies teens can use when navigating crisis mode and trying to overcome challenges. Managing emotional pain in healthy ways can be difficult, especially for teens who rely on destructive, unhealthy, or unhelpful habits, so distress tolerance can be crucial in managing difficult times.

Teens learn distress tolerance skills like:

• Evaluating the pros and cons of a situation
• Using self-soothing techniques
• Finding things to distract them from their current state of mind
• Implementing acceptance into their life
• Stopping themselves from engaging in destructive or impulsive behaviors
• Using the idea of TIPP (temperature, intense exercise, paced breathing, paired muscle relaxation)

Emotion regulation to manage intense feelings

Emotion regulation teaches teens to manage intense feelings. They'll learn to recognize emotions, understand where they come from, and decide how to respond rather than using an impulsive reaction.

Teenagers who participate in DBT therapy learn to regulate their emotions by:

• Acknowledging feelings: This means allowing a feeling to surface without reacting.
• Distinguishing between fact and feeling: It can be hard to determine what's real vs. what's just a reaction to a situation or person. Learning to separate facts from feelings helps teens see things clearly so they can assess the best way to move forward.
• Picking battles: While in the moment, an intense emotion can feel like it needs to be dealt with immediately, they don't always require an instant reaction. Sitting with discomfort teaches the young person how to respond in healthy ways instead of using avoidance or engaging in destructive responses.

Interpersonal effectiveness for healthier relationships

Relationships are often complex and confusing, especially during the teen years, so learning to navigate them in healthy ways is important. DBT therapy for teens can be pivotal in helping young people foster deep bonds that result in productive and mutually rewarding relationships.

DBT treatment helps teens develop healthy interpersonal relationships by teaching the importance of:

• Saying what you mean: Learning to ask for what you need clearly and assertively is a life skill everyone should know.
• Learning to deal with "no": Hearing no without falling apart can be challenging for teens or young adults. Acceptance is pivotal in keeping doors open for future interactions, opportunities, and conversations.
• Setting boundaries: Prioritizing healthy boundaries and knowing how to enforce them helps the teen or young adult become better at demanding self-respect and teaching people how to treat them.

Walking the middle path: balancing acceptance and change

Balance and acceptance are skills all teens should master. Finding that equilibrium is easier when a teenager has the coping skills and tools to help them make sense of their world. DBT can effectively help teenagers learn to accept difficult emotions and work to change their behaviors.

How Can Parents Choose the Right DBT Therapist?

Finding the right therapist for your teen is an important step. When you're considering dialectical behavior therapy for teens, look for a licensed therapist with:

• Specific DBT training
• Experience working with adolescents
• An understanding of adolescent development

You can ask potential therapists about:

• Their experience working with teens
• The DBT skills they typically teach
• How they involve parents or caregivers in treatment
• How they support teens in applying skills outside sessions

A comprehensive DBT-A program can include:

• Individual therapy
• Skills training
• Family or caregiver involvement
• Support for applying skills outside sessions

The exact format can vary by provider and level of care.

It's also worth considering practical factors:

• Does the therapist's schedule work with your teen's school and activities?
• Is the format, whether in person or online, something your teen is likely to engage with consistently?
• Does your teen feel comfortable enough with the therapist to participate honestly and practice new skills?

DBT therapy for teens teaches young people to identify and accept how they think and feel while developing new ways to respond. Finding a provider who understands adolescent development and has appropriate DBT training can help make that process more useful and comfortable for your teen.

How Can Talkspace Support Teens with DBT?

Talkspace, an online therapy platform, simplifies the therapy process by offering convenient, affordable sessions that are easy for teens to fit into their busy lives.

Talkspace connects people with mental health providers who are skilled, experienced, and qualified to use DBT for teens seeking help. Teens can access care from home, school, or anywhere with an internet connection.

This flexibility removes common barriers to treatment, and message-based therapy allows teens to communicate when they're ready. If you're interested in learning more about online therapy for teens, reach out to Talkspace today to get started. If you're a teen living in New York City, you may qualify for free online therapy through Talkspace.

Frequently Asked Questions (FAQs)

What age is best to start DBT for teens?

There's no one single age that's best for therapy. DBT for teens is commonly adapted for adolescents, including teens aged 13–17, although the appropriate age and treatment approach depend on the individual. A therapist trained to work with adolescents can help determine whether DBT fits your teen's needs and developmental stage.

How long does DBT for teens typically take to work?

Most DBT for teens programs run 6-12 months. Teens often notice improvements in emotional regulation within the first few months. Full skill mastery takes consistent practice,  and some teens continue maintenance sessions after completing the initial program to reinforce skills.

Can DBT for teens be done safely online?

Yes, online DBT therapy for teens is effective and safe. Virtual sessions provide the same skill-building and therapeutic relationship as in-person care. Message-based formats offer additional benefits, allowing teens to practice skills and communicate between sessions when emotions arise.

Is DBT for teens only for those with self-harm behaviors?

No. While DBT for teenagers effectively treats self-harm, it helps with many challenges, including anxiety, depression, ADHD, and relationship struggles. Any teen who experiences intense emotions or impulsive reactions can benefit. The skills are valuable for overall emotional wellness.

What should parents look for in a DBT for teens therapist?

Seek therapists with specific DBT for teens training and adolescent experience. Ask about their approach to involving parents in treatment. Verify they're licensed and match your teen's needs. Consider whether an online or in-person format works better for your family's schedule.

Sources

1. Roughly 1 in 5 adolescents report experiencing symptoms of anxiety or depression. KFF. February 6, 2024. Accessed March 15, 2024. https://www.kff.org/coronavirus-covid-19/press-release/roughly-1-in-5-adolescents-report-experiencing-symptoms-of-anxiety-or-depression.
2. Wisniewski L, Ben-Porath DD. Dialectical behavior therapy and eating disorders: The use of contingency management procedures to manage dialectical dilemmas. American Journal of Psychotherapy. 2015;69(2):129-140. doi:10.1176/appi.psychotherapy.2015.69.2.129. https://pubmed.ncbi.nlm.nih.gov/26160619/. Accessed March 15, 2024.
3. Kothgassner, OD. Goreis, A. Robinson, K. Huscsava, MM. Schmahl, C. Plener, PL. Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: A systematic review and meta-analysis. Psychological Medicine. https://doi.org/10.1017/S0033291721001355. 2021 May;51(7):1057-1067. Accessed September 7, 2026.
4. Pardo ES, Rivas AF, Barnier PO, et al. A qualitative research of adolescents with behavioral problems about their experience in a dialectical behavior therapy skills training group. BMC Psychiatry. 2020;20(1). doi:10.1186/s12888-020-02649-2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7238612/. Accessed March 15, 2024.
5. Eeles J, Walker D. Mindfulness as taught in dialectical behaviour therapy: A scoping review. Clinical Psychology & Psychotherapy. 2022;29(6):1843-1853. doi:10.1002/cpp.2764. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10084181/. Accessed March 15, 2024.
6. Russo MA, Santarelli DM, O'Rourke D. The physiological effects of slow breathing in the healthy human. Breathe. 2017;13(4):298-309. doi:10.1183/20734735.009817. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5709795/. Accessed March 15, 2024.

Talkspace articles are written by experienced mental health-wellness contributors; they are grounded in scientific research and evidence-based practices. Articles are extensively reviewed by our team of clinical experts (therapists and psychiatrists of various specialties) to ensure content is accurate and on par with current industry standards.

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