Health Library

Dialectical Behavior Therapy (DBT) for Kids

Dialectical Behavior Therapy Skills

The skills that children and teens learn during dialectical behavior therapy fall into four main categories:

• Mindfulness: How to notice thoughts, emotions and body sensations without judgment
• Distress tolerance: How to survive and manage a crisis without making things worse
• Emotion regulation: How to respond when you’re having big or intense emotions
• Interpersonal effectiveness: How to communicate well to set boundaries, handle conflicts or work with others

What is Dialectical Behavior Therapy Used to Treat?

Dialectical behavior therapy for kids and teens helps address certain needs and behaviors—especially when they become life-threatening. This therapy is less about treating a diagnosis. It may benefit a child or teen who has had:

• Multiple psychiatric admissions for suicide attempts
• Repeated medical treatments because of self-injury

A child or teen who receives a referral for dialectical behavior therapy may have several diagnoses, such as:

• Attention-deficit/hyperactivity disorder (ADHD)
• Anxiety disorders
• Depression
• Mood disorders
• Post-traumatic stress disorder (PTSD)

In adults, dialectical behavior therapy can help treat borderline personality disorder (BPD). This condition isn’t diagnosed in children and teens, though they may show early symptoms.

How Does Dialectical Behavior Therapy Work?

Dialectical behavior therapy starts with a referral to the Dialectical Behavior Therapy program—usually from a child or teen’s current mental health provider. Then, a child or teen and their family focus on building dialectical behavior therapy skills for at least six months. Because the program requires a longer commitment, at Cincinnati Children’s, patients and families sign an agreement beforehand.

The dialectical behavior therapy process has four parts.

Individual Psychotherapy

Children and teens receiving dialectical behavior therapy attend weekly, one-on-one therapy sessions for six months. They meet with their personal dialectical behavior therapy provider. This mental health provider offers personalized treatment focused on building certain skills.

Group Dialectical Behavior Therapy Skills Training

The second part of dialectical behavior therapy is a weekly group session with four to six teens and their families. These sessions offer a hands-on skills class that lasts 90–120 minutes.

Dialectical behavior therapy providers take turns leading each session. They start with a mindfulness activity. Then, both teens and caregivers review practice homework from the last session. After discussion, the dialectical behavior therapy provider teaches a new skill based on one of the four core dialectical behavior therapy skills.

Crisis Coaching Calls

The third part of dialectical behavior therapy is weekly phone coaching. Dialectical behavior therapy participants have a 5- to 10-minute call with their same individual psychotherapy provider. During the call, coaches help teens apply a skill they learned in the group session to a real situation.

Parents or caregivers also have a weekly call but with a different coach. The goal of these calls is to help caregivers use the skills they learn in group training to support their child or teen.

Therapist Consultation as a Team

The last part of dialectical behavior therapy is not for patients and families but for their providers. Each week, all dialectical behavior therapy providers meet for a two-hour consultation session. They discuss cases and seek advice and support.

What is the Long-Term Impact of Dialectical Behavior Therapy?

Dialectical behavior therapy is evidence-based treatment. When a child or teen struggles with life-threatening behavior, dialectical behavior therapy has been shown to help them. They develop skills to recognize, accept and validate strong emotions. These skills also teach techniques, so teens avoid self-harm in response to certain triggers and stressful situations.

Most patients receive dialectical behavior therapy for at least six months. Then, they transition to another type of mental health care. However, dialectical behavior therapy may last longer based on a patient’s specific needs. Not all, but some patients may complete dialectical behavior therapy again in the future—especially if life-threatening behavior becomes a concern.