Dialectical Behaviour Therapy for Adolescents (DBT-A) is a developmentally adapted, evidence-based intervention for young people experiencing emotion dysregulation, self-harm, and suicidal ideation. In recent years, a growing body of evidence such as randomised trials and meta-analyses have suggested DBT-A’s effectiveness across outpatient, inpatient, and community settings (Mehlum et al., 2014; McCauley et al., 2018; Kothgassner et al., 2021; Syversen et al., 2024).
DBT-A is an evidence-based intervention designed to address emotion dysregulation and high-risk behaviours in adolescence.
Emotion dysregulation and risk in adolescence
Adolescence is a developmental period characterised by heightened emotional reactivity, increasing autonomy, and ongoing neurobiological and social change. For some adolescents, difficulties in emotion regulation may cause significant distress and high-risk behaviours, including self-harm and suicidal ideation (Crowell et al., 2009). These presentations are seen across different clinical contexts, including mood and trauma-related difficulties, neurodevelopmental conditions, and emerging personality difficulties.
Standard outpatient approaches may be insufficient for adolescents with persistent self-harm or frequent emergency presentations, contributing to the need for structured, multi-component interventions that address risk while supporting longer-term behavioural and relational change (McCauley et al., 2018; Syversen et al., 2024).
Difficulties with emotion regulation and risk behaviours are common drivers of referral to specialist adolescent mental health services.
The DBT-A model: Theory and principles
DBT-A is grounded in a biosocial model, which conceptualises emotion dysregulation as arising from the interaction between biological vulnerability and invalidating or poorly matched environments (Linehan, 1993). Within this framework, high-risk behaviours such as self-harm are understood as attempts to manage overwhelming emotional states, rather than as attention-seeking or manipulative acts. A defining feature of DBT-A is its emphasis on dialectics, balancing acceptance-based strategies (e.g., validation and mindfulness) with change-oriented interventions (e.g., skills training and behavioural analysis). Clinicians work collaboratively with adolescents and families to validate current experiences while supporting the development of new skills to manage distress, improve relationships, and reduce risk. The adolescent adaptation retains DBT’s core principles while adding developmentally relevant modifications such as stronger family involvement, explicit attention to the adolescent’s social context, school and peer relationships (Miller et al., 2007; Miller & Rathus, 2015).
DBT-A integrates acceptance and change strategies within a developmental framework.
Structure and modes of delivery
DBT-A is typically delivered as a multi-component intervention combining diferente treatment modes. Components include individual therapy (targeting life-threatening and therapy-interfering behaviours), skills training (mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness), family involvement through multifamily skills groups and treatment planning and coaching to support skills generalisation during crises between sessions. (Miller et al., 2007; McCauley et al., 2018). Recent evidence suggests that when services can sustain core treatment modes and team supports, DBT-A can be implemented successfully outside research settings, although availability of training and organisational resources remains a key determinant of delivery quality (Camp et al., 2023; Syversen et al., 2024).
DBT-A is delivered through coordinated treatment modes designed to support adolescents and families.
Evidence base for DBT-A
Randomised controlled trials (RCTs) provide evidence suggesting that DBT-A is associated with reductions in self-harm and suicidal ideation among adolescents with high-risk presentations, alongside improvements in broader clinical outcomes such as psychiatric hospitalisation (Mehlum et al., 2014; McCauley et al., 2018). In a systematic review and meta-analysis, Kothgassner and colleagues (2021) reported that DBT-A is associated with reductions in adolescent self-harm and suicidal ideation, though effect sizes vary across outcomes and study designs. Alongside controlled trials, evidence from routine clinical practice continues to grow. Syversen and colleagues (2024) reported substantial reductions in self-harm over a 20-week DBT-A programme delivered in outpatient CAMHS across multiple clinics, illustrating how DBT-A may perform in real-world service settings.
Research consistently supports DBT-A for reducing self-harm and suicidal behaviours in adolescents.
Engagement, risk management, and treatment challenges
DBT-A places explicit emphasis on engagement and retention, acknowledging that adolescents with high-risk behaviours often experience ambivalence about treatment. Structured commitment strategies, collaborative goal-setting, and transparent discussion of risk are central to the model (Miller et al., 2007; McCauley et al., 2018). Risk management is proactive and ongoing, clinicians routinely monitor self-harm behaviours, prioritising life-threatening risks within sessions, and supporting adolescents to identify and practise alternative coping strategies. This structured, prioritised approach is often cited as a practical strength of DBT-A for managing ongoing risk (Camp et al., 2023; Syversen et al., 2024). Implementation challenges have been reported, including the intensity of training required, the time and staffing needed to provide multi-component delivery, and the resources required to support consultation teams. Recent literature emphasises the importance of organisational readiness, supervision, and maintaining core elements over time (Flynn et al., 2021; Tebbett-Mock et al., 2021).
