Interpersonal effectiveness in action: The therapeutic milieu for DBT assertiveness skills practice

Abstract

Individuals with emotional dysregulation often struggle with assertiveness and interpersonal problem‐solving for a variety of reasons. Adolescence reflects a developmental period with well‐characterized changes in social processes that can be disrupted by affective psychopathology. In these situations, the expected challenges associated with typical adolescence can be amplified by inhibiting emotions, like anxiety and shame. Symptoms of common adolescent anxiety and mood disorders, such as social anxiety, generalized anxiety, obsessive‐compulsive disorder (OCD), and major depressive disorder, frequently exacerbate teens’ experiences of these dysregulated emotions, which in turn increase anxiety and mood symptoms. Such emotional disturbances present barriers to many important developmental tasks of adolescence. These include skillfully navigating social relationships, developing a sense of autonomy, and learning how to express and assert one's independence, while simultaneously asking for help when needed. Dialectical behavior therapy for adolescents (DBT‐A; Miller, Rathus, & Linehan, 2007; Linehan, 2015) is an empirically supported treatment developed for emotionally dysregulated youth with multiple, serious psychiatric problems, including suicidality. The treatment explicitly teaches skills to address these common challenges, while structuring the environment to support effective behaviors and ensure skills generalization across environments.