DBT Skills Group, Dialectical Behavior Therapy

DBT Skills: A Life In Balance


(This article was initially published in the June 2017 edition of Adoption Today. Please see citation at the end of the article.)

Today, adolescent mental health is a concern our society, and around the world. Just reflecting on the names Columbine and Sandy Hook bring clear memories of devastation, loss, and adolescents who suffered with emotional instability.

Unfortunately, statistics validate mental health concerns for our children. The National Alliance for Mental Illness recently shared facts about youth provided by the National Institute of Mental Health. In their fact sheet they reported: 20% of youth ages 13-18 live with a mental health condition, 11% of youth have a mood disorder, 10% of youth have a behavior or conduct disorder, 8% of youth have an anxiety disorder, and 50% of all lifetime cases of mental illness begin by age 14 and 75% by age 24. (https://www.nami.org/getattachment/Learn-More/Mental-Health-by-the-Numbers/childrenmhfacts.pdf0)

Given the instability of adolescents in today’s world, it is our responsibility to teach young people skills they are missing due to mental health issues, and any level of trauma they have endured. In the late 1990’s, Dr. Marsha Linehan created a new type of treatment that addresses these skill deficits. She named this therapy, Dialectical Behavior Therapy, widely known as DBT. Although DBT was originally created for adults, it has been modified to be used for teens and older children since around 2011.



According to Dr. Linehan, “DBT is a cognitive behavioral therapy that was originally developed to treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD) and it is now recognized as the gold standard psychological treatment for this population. In addition, research has shown that it is effective in treating a wide range of other disorders such as substance dependence, depression, post-traumatic stress disorder (PTSD), and eating disorders.” (http://behavioraltech.org/resources/whatisdbt.cfm)

Dialectical Behavior Therapy is based on bio-social theory. Dr. Linehan found that “emotionally sensitive” individuals who have been raised in an “invalidating environment” can later lead to a difficulties and even a diagnosis of Borderline Personality Disorder. The term invalidating environment refers to a situation where the personal experiences and responses of a child are “put down” or “invalidated” by the significant others in his or her life. As an example, a child’s is hurt and cries; the adult responds to the situation by saying, “No crying . . . move past it.”

While the combination of emotional sensitivity and an emotionally invalidating environment can lead to a diagnosis of Borderline Personality Disorder, let’s remember this diagnosis is typically not given before the age of 18. Borderline Personality Disorder has it’s roots in trauma and ambivalent attachment difficulties. Over time, if they are not treated, they can develop into BPD. The symptoms of Borderline Personality Disorder include:
Impulsive behaviors
Difficult relationships
Low self-image
Intense and frequent mood swings


DBT has four groups of skills, or modules: Mindfulness, Distress Tolerance, Emotional Regulation, and Interpersonal Effectiveness. Under each group, there are numerous techniques and hands on tools to help a child or teen learn the overall life balancing concepts. It’s extremely valuable for parents to learn and implement DBT skills alongside their child or teen to ensure their success in learning the skills.

Let’s look more closely at the four modules:

1. Mindfulness- Mindfulness is a practice of being in the moment, without judgment, and awareness of our thoughts, feelings, body sensations, and environment. We learn to be mindful by using our five senses to stay fully in the moment, without multi-tasking.

2. Distress Tolerance In Distress Tolerance we are learning skills to stay out of emotional crisis ranging from either out of control emotions and behavior to complete shut down of emotions and behavior. These skills help us to get through difficult emotions and situations we have to deal with or accept.

In distress tolerance skills, one strategy is to distract for a period of time in a healthy manner. One tool in this module is called, Self-Soothe With 5 Senses. In Self Soothe we use our five senses (see, hear, touch, taste, smell) to soothe our emotions and prevent them from getting out of control, and at the same time increasing our physical and emotional calmness. Let your child or teen choose some items to place in a box, and keep them handy in a certain location in their room. Many of the teens in my practice like this skill and find it helpful. Some examples they’ve given are:

See- A picture of the ocean, seeing friends or a younger family member, a picture of a TV or movie character.

Hear- Orchestra music, favorite song/artist, worship music, white noise, sound of rain.

Touch- A warm, comfy blanket; a fuzzy stuffed animal; a soft, cuddly family pet.

Taste- Sweet or sour candy, soft yeast rolls, macaroni and cheese, chewy foods.

Smell- The aroma of foods like coffee, ice cream or caramel; candles or lotion with warm vanilla sugar scent (or another favorite scent).

3. Emotion Regulation In this module, the skills teach your child or teen about emotions: recognizing, identifying, and staying in charge of them. We also explore and get to know emotions by asking questions like, “What are my emotions job?” “How do I experience my emotions: how do they make my feel in my heart, in my body, in my voice, and in my facial expressions?”

One of my favorite DBT- ER skills is the acronym, MEDDSS, which stands for: mastery, exercise, diet, medication management, sleep, and spirituality. MEDDSS is about self-care, and keeping our body, mind, and emotions in balance.

4. Interpersonal Effectiveness– Everyone has to handle relationships in an effective, healthy manner as relationships are all around us. Relationships may be with parents, birth family, foster family, siblings, teachers, coaches, peers, neighbors, and also —ourselves. DBT skills teach us to invest in relationships, get our needs met in a healthy way, and to maintain self-respect.

FAST is an DBT acronym to practice self-respect. The letters stand for: Fair to self and others, Apologize less (don’t over-apologize), Stick to your values, and Truthful with self and others.

Validation is another powerful IE skill. We validate others by helping them feel heard and understood. Our communication brings a sense of connection and understanding in the relationship, helping it to heal and grow.

DBT is an extremely effective group of practical tools to help people regulate emotions, manage emotional crisis, and get along better with others.

Lozier, C., MSW, LCSW. (2017, June). DBT: A Life in Balance. Adoption Today, 19(10), 24-25.


Carol Lozier earned a Masters in Clinical Social Work from Florida State University in 1989. Ms. Lozier is a licensed therapist in Kentucky, and has been in private practice since 1998.

Ms. Lozier specializes in trauma; and adopted and foster children, teens, and adults. Ms. Lozier offers a Dialectical Behavior Therapy (DBT) skills groups with kids and teens. She plans to start an online DBT skills group for moms; visit her website to sign up -www.carollozierlcsw.com.

Ms. Lozier is the author of three books for adoptive and foster children and families. Learn more about Ms. Lozier and her books at http://www.carollozierlcsw.com.

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