Fifteen-year-old Thomas was diagnosed with ADHD, learning disabilities, and depression. Despite participating in mental health treatment programs, his level of depression increased, and he grew more impulsive and defiant. His relationship with his family became fraught with conflict, anger, and misunderstandings. As he continued to struggle, he began to shut down and withdraw from his family, who reacted with anxiety and distress. Thomas’s despair, combined with his LD and ADHD symptoms, made it difficult for him to function appropriately, academically and socially. He could not control his emotions or make thoughtful decisions; he was constantly yelling at his family.
Problem: Inability to Regulate Emotions
Many adolescents and young adults with LD, ADHD and co-existing conditions have trouble modulating and controlling their intense responses to certain emotional situations. Because of their inability to regulate their emotions, these kids often react with extreme and inappropriate behaviors.
No matter the diagnosis, when your adolescent can’t self-regulate, problematic behaviors abound, some observable and others less so. For example, in response to classroom demands, your teen may experience sudden mood swings, express anger inappropriately or demonstrate hyperactive, impulsive, or otherwise disruptive behaviors, such as hitting, blurting out answers, threatening self-harm or requesting to leave the room.
Some behaviors may be less obvious. By shutting down, becoming inattentive, or losing focus, he may bring himself temporary relief from an excessively demanding environment. Often kids over-think situations obsessively. Once their negative thoughts are triggered – “No one likes me. I must be a terrible person” – their thoughts and feelings spiral out of control.
Such outpourings of intense emotions often cause conflicts with family members, teachers, and friends—especially when the reaction is extreme, long-lasting, and your child can’t calm down or recover before his next outburst.
Solution: Dialectical Behavior Therapy
Dialectical Behavior Therapy (DBT) is a highly structured type of talk therapy developed in the 1980s by psychologist Marsha M. Linehan. It uses cognitive behavioral ideas together with Zen concepts of acceptance and mindfulness, skills that teach emotional regulation, and principles of validation.
The underlying purpose of DBT is to help adolescents acquire strategies to break their cycles of undesirable responses: to learn to tolerate distress, control negative thoughts, understand and manage emotions, improve relationships, and move toward having “a life worth living” with goals that are meaningful to them.
The “D” in DBT refers to dialectics – the balancing of opposites – and the dialectic at the core of DBT is acceptance and change.
The DBT therapist works to promote the balancing of these two seemingly contradictory principles at once: the acceptance of feelings (“I’m doing the best I can”) and the use of conscious thoughts to confront and change problematic feelings and behaviors (“I still need to do better”). In other words, by accepting reality, one is not necessarily approving of that reality.
DBT In Practice
A comprehensive DBT program is support-oriented. One of its objectives is to encourage adolescents to recognize their strengths and build on them so they can feel better about themselves. A second goal is to help teens identify thoughts and assumptions that make life harder for them (“If I can’t complete this project perfectly, no one will like me”) and help them learn different ways of thinking to make life more tolerable (“I don’t need to be perfect at everything for people to like me. Everybody makes mistakes. I will keep trying to do better.”)
DBT is made up of at least two components: Individual psychotherapy sessions emphasize problem solving, with the therapist teaching your child how to manage emotional trauma; group skills training sessions bring you and your teen together to learn collaboratively and role-play skills from the five “modules.” (see below).
If necessary, DBT may also include phone consultations, especially for kids with suicidal thoughts or the impulse to harm themselves, and weekly consultations between the therapist and other involved professionals.
- Mindfulness skills: Encourages core mindfulness techniques—learning to accept life as it is in the moment. These skills use all the senses to pay attention to and participate fully in the present, are practiced non-judgmentally, and focus on what is necessary to be successful.
- Distress tolerance skills: Strategies to recognize when kids have urges to do ineffective things, such as to threaten suicide or self-harm or to act impulsively. It also focuses on skills necessary to cope with stressful situations, tolerate and survive crises, and consciously control problematic urges and re-frame thoughts.
- Emotion regulation skills: Skills to identify, understand, adapt, change, and manage difficult situations, mood swings, inappropriate expressions of anger, and emotional extremes. Strategies focus on helping kids increase positive experiences, implement self-soothing techniques, and focus on the body by eating properly, getting enough sleep, taking medications correctly, and avoiding alcohol and drug abuse.
- Interpersonal effectiveness skills: Tools to assess what kids need from a relationship; to establish and sustain healthy relationships; to maintain self-respect (e.g., being able to say, “No,” assertively); and to learn to cope with inevitable loss and interpersonal conflict.
- Walking the middle path skill: DBT acknowledges a complex worldview, as opposed to seeing the world in black-and-white (“I’m right and you’re wrong”). By walking the middle path, your child learns to see other sides of the story, how to negotiate and compromise, and how to validate others.
This article is based on How Parents Can Help by Not Helping Too Much: A DBT Perspective, presented by Melville M. Francis, Psy.D., a licensed staff psychologist with Cognitive & Behavioral Consultants, LLP, White Plains, NY. Eve Kessler, Esq., a criminal appellate attorney with The Legal Aid Society, NYC, is co-founder of the not-for-profit SPED*NET, Special Education Network of Wilton (CT), www.spednetwilton.org, and a Contributing Editor for Smart Kids with Learning Disabilities.