Dialectical Behaviour Therapy (DBT) for Children

child in a dialectical behaviour therapy (DBT) session

All parents experience the occasional tantrums at home, meltdowns at the mall, and foot-stomping when they deny their children a request. However, some parents have to deal with these on a daily basis, and it seems like it only escalates as the months fly. When children go beyond the tantrums and show aggressive behaviours such as self-harm, biting, cutting, and hurling things, there’s a bigger problem. Dialectical Behaviour Therapy (DBT) is a way to teach children with extreme emotions to get a better handle on themselves. Continue reading for all you need to know about DBT counselling, how it works, and how it can improve your kids.

What Is DBT-C?

Dialectical behaviour therapy (DBT) is a type of cognitive-behavioural therapy that helps people who struggle with managing their emotions because of various mental health issues. It aims to change their behaviour by recognising and accepting their feelings at the moment and offering tools that can improve in areas, such as emotional regulation, mindfulness, relationships, and tolerance to distress.

DBT-C, which is dialectical behaviour therapy for children, is DBT modified to address children’s specific needs. It focuses on teaching coping skills, recognising problematic thought patterns, reducing emotional extremes, and finding a balance between acceptance and change.

For What Age Kids Is It Usually Recommended?

The DBT-C is specifically suited for the developmental level of kids from the ages 6 to 12 years. Teenagers and young adults can take up regular DBT treatments.

When Should Parents Consider DBT-C for Their Child?

Many parents wonder if they need to consider DBT for their children or wait and watch if they would naturally outgrow the emotional outbursts. While tantrums aren’t usually signs of a deeper issue, children who have it frequently and are irritable most days can find it useful. These are the circumstances where parents should consider DBT-C for their child:

1. High Emotional Sensitivity

Children who are very sensitive emotionally tend to react instantly and intensely to any emotional trigger. Due to the extreme emotional arousal, they will experience long-lasting reactions and find it very difficult to process their emotions.

2. Impulsive Behaviour Corresponding to Intense Emotional Sensitivity

The child with emotional sensitivity can display other behaviours in response, such as verbal or physical aggression, or self-injurious behaviour. Some other behaviours include:

  • They are easily bored.
  • Do not like change.
  • Their attention shifts attention.
  • They are hyperactive.
  • They act impulsively.
  • They have a high sensory sensitivity.
  • Black and white thinking.
  • They face interpersonal difficulties.
  • They have a low tolerance to delayed gratification.
  • They show signs of disruptive mood dysregulation disorder (DMDD).

Children who have frequent outbursts and tantrums almost every day, and are in an irritable mood almost every day have the diagnosis of DMDD. Severe outbursts in many of these children occur several times a week. While DMDD is a relatively new diagnosis, DBT-C is recommended as an effective treatment for the condition.

3.  Attention Deficit Hyperactivity Disorder (ADHD)

Many children are inattentive and have more energy; however, those are also symptoms associated with ADHD and impulsivity. ADHD diagnosis is given if the child has trouble staying seated in school, gets easily distracted, or finds it difficult to follow instructions. DBT-C is also used to help these children cope with the symptoms.

4. Other Diagnosis

DBT for eating disorders, depression, anxiety disorder, or any other condition can also help deal with high emotional sensitivity. On the other hand, your child experiencing high emotional sensitivity isn’t always a sign that there is something wrong with them. They can still benefit greatly from DBT-C in regulating their emotions and their behaviour.

What Does DBT-C Focus On?

DBT-C primarily focuses on skills that help children and parents gain awareness of their emotional states and thoughts. It also teaches them how to deal with stress and express their thoughts and feelings effectively. Here are some DBT skills for kids that you can expect:

1. Mindfulness

The more important skill taught in the DBT-C sessions is mindfulness. Mindfulness is to be aware or mindful of the thoughts and feelings as they come and go. It also helps children stay grounded in the present moment and not get carried away by intense emotions. A commonly used principle in this is the idea that the mind has three states – the emotional mind, the reasonable mind, and the wise mind. To be in the wise mind is to strike a balance between facts and emotions. In the therapy, children will learn how to be in the wise mind and pull themselves back into it when they feel they are losing control. To bounce back to the wise mind in a stressful situation, children are taught breathing techniques that help manage stress and anxiety. Square breathing is one such effective technique that can help children when they are feeling angry and overwhelmed.

