Application of Dialectical Behavior Therapy to Suicidality in Adolescents

Available with English captions and subtitles in Spanish.

Blaise Aguirre, MD, McLean Hospital, presents as part of the 2022 Suicide-Focused Assessment and Treatment: An Update for Professionals course.

DBT, Adolescents, and Suicide

Dialectical behavior therapy (DBT) implements aspects of cognitive behavior therapy (CBT) combined with acceptance strategies and mindfulness.

From a clinical perspective, Aguirre explains how DBT is a powerful tool in reducing suicidality in adolescents.

Watch now to learn more about:

  • How DBT was developed
  • Why DBT skills are effective in preventing suicide
  • How clinicians can address the myths of suicide

DBT helps young people develop emotional regulation, interpersonal effectiveness, distress tolerance, and the ability to mentalize.

Aguirre states that the therapy prioritizes treating a patient’s suicidality.

“If you keep chasing symptoms, it’s going to be a very long therapy,” Aguirre said. “So, the idea in dialectical behavior therapy is to target the suicidality first and foremost. Yes, you might want to talk about rejection and other concerns, but clinicians have to reduce suicidality and self-injury.”

DBT consists of three treatment targets.

Stage 1 addresses life-endangering behaviors, such as suicidality and self-injury; treatment interfering behaviors, including multiple hospitalizations and missed appointments; and quality of life interfering behaviors, such as substance misuse and multiple sex partners.

Stage 2 utilizes exposure therapy and emotional processing of the past.

Stage 3 works to build a life worth living by increasing self-respect and creating individual life goals.

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DBT treatment includes individual therapy, family skills training, skills training groups, telephone coaching, as well as other treatments, such as medications. Therapists who provide the treatment are part of a consultation team.

DBT is based on assumptions that patients are doing the best they can and want to improve.

“Patients may not have caused all of their problems, but they have to solve them anyway,” Aguirre says. “That’s agency, that’s autonomy.”

“It’s important for DBT therapists to understand that the lives of suicidal patients are unbearable as they are currently being lived,” Aguirre shares.

He emphasizes that talking about suicide with teens is an opportunity for communication: “Talking about it brings it out into the open and allows you to target it.”


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About Blaise Aguirre

Dr. Blaise Aguirre is The Michael Hollander, PhD, Endowed Director of McLean Hospital’s 3East Continuum, an array of programs for teens that use dialectical behavior therapy to target self-endangering behaviors as well as the symptoms of borderline personality disorder traits.

An assistant professor of psychiatry at Harvard Medical School, Aguirre is nationally and internationally recognized for his extensive work in the treatment of mood and personality disorders in adolescents.