Closeup of teenage girl holding smartphone outdoors while sitting on metal stairs with group of teen friends in background

For Teens Struggling with Mental Health, Intensive DBT Can Help

Rates of mental health disorders in teens have been escalating over recent decades. We are in an adolescent mental health crisis and epidemic right now: Young people are experiencing higher rates of dying by suicide, suicidality, depression, and anxiety. Simply: Teens are struggling more with the amount they need to learn about themselves and the rapid pace at which they must learn to navigate their world.

“Teenagers have to transition from a world where many people made decisions and rules for them to a world where they have to be able to advocate for themselves and make their own decisions and rules by which they will live. They have to start developing their own identity and their values,” says Columbia psychologist Casey O’Brien, PsyD.

“Developmentally, teenagers are going to experience more emotions more intensely than they will at other times in their lives, so everything has bigger impact and influence on their experiences.”

Everyone can use help at this life stage. Some need extra help.

To increase access to care and help struggling teens get back into their lives, Columbia launched the Intensive Adolescent & Family DBT Program (Intensive DBT) in December 2022, made possible with the support of a generous donation to the Department of Psychiatry last year.

We spoke with O’Brien to find out more about mental health programs specific to adolescents and what Intensive DBT is all about.

What is DBT?

Dialectical Behavior Therapy (DBT) is a type of cognitive-behavioral therapy that weaves in acceptance strategies and skills to change behavior. DBT is proven to help people who have suicidality have a satisfying and meaningful life, one that feels worth living.

Learn more: Adolescent Dialectical Behavior Therapy (DBT) Program at Columbia

Are DBT and Intensive DBT the same thing?

No. DBT is comprehensive treatment, requiring commitment of time and energy by the person and their immediate support group, usually their caregivers or parents.

Intensive DBT builds on traditional DBT to offer more support and more care for families that need it. Our program is often a bridge for people transitioning from a residential or inpatient program, such as a treatment facility or hospital, to an outpatient program. It can also be for teens and families who need more support than traditional DBT or outpatient therapy.

How Do DBT and Intensive DBT work?

At any point in DBT we’re working to accept that we're doing the best we can, to understand our experience, and to increase our awareness of the moment. At the same time, we’re using skills to change ineffective behaviors towards more effective ones that better meet our needs, and communicate those needs in ways that other people understand.  

A core principle of DBT is that everyone is doing the best they can: Acceptance means accepting yourself and others. And we also need to do better, try harder, and be more motivated to change.

Very often psychological treatments focus on one or the other. DBT says we need both: Accept ourselves, accept others, accept the world we live in, and at the same time actively put in effort to change our behaviors, change the way we relate to others, change the way we relate to the world that we live in, and/or actively change the world that we live in. For example, if you are depressed, you want to accept that feeling depressed will make you feel less motivated to do things that bring you joy, to engage in activities and socialize. We want to accept and understand our vulnerabilities so we know where we need to put effort.

DBT teaches specific, concrete, tangible skills towards acceptance and changing behaviors.

As DBT therapists, we value empowering people to directly advocate for what they need. We teach them the skills so they can advocate for themselves with parents or teachers, rather than us speaking for them. Our Intensive DBT program is different from other therapeutic programs because we add on additional supports, like multifamily skills groups and phone coaching.  

Why are families involved in DBT treatment?

When you have a teenager who is distressed, families feel it. It can be hard to find ways to support teens who constantly feel like their emotions are on fire, other than eliminating the cause of each fire, like an upcoming test or a changing friendship or a household responsibility.

We recognize that parents and caregivers need support too, so they can show their teenager that they understand their distress and effectively encourage addressing emotions. When a teenager is struggling with suicidal thoughts or actions, it can be traumatic for everyone. If we're just working with teens alone, we miss the fact that the family as a whole system is stressed, scared, and impacted.  

Who is Intensive DBT right for?

Teens and families, including parents and/or caregivers who need more support than weekly therapy can provide. More specifically: teens who are experiencing worsening moods, engaging in higher risk behaviors (impulsive spending; risky sex; thoughts of death; inability to express anger), experiencing more intense or more frequent suicidality or self-harm, and/or are socially isolated and struggling with social engagement. And it’s for teens and parents motivated to try a different approach.  

We usually see teens and families who are feeling a little at their wit's end, like they're constantly putting out fires, not living their lives. The overarching DBT goal is to build a life worth living.

How can people join Columbia’s Intensive DBT program?

People can be referred by a doctor or refer themselves. All undergo an evaluation and consultation session to determine if our program is the right fit. If not, we provide referrals to what we think would be the right fit.  

Does Columbia’s Intensive DBT program accept insurance?

Yes. We are one of the few Intensive DBT programs that accepts insurance.


Casey O'Brien, PsyD, is a psychologist, team lead of Adolescent DBT Programs, and assistant professor of medical psychology in the Department of Psychiatry at Columbia University Vagelos College of Physicians and Surgeons.