2. Distress Tolerance

Distress tolerance is the set of skills that helps children get through stressful situations without making it worse for themselves and others. A major component of distress tolerance is radical acceptance, where the children learn to accept their circumstances fully, rather than resist it, and tolerate the stress. With radical acceptance, they learn that they do not have complete control over any situation, but they do have the power to make better choices and make the best of what is available.

The COVID-19 pandemic, for example, brought about tremendous stress for most people as they lost their jobs, probably lost their loved ones to the disease, and found it difficult to get by every day. The only thing that comes out of sulking in the misfortunes that the pandemic brought will give more stress and anxiety. Radical acceptance, on the other hand, teaches people to accept that there is nothing they can do to control what has happened, but instead, they can do everything possible to ensure they do their part in minimising the damage. Taking up tests or exams is an area of application for this where they accept the situation as it is and give it their best, not worrying about the outcome.

3. Emotional Regulation

Emotional regulation skills can go a long way in letting children handle their intense emotions. DBT-C teaches mindfulness of emotions using a variety of visualisation techniques. One popular method is ‘Riding the wave’, where they are taught to experience emotions like they are waves in an ocean. The child will be taught to view it as a passing wave and experience it but not react to it. Anger, for example, can be observed as a passing wave. Instead of suppressing the emotions, the child will learn to recognise it and watch it come and go naturally without choosing to participate in it. The technique is especially important for kids and youngsters to handle highly volatile emotions such as rage and grief, often leading to physical conflicts or self-destructive behaviours.

Taking care of physical health through good habits and exercise, learning to let go of worries, and increasing positive emotions is also emphasised to regulate emotions. Although intense emotions are natural in their case, the bottom line is that they won’t have to do what the emotions trigger them to do.

4. Interpersonal Effectiveness

Interpersonal skill development that helps build and maintain healthy relationships are also part of DBT-C with some commonality with DBT for borderline personality disorder. Children are taught to maintain healthy relationships with realistic expectations with the people around them, such as family, peers, etc. They are taught to express their emotions and thoughts directly and ask for what they need, in a respectful and fair manner while still being assertive.

5. Failing Forward

Failing forward is probably one of the hardest skills for children and parents to master as it involves accepting failures and using it as a learning process for growth. Since the general society focuses largely on success, failures are often criticised and even held as something to be ashamed of. For children who cannot maintain this level of standard, it can add additional stress and anxiety, which makes things worse. Failing forward teaches the mindset to accept the consequences of decisions without shame and focus instead on encouragement to do better the next time incrementally.

What Are the Components of DBT-C?

There are two main components of DBT-C:

1. Individual Therapy for the Child

Individual therapy sessions are aimed at teaching children about their emotions, how they work and why they matter. During the DBT-C sessions, the therapist will work with the children to help build their coping skills and the thought process that goes behind it. They will discuss goals and how to overcome problems as they arise with the therapist, specifically targeting destructive behaviours.

2. Parent Training

Children do not possess the understanding to take full advantage of the DBT-C skills by themselves. Therefore, parents must support by taking over after the therapist to continue helping their kids to stick to their skills. The parents will be trained in everything they need to know about how to model skills, helping their children with their practice, and creating a validating environment to practice DBT skills every day.

Parents Role in DBT-C Therapy

As mentioned earlier, parents play an important role in helping their children develop their skills during the therapy sessions and after. They will learn about dialectics, behaviour modification, and validation techniques, along with other topics, such as:

1. Principles of Dialectical Thinking

The therapists would discuss a little about the principles of dialectical thinking, such as the nature of truth, how there is nothing absolute, and how opposites can be just as true.

2. Creating a Validating Environment

A validating environment is where parents listen to their children openly and judge as little as possible. They will also accept their thoughts and feelings as justifiable or meaningful and reflect back without judgment.

3. Behaviour Changing Techniques

Parents are taught many ways to influence their children’s behaviour and reinforce positive ones.

4. Reinforcement

Parents are taught the methods and approaches to help their children reinforce the learnt DBT skills and coping behaviours. They would know how to help their children practice and reinforce the behaviours every day.

5. Punishment

Parents will learn about punishments and where they are to be used appropriately. They will also learn about what is effective and what is ineffective when it comes to handling their child.

Parents who are helping their children with DBT-C should expect to see incremental changes in the children. There will be lots of repetition and reminders before the children understand it. Even then, there will be times of failure, and parents will have to get up along with their children and persevere.

Also Read:

Strategies for Handling Negative Behaviour in Children
Tips For Antisocial Behaviour in Kids
Attention Seeking Behaviour in Kids

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