Engagement and risk management are central components of the DBT-A model.
Accessibility, inclusion, and emerging considerations
Research has increasingly focused on how DBT interventions can be delivered in ways that are responsive to adolescents from diverse and minoritised backgrounds, including those who face systemic barriers to accessing care. A systematic review of cultural adaptations of DBT signals that adaptations commonly involve modifications to language, metaphors, methods, and context, highlighting that evidence on comparative efficacy of adapted versus non-adapted protocols remains limited (Haft et al., 2022). There is also growing interest in school and community contexts DBT skills curricula, as a potential route to broaden access, particularly in settings where specialist programmes are difficult to deliver at scale. For example, DBT STEPS-A has been implemented in school-based health classes in low-income contexts (Chugani et al., 2022).
Ongoing research is examining how DBT-A can be delivered in inclusive and accessible ways.
Conclusion
Dialectical Behaviour Therapy for Adolescents is a structured, evidence-based intervention for young people experiencing emotion dysregulation, self-harm, and suicidal ideation. Research across trials, meta-analyses, and systematic reviews suggest DBT-A’s effectiveness in reducing self-harm and suicidal outcomes for high-risk adolescents (Mehlum et al., 2014; McCauley et al., 2018; Kothgassner et al., 2021; Syversen et al., 2024). As services continue to face rising demand and complexity, emerging work increasingly focuses on implementation, accessibility, and adaptation for diverse populations while maintaining fidelity to core DBT principles (Flynn et al., 2021; Haft et al., 2022; Camp et al., 2023).
DBT-A is a structured, evidence-based approach addressing complex adolescent mental health needs.
Where next?
We are are delighted to have Dr. Jake Camp, Senior Clinical Psychologist, DBT Therapist, and Clinical Academic Fellow, provide an overview of the DBT-A model, including its theoretical foundations, core principles, and the structure and modes of delivery. Attendees will learn how DBT-A addresses the developmental needs of adolescents, and how parents/carers are engaged as partners in the intervention. Full details can be found at Dialectical Behaviour Therapy for Adolescents (DBT-A)
References
Camp, J., et al. (2023). Implementing dialectical behaviour therapy in routine practice: An evaluation of a national CAMHS DBT service for adolescents. The Cognitive Behaviour Therapist.
Chugani, C. D., et al. (2022). Implementing dialectical behavior therapy skills training for emotional problem solving for adolescents (DBT STEPS-A) in a low-income school. School Mental Health.
Crowell, S. E., Beauchaine, T. P., & Linehan, M. M. (2009). A biosocial developmental model of borderline personality disorder: Elaborating and extending Linehan’s theory. Development and Psychopathology, 21(3), 495–515.
Flynn, D., et al. (2021). Dialectical behaviour therapy: Implementation of an evidence-based intervention in community settings. The Lancet Psychiatry, 8(4), 287–295.
Haft, S. L., et al. (2022). Cultural adaptations of dialectical behavior therapy: A systematic review. Psychotherapy.
Kothgassner, O. D., et al. (2021). Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: A systematic review and meta-analysis. Psychological Medicine.
Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.
McCauley, E., et al. (2018). Efficacy of dialectical behavior therapy for adolescents at high risk for suicide. JAMA Psychiatry, 75(8), 777–785.
Mehlum, L., et al. (2014). Dialectical behavior therapy for adolescents with repeated suicidal and self-harming behavior: A randomized trial. Journal of the American Academy of Child & Adolescent Psychiatry, 53(10), 1082–1091.
Miller, A. L., Rathus, J. H., & Linehan, M. M. (2007). Dialectical behavior therapy with suicidal adolescents. Guilford Press.
Miller, A. L., & Rathus, J. H. (2015). DBT with adolescents and families. Child and Adolescent Psychiatric Clinics of North America, 24(1), 61–79.
Ohlis, A., et al. (2023). Experiences of dialectical behaviour therapy for adolescents: A qualitative analysis. Psychology and Psychotherapy: Theory, Research and Practice.
Syversen, A. M., et al. (2024). Evaluation of dialectical behavior therapy for adolescents in routine clinical practice: A pre-post study. BMC Psychiatry.
