Question 1

I have explored DBT for adolescents and think it would fit well with SOME of our young people in a pediatric psychology setting. Most would benefit from some emotional regulation techniques. Are there any research papers that I can present to my manager (who believes DBT is only for self-harming young people) that show DBT skills can be helpful to adolescents in schools and elsewhere, not just those who self-harm?

James Mazza · Accepted Answer

Yes, there are several published papers that show the effectiveness of DBT STEPS-A in reducing mental health difficulties in schools. I have attached two papers that provide strong evidence that DBT STEPS-A is useful for the general student population, not just those at risk. We certainly want to expand the utility of DBT STEPS-A and promote it as an emotion regulation curriculum rather than a suicide prevention program.

Question 2

Does DBT STEPS-A offer a pathway for helping young people who are experiencing feelings of loneliness?

James Mazza · Accepted Answer

Yes – and loneliness can be a strong emotion. The selection of skills depends on whether the student is at-risk for self-harm, self-medicating and/or suicidal behavior. If that is not the case, I would focus on the emotion regulation skills of “check the facts,” “opposite action” and the “wave” skill along with interpersonal effectiveness skills of “DEAR MAN,” “GIVE” and “FAST.”

In saying this, I would also make sure that the student who is experiencing loneliness has skills in mindfulness and distress tolerance so that the approach is balanced.

Question 3

What led to your interest in adolescent mental health and DBT?

James Mazza · Accepted Answer

As a school psychologist working to reduce suicidal behavior among middle and high school students, it is disheartening to watch schools prioritize academics over the mental health needs of their students. In addition, most schools use a “waiting to fail” model in which they “wait” until the student is engaging in at-risk behaviors before receiving services. This approach is intervention not prevention and if schools truly want to reduce adolescent suicidal behavior, then finding an upstream approach that is delivered to all students needs to be found.

The skills in DBT offer an evidence-based intervention that can be delivered as a class by general education teachers, providing an opportunity to truly provide mental health wellness and suicide prevention.

Question 4

What do you make of some of the findings from the MYRIAD project suggesting that mindfulness universal prevention may be ineffective or harmful for adolescents identified as at-risk for depression?

James Mazza · Accepted Answer

I am not sure there is any data suggesting that mindfulness activities are harmful and the results of the MYRIAD project simply said it had no impact. I am not too surprised at the findings in the MYRIAD project, as I think mindfulness is a core component of emotion regulation, yet the technique by itself is likely not enough.

The MYRIAD project concluded that it is likely that teaching coping strategies and skills to children is needed and I agree with this perspective. I think mindfulness is definitely needed in combination with emotion regulation skills and coping strategies, which is the approach of the DBT STEPS-A curriculum.

Question 5

Have you received pushback that mental health is not a core educational issue?

James Mazza · Accepted Answer

Yes, definitely. We have experienced pushback from principals who believe that schools are a setting to teach academics and that mental health classes are elective or only for students who are struggling. We have also received pushback from school boards and parent associations who want school curricula to only focus on academic learning and achievement scores.

Question 6

I am a school psychologist. How can I start to incorporate DBT skills into my school counselling work?

James Mazza · Accepted Answer

If you are a school psychologist, school social worker or counselor, my suggestion would be to go through the DBT STEPS-A book and identify the skills and strategies that could be helpful to your small groups or individual students. It is important to keep a balanced approach working with students identified as needing more mental health services. Thus, teaching some skills from each of the four modules – mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness – will be important.

Question 7

What is DBT STEPS-A and how does it help young people?

James Mazza · Accepted Answer

DBT STEPS-A is a universal social emotional learning (SEL) curriculum designed to teach the skills of DBT to middle and high school adolescents in a classroom format. DBT STEPS-A stands for Dialectical Behavior Therapy: Skills Training for Emotional Problem Solving for Adolescents.

The curriculum helps provide students with skills and strategies to regulate their emotions before they get too big or intense. For those that are already experiencing intense or big emotions, DBT STEPS-A offers strategies to tolerate the emotion and make effective decisions. The skills are taught as lessons and students receive homework or activities to help them practice.

Question 8

Is DBT STEPS-A incorporated into existing social emotional learning (SEL) curriculum or is the aim to replace the current SEL curriculum? How is DBT STEPS-A different or better than established SEL programs?

James Mazza · Accepted Answer

I think there can be several approaches. Firstly, the DBT STEPS-A curriculum is designed to be an independent, stand-alone SEL curriculum. However, if the school already has an SEL program they prefer, integrating the DBT STEPS-A skills into an existing curriculum is a viable solution too.

What makes DBT STEPS-A unique is that it focuses on two components of emotion regulation – when the emotions are strong and intense and reducing or changing the emotion that is currently being experienced. The DBT STEPS-A curriculum teaches adolescents when to use what skills and/or strategies. Most SEL curricula focus on only trying to change emotions.

Question 9

Who delivers DBT STEPS-A? Is it teachers, school counsellors or external consultants?

James Mazza · Accepted Answer

DBT STEPS-A is designed to be delivered by general education teachers. There is no need to have any formal training in the area of mental health. We have numerous schools that have pushed for DBT STEPS-A to be delivered by school counselors, psychologists and social workers as well. Our ideal implementation would be with general education teachers so that the class becomes a core component of the education curriculum like science, math and language arts.

Question 10

How does your perspective on building adolescent resilience fit with the idea that young people are arriving to college from a childhood of less free play, overprotective parents and a culture of “safetyism” where they have been given less independence and exposure to risk?

James Mazza · Accepted Answer

As a professor who teaches undergraduates a resilience and wellness course, there is a lot of truth that students, especially incoming freshmen, have not developed similar coping strategies and emotion regulation skills to previous generations. The reason for this is complex and may be a sign of the times and technology.

Moreover, being a parent of three children (two high school and an elementary student) I have watched in-person social skills be reduced to texting, snap-chatting and conversing via headsets while playing video games. Thus, many young people today have not had the experience or frequency of experience to help them build effective strategies for different situations. Therefore, when they get to college, they often experience new situations and emotions without a toolbox of strategies and skills to effectively cope with them.

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