With Licensed Master Social Worker Kimberly Knickerbocker

When getting help for a loved one struggling with intellectual disabilities, it can be challenging to narrow down the type of help that would be the most beneficial for them, as many therapies are ill-equipped to handle the unique challenges these individuals face.

Most therapies rely on the individual to reflect on their behavior and uncover underlying issues, something those who struggle with intellectual disabilities may not be capable of.

Dialectical Behavior Therapy, also known as DBT, can be highly beneficial in these cases because it focuses on gaining self-control, problem-solving skills, and reforming thought processes.

We asked Licensed Master Social Worker and DBT therapist Kimberly Knickerbocker, Senior Executive Director of Behavioral Health at Beacon, to break down what Dialectical Behavior Therapy is and how it can help those struggling with mental health.

Licensed Master Social Worker and DBT therapist, Kimberly Knickerbocker
Kim Knickerbocker, Senior Executive Director of Behavioral Health

Kimberly has worked in Mental Health for over eight years. She has spent most of this time working in Community Mental Health, where she supervised multiple programs, including Assertive Community Treatment, DBT, and Adult and Children Crisis stabilization. She has also worked in private practice, focusing on individuals with personality disorders, where she gained more experience providing DBT Therapy services.


What is Dialectical Behavior Therapy?


Dialectical Behavior Therapy is the kind of therapy that focuses on teaching acceptance and change-focused strategies to help people learn to live a life worth living. DBT is typically used for mood disorders, suicidal ideation, self-harm, and substance abuse.”

Kim Knickerbocker

DBT includes four modules (or practices), all working together to create a healthier mind.

Mindfulness is a key component of DBT and can be extremely useful for helping those with intellectual disabilities.

Woman sitting in a field, legs crossed and eyes closed

For example, if the individual feels overwhelmed or overstimulated, teaching them to ground themselves in the moment by taking deep breaths or taking note of their body can help calm them and take the focus off the things they can’t control.

A study published by Sage Journals showed that those with mild intellectual disabilities who practiced mindfulness by focusing on the soles of their feet were more likely to be able to control their aggression.

Change is hard for anyone, but it can be incredibly challenging for those with intellectual disabilities. When an unexpected change to routine arises, reactions like resistance or lashing out are not uncommon.

Routine is crucial to these individuals. For some people, change in that routine can take years to adjust to. Learning acceptance through DBT can help move that process along by teaching them mindfulness and repeatedly showing them that they are safe.

Distress tolerance is something individuals with IDD (intellectual or developmental disabilities) struggle with more than most. Because they have a more challenging time coping with the world around them, they may tend to “act out” to communicate their distress.

Much like with acceptance and change, DBT can teach them how to feel safe within themselves. The effectiveness will vary depending on the person, but the goal is to teach small, actionable skills for them to implement whenever they feel unsafe or unsure.

For those with intellectual disabilities, emotional regulation can be difficult. DBT focus on showing the person that they have the ability to control their reaction to things. Depending on the person, this could take quite some time to learn. Still, given the time, DBT is designed to improve emotional regulation for those with intellectual disabilities, as we will discuss more later.


Man pressing his hands over his ears, screaming

These skills sit at the core of anyone participating in DBT. This type of therapy will teach your loved one how to perform each of these practices to improve thought patterns and decision-making.

All these skills and teachings can work for everyone,” says Kim. “It just depends on what you are needing to achieve.”


How Can DBT Help Those with Intellectual Disabilities?


DBT focuses on teaching problem-solving, action, and skills rather than ideas and philosophies. This is good news for those with intellectual disabilities who may find it difficult to understand more complex forms of therapy.

According to a paper published in Mental Health Aspects of Developmental Disabilities, 2006, DBT “…has a strong focus on teaching individuals to advocate for themselves within the system of providers … which is decidedly consistent with values of assertiveness, independence, empowerment, and self-advocacy.”

Kimberly echoed this, saying, “One of the most important things that it teaches individuals is that they have the power to change their response to stressful moments. Life is full of challenging moments. DBT gives you the skills to tolerate those distresses.”

DBT can be helpful for most, but for those with intellectual disabilities, Adapted Skills Training is applied to the process in order to meet them where they are at.


Person holding out lightbulb against a blue and pink backdrop

What is Adapted Skills Training?


Many individuals with IDD struggle with cognitive abilities, though the severity of this issue varies from person to person. Because of this, not all aspects of DBT can be applied effectively.

However, DBT can be adapted to combat this issue using “The Skills System.” According to a paper on the topic published by Taylor & Francis Group, LLC in 2013, The Skills System “is designed to build mindfulness, interpersonal effectiveness, emotional regulation, and distress tolerance capacities, as in standard DBT skills modules, but the adapted curriculum significantly modifies language and format to accommodate the specific learning and processing needs of the population.”

This simply means that while using the basis of DBT, The Skills System is modified to fit the person’s needs rather than forcing them into a therapy model that may not be effective for them.


What are Some Techniques That Help When Exercising This Treatment Plan?


It’s important to remember with any treatment plan that there will be ups and downs, regardless of who is seeking treatment. Kimberly highlighted this saying, “Be mindful that everyone is doing the best they can at any given moment. We must remember that everyone is a product of their own experiences, both good and bad. It is the therapist’s job to ensure they are applying the skills taught to each individual and their life.”


Dark brown puzzle with one piece missing

DBT is based on problem-solving, as we discussed previously. According to Kimberly, “There are four problem-solving options, and we have the ability and skills to use any or all of them.

  1. Solve the problem (by changing or leaving the situation)
  2. Feel better about the problem (regulating the emotion that the problem elicits)
  3. Tolerate the problem (accept and tolerate the problem, along with your response to it)
  4. Stay Miserable (Don’t make any changes at all)

While the therapist is there to help along the way, DBT, like any form of therapy, will only work if the person receiving it accepts what they are learning and does their best to apply it.

It may seem like an uphill battle at times, but it’s important to remember that the thoughts and beliefs a person has held onto for years aren’t going to take their leave easily. The DBT therapist will take every issue one at a time and allow your loved one to learn these skills over time.


What Does a Typical Therapy Session Look Like While Utilizing DBT?


Typically, in a weekly session, the therapist will identify areas of the individual’s life that have caused distress. These examples are used to teach specific skills that will help the individual learn how to alleviate their emotional reaction to the stressors. Therapy is all about taking real-life examples and experiences as teaching moments.”

Kim Knickerbocker
Man sitting on a couch, hands clasped in his lap

Remember, therapy sessions will look different for everyone, depending on the individual’s background, what is wanted from sessions, and how well your loved one is able to apply the techniques outside of therapy.


Consider Beacon for Your Loved One

There’s no special audience for Dialectical Behavior Therapy. “There are no inappropriate audiences! DBT can be used for anyone!!” Says Kim. So if your loved one could benefit from there services, we encourage you to reach out to us!

For more information about Beacon Specialized Living and the services we provide, please contact Alexander Furman, executive director of marketing, at alexander.furman@beaconspecialized.org.

We can’t wait to help you and your loved ones!


DBT Therapy for Individuals with Intellectual Disabilities

Reviewed and published by Alexander Furman.

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