Project ECHO - Adolescent DBT

Adolescent Dialectical Behavior
Therapy Skills Training
Melissa Butler, Ph.D., HSPP

What is DBT?
• “Dialectical Behavior
Therapy”
• Developed by Marsha
Linehan
Development of Adolescent DBT
Jill Rathus, PhD Alec Miller, PsyD

DBT is helpful for people who have trouble
controlling and regulating their emotions
“What the Heck is DBT?”
• https://youtu.be/Stz--d17ID4
• Created by Esmee Shaller at University of
California San Francisco
Dialectics
• Two opposites can be true at the same time
• Create a new way of viewing the situation
Components of Adolescent DBT
• Weekly Individual psychotherapy

• Additional Family Therapy Sessions
• Multifamily Group Skills Training
• Youth and Parent Telephone Coaching
• Therapist Focused Consultation
Teams
Components of Adolescent DBT:
Weekly Individual Psychotherapy
Adolescent DBT Skills Training
Modules
• Mindfulness
• Distress Tolerance
• Emotion Regulation
• Interpersonal
Effectiveness
• Walking the Middle
Path
MODULE 1: Mindfulness Skills
What is Mindfulness?
• Paying attention • In the present moment

• On purpose • Non-judgmentally
Examples of Mindfulness Practice
• Mindful Breathing
• Mindful
Observation
• Mindful Eating
• Mindful Listening
• Walking the Line
MODULE 2: Distress Tolerance
Skills
Distress Tolerance
• Skills focus on tolerating and surviving crises
• Skills Include:
– Crisis Survival Skills
– Reality Acceptance Skills
TIPP Skills – used to change body
chemistry quickly
Temperature
Four Square Breathing
Repeat at least 4 times….

Progressive Muscle Relaxation for Kids
Distraction Techniques
• Count Backwards from
100 by 7 (or from 20 by 3)
• 5-4-3-2-1 Grounding
Exercise
• Alphabetize DVD
collection
• Count Freckles, Ceiling
tiles, anything
• Say alphabet backwards
• Find the Rainbow
Crisis Survival Kit
• Usually includes a list

of 10 “tools” and an
actual kit of items
Radical Acceptance
• When faced with a difficult problem:
– You can problem-solve
– Change how you feel about the problem
– Accept it
– Stay miserable (no skill use)
– Make things worse (act on urges)
• When you can’t solve the problem or change
your emotions about the problem, try
acceptance
Radical Acceptance
• Skill of accepting the things you can’t change
(Miller, Rathus, & Linehan, 2017, p.304)

MODULE 3: Emotion Regulation
Skills
Emotion Regulation
1. Understanding and 2. Changing unwanted
Naming emotions emotions
a. Understanding the 3. Reducing Vulnerability
function of emotions to Negative Emotions
b. Identifying obstacles to
changing emotions
4. Managing extreme
emotions and difficult
c. Identifying and labeling
emotions situations
“Ride the Wave”
Skill
Opposite Action
• Each emotion has an
action urge
(sad = shut down, isolate)
• Practice doing the

opposite
(opposite action = be active,
be with people)
Pleasant Events List –
accumulate positive emotions
• Meditating, yoga • Call a friend
• Watching TV • Read a book
• Going for a walk • Lighting candles
• Listening to music • Getting a massage
• Taking a bath • Go out for coffee
• Coloring • Being alone
• Painting nails • Daydreaming
• Pet dog • Dancing
MODULE 4: Interpersonal
Effectiveness
• Asking for what one

needs
• Saying no
• Managing interpersonal
conflicts
• Skills to maintain close
and intimate
relationships
DEAR MAN
• Describe the situation
• Express your feelings
• Assert and ask for what you want or say “no”
• Reinforce - the person by stating positive
benefits
• Mindful and stay focused on what you want
• Appear confident
• Negotiate – be willing to give to get
GIVE Skills – keeping the relationship
• Gentle – be nice and respectful, no attacks, no
threats, no judging, no sneering
• Act Interested
• Validate – with words and actions that you
understand the other person’s feelings and
thoughts
• Easy Manner – smile, use humor, leave
attitude at the door
Module 5: Walking the Middle Path
Skills Covered:
• Works on balancing
acceptance and
change
• Validation skills
• Behavioral Change
Strategies
Validation vs. Invalidation
Invalidation
Increased
Conflict &
Distress
Validation
• Validation – communicates that a person’s
feelings, thoughts, and actions are understandable
• Invalidation – communicates that a person’s
feelings, thoughts, actions in a particular situation
make no sense.
• “manipulative” “stupid” “overreaction” “attention-

seeking,” or not worthy of time, interest, or
respect
We can invalidate with the best of
intentions….
• Jane: “I’m a terrible person.”
• Jenny: “What are you talking about? You’re
great.”
Validation
• The Validation skill is rated by adolescents and
parents as the most helpful (Rathus et al., 2015)
DBT Resources
• Behavioral Tech LLC –
www.behaviortech.org
• www.BPDCentral.com
• Mindfulness:
www.dbtselfhelp.com
• Apps:
– Stop, Breathe, Think, & Relax
Evaluating Adolescent DBT:
Does it Work?
Meta-analyses:
• Cook & Gorraiz (2016)
• Iyengar et al. (2018)
Randomized Clinical Trials:

• Mehlum et al. (2014).
• McCauley et al. (2018)
• DBT Skills
Training Alone –
shows promise
but more data
needed
Valentine et al. (2015)

Contact Information
Melissa A. Butler, Ph.D., HSPP

Indiana University School of Medicine,
Department of Psychiatry
Email: [email protected]
References
Harvey, P., & Rathbone, B. (2015). Parenting a Teen Who Has Intense
Emotions. Oak Land: New Harbinger Publications.
Linehan, M. (2015). DBT Skills Training Handouts and Worksheets 2nd Edition.
New York: The Guilford Press.
Linehan, M. (2015). DBT Skills Training Manual – 2nd Edition, New York: The
Guilford Press.
Rathus, J., & Miller, A. (2014). DBT Skills Manual for Adolescents. New York:
Guilford Publications.

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Adolescent Dialectical Behavior

Therapy Skills Training

Melissa Butler, Ph.D., HSPP

Jill Rathus, PhD Alec Miller, PsyD

• Weekly Individual psychotherapy

• Paying attention • In the present moment

Repeat at least 4 times….

• Usually includes a list

(Miller, Rathus, & Linehan, 2017, p.304)

• Practice doing the

• Asking for what one

• “manipulative” “stupid” “overreaction” “attention-

Randomized Clinical Trials:

Valentine et al. (2015)

Melissa A. Butler, Ph.D., HSPP

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