Dialectical behavioural therapy is a type of talking therapy originally designed for adults with borderline personality disorder. Since then, it has been adapted for treatment among adolescents and offered for a wide range of mental health concerns, including eating disorders, self-harm, and emotional dysregulation. Usually delivered in outpatient settings, studies have shown that DBT is highly effective in improving young people’s mental health symptoms and quality of life.
Witnessing the effectiveness of DBT in adolescent outpatient care, clinicians started to offer DBT in residential treatment as well. Many young people who can benefit from DBT treatment find themselves in inpatient care, especially those engaging in self-harm or suicidal behaviours. Within residential settings, mental health professionals recognised the need for effective, short-term programs that promote safety, stability, and skill learning: a profile that DBT fulfils.
What Is Dialectical Behavioural Therapy -A?
Dialectical behavioural therapy -A, or DBT-A, is a behavioural therapy that supports adolescents in accepting their emotions and experiences while making positive changes to unhelpful or harmful ways of thinking or acting. It involves several different modes of learning, including group skills learning sessions and individual therapy. Group skills learning sessions constitute the core of DBT programs, teaching skills in four areas: mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation.
DBT-A also involves families in the treatment process through multi-family skill-building sessions and, when necessary, family therapy sessions.
Research has found that DBT-A is an effective treatment for adolescents experiencing self-harm and suicidal ideation, borderline personality disorder, and depressive symptoms. It’s also been shown to effectively address emotional dysregulation, a core trait underpinnig many mental health disorders.
DBT-A in Residential Treatment
Many young people can effectively and safely recover from mental health disorders in outpatient care. However, for some adolescents, higher levels of care are required to ensure their safety as they engage in treatment. Residential care may also be suitable for young people whose home environment or certain aspects of their everyday life make recovery difficult.
In the United States, inpatient visits for suicide attempts, suicidal ideation, and self-injury among increased 104% among young people aged 1–17 years between 2006 and 2011. With suicide among the leading causes of death in young people, offering effective residential treatment programs is crucial.
DBT-A in residential treatment usually maintains the same core elements as in outpatient programs. A systematic review of DBT-A in inpatient care found that most programs offered DBT skills sessions and individual therapy at least once a week. In residential treatment, the length of DBT programs offered at different facilities varies, ranging from one month to one year.
Outpatient DBT programs include some form of phone coaching between therapists and young people and their parents. Phone coaching helps young people avoid crisis moments, self-harming behaviours, and interpersonal difficulties, while supporting them to use and reinforce their skills. In residential settings, phone coaching is often replaced by ongoing coaching from the community or support team of a treatment space, including nursing staff and other support staff.
Residential treatment spaces often offer a comprehensive treatment program combining more than one treatment approach. For example, residential spaces may offer creative art or experiential therapies alongside DBT skills sessions, individual therapy, and other core components of DBT. They may also manage a young person’s medication.
How Effective is DBT for Adolescents in Residential Treatment?
A 2021 systematic review assessed four examples of DBT in acute hospitalisation settings and thirteen examples of DBT in residential treatment. They found that across all the studies, young people receiving DBT saw improvements in at least one mental health symptom or behaviour.
Some of the studies found significant improvements in depression symptoms, borderline personality disorder symptoms, and emotional regulation. Individual studies also reported positive changes in internalising and externalising symptoms, hallucinations and delusions, self-care and independence, daily living, and distress tolerance.
The Benefits of DBT-A in Residential Treatment
Several aspects of DBT-A make the treatment well-suited to residential settings.
Transdiagnostic Therapy
Residential settings are often transdiagnostic, meaning that young people’s treatment may address a range of mental health symptoms and disorders at the same time. Equally, DBT helps young people to develop skills that can support recovery from several different mental health disorders, focusing on core traits like emotional dysregulation that contribute to or underpin many mental health symptoms.
Comprehensive and Flexible
DBT-A is a broad and flexible program, combining several different core elements, including skills training, individual therapy, and family therapy. This means that the program can be easily adapted to fit young people with different needs, who may not be suited to every element that DBT offers.
Community Support
A core process within DBT-A programs is applying skills learned in DBT skills sessions in everyday life. While in outpatient programs, this can be supported through phone coaching; residential programs offer the opportunity for support staff and other team members to take on this role. These individuals are an important part of a young person’s community during their stay at a residential space, offering help and support to use DBT during their everyday life, not only in treatment sessions.
Varied Treatment Goals
DBT programs include four stages incorporating different treatment goals, including decreasing life-threatening behaviours, decreasing post-traumatic stress, and finding freedom and joy. Residential treatment programs may support young people through multiple stages, in both urgent, crisis care and support in building a fulfilling life.
Radically Open Dialectical Behavioural Therapy (RO-DBT)
Dialectical behavioural therapy is often offered to young people whose emotions are usually directed outwardly. This might include impulsive behaviours like self-harm, binging and purging, or displays of intense emotion towards others. But for some young people, emotional dysregulation leads to a different way of coping: directing emotions inwards through overcontrol.
Overcontrol is a trait that underpins different mental health disorders, including anorexia nervosa and obsessive-compulsive personality disorder. Teenagers with excessive self-control may be seen as hyper-vigilant and struggle in interpersonal relationships, developing rules and rigid behaviours that can be detrimental to their well-being.
Radically open dialectical behavioural therapy is an adaptation of DBT that addresses over-control and other related traits. It focuses on fostering openness, flexibility, and social connectedness, supporting young people to express their emotions towards other people and be excited by the potential of close relationships, rather than fearing them. RO-DBT holds that most of the negative consequences of overcontrol centre around interpersonal difficulties, so improving these relationships can lead to transformative change.
Like standard DBT, RO-DBT may be offered in residential treatment for young people with a range of diagnoses, including anorexia nervosa, obsessive-compulsive disorder, and chronic depression. While it focuses on different sets of skills, it contains the same basic elements as standard DBT: skills training, individual therapy, and coaching.
RO-DBT is a relatively new, innovative therapy, so studies assessing its effectiveness are limited. However, studies so far suggest it may be an effective treatment for adolescents with eating disorders, chronic depression, and other mental health disorders, in residential or intensive outpatient settings.
DBT-A in Residential Treatment for Teens at The Wave Clinic
At The Wave Clinic, we offer DBT-A therapy as part of our residential programs for young people from our treatment space in Kuala Lumpur, Malaysia. We provide both DBT-A and RO-DBT-A, depending on each young person’s presentation and needs. Our programs combine a diverse selection of evidence-based modalities, interweaving DBT with other approaches, including creative arts therapies, trauma-focused therapies, and experiential therapies.
For young people at The Wave, DBT skills learning is one aspect of a broader process of development and education that includes personal curriculum learning, vocational training, internships, and life skills. We support adolescents and young adults to discover life paths and build fulfilling futures, underpinning stable and lasting recovery.
We understand the importance of the family in mental health recovery, placing family involvement at the centre of our programs. From family therapy to family DBT skills sessions, we help families develop structures and dynamics that nurture a young person’s recovery.
If you’re interested in our programs, contact us today.
