Dialectical Behavior Therapy Skills Training for Emotional Problem Solving for Adolescents

Mental Health Does Not Currently Meet Criteria

Dialectical Behavior Therapy Skills Training for Emotional Problem Solving for Adolescents (DBT STEPS-A) is an adaptation of DBT® designed for adolescents in middle and high school. DBT STEPS-A aims to help adolescents “build a life worth living” by developing skills such as emotion management, relationship building, and decision-making to help them navigate challenging situations and stressors that can arise during adolescence. DBT STEPS-A’s approach is grounded in the idea that two seemingly opposing facts can both be true, most notably that the curriculum’s goals include both acceptance and change. DBT STEPS-A instructors strive to help adolescents both accept themselves and make changes in their behavior.


DBT STEPS-A can be delivered school-wide as a general education intervention with just classroom-based group skills training, or in a tiered approach with additional components for adolescents who need more support. The tiered approach can be applied in schools that use a response to intervention model where adolescents are designated into three academic support tiers: (1) general education, (2) needing additional academic or social emotional support, or (3) receiving intensive support through the special education system. All three tiers receive the classroom-based group skills training. Adolescents in Tier 2 and Tier 3 also receive individual coaching focused on practicing the skills learned in group skills training. Adolescents in Tier 3 participate in multi-family group skills training sessions with their parents, and their instructors participate in consultation team meetings where they discuss any implementation challenges and receive support designed to improve their capacity to deliver the curriculum.


During the group skills training, instructors guide adolescents in identifying target behaviors to increase or decrease (e.g., increasing studying and going to school and decreasing substance use). Instructors also teach behavioral skills to groups of adolescents over four modules: (1) mindfulness, (2) distress tolerance, (3) emotion regulation, and (4) interpersonal effectiveness. The mindfulness and distress tolerance modules focus on building acceptance-oriented skills while the emotion regulation and interpersonal effectiveness modules focus on building change-oriented skills. In the mindfulness module, instructors emphasize accepting current circumstances and being present. In the distress tolerance module, instructors instruct adolescents on how to accept and tolerate painful situations without engaging in harmful behaviors. In the emotion regulation module, instructors strive to help participants become less susceptible to painful emotions. Finally, in the interpersonal effectiveness module, instructors teach adolescents to ask for what they want, to say no when necessary, and to maintain respectful relationships with themselves and others. 

DBT STEPS-A does not currently meet criteria to receive a rating because no studies of the program achieved a rating of moderate or high on design and execution.

Date Research Evidence Last Reviewed: May 2024


The following sources informed the program or service description, target population, and program or service delivery and implementation information: the program or service manual, and the program or service developer’s website.

This information does not necessarily represent the views of the program or service developers. For more information on how this program or service was reviewed, visit the Review Process page or download the Handbook.

Target Population

DBT STEPS-A is designed for adolescents ages 12–19 in middle and high school. DBT STEPS-A is designed to be delivered school-wide to adolescents in general education settings. In schools with a response to intervention model, instructors can deliver DBT STEPS-A with additional components for students in the special education system or who need more support.


Instructors typically deliver DBT STEPS-A to groups of adolescents over 30 sessions. Sessions can be delivered weekly or over 20–40 weeks depending on the school schedule. Instructors start with an orientation session followed by a session introducing the concept of dialectics. Next, instructors provide three sessions on mindfulness followed by 5-7 sessions on each of the other three skills modules. Instructors also provide an additional two sessions of mindfulness between each module.

When implemented as a school-wide intervention or for adolescents receiving Tier 1 support, instructors typically deliver the classroom-based skills training in 50-minute sessions. Instructors generally deliver the four skills modules once per week over two semesters or twice per week over one semester. 

For teens receiving Tier 2 and Tier 3 support, instructors deliver DBT STEPS-A skills training in a smaller classroom setting to groups of 10–15 students. Instructors may complete two cycles of the four skills modules, or split each session over two class periods, to give adolescents more opportunities to learn and practice the skills in each module. 

For teens receiving Tier 2 and Tier 3 support, instructors provide individual coaching as needed to adolescents. For adolescents receiving Tier 3 support, instructors typically offer additional monitoring and mentoring for 15–45 minutes weekly. Finally, instructors can offer evening multi-family group skills training sessions once or twice a month for adolescents in Tier 3 and their parents. 

Schools may have multiple instructors delivering DBT STEPS-A to adolescents receiving Tier 3 support. In this case, instructor consultation teams meet weekly for 45–90 minutes throughout the program period.

Location/Delivery Setting
Recommended Locations/Delivery Settings

Instructors deliver DBT STEPS-A in school settings. DBT STEPS-A can be delivered as a standalone mandatory course, as part of an existing course, such as a health course, or as an elective course. 

Education, Certifications and Training

Instructors are typically general education teachers or school personnel, such as health teachers, school counselors, school psychologists, or social workers. Instructors delivering DBT STEPS-A to adolescents receiving Tier 2 and Tier 3 support should have adolescent mental health expertise. 

DBT STEPS-A training is recommended for instructors. The three-day DBT STEPS-A training provides a comprehensive overview of DBT STEPS-A sessions, describes implementation strategies, identifies potential challenges and solutions for delivering the curriculum and supporting students, and provides instructors with opportunities to practice delivering the curriculum with other training participants.

Program or Service Documentation
Book/Manual/Available documentation used for review

Mazza, J. J., Dexter-Mazza, E. T., Miller, A. L., Rathus, J. H., & Murphy, H. E. (2016). DBT skills in schools: Skills Training for Emotional Problem Solving for Adolescents (DBT STEPS-A). Guilford Press.

Available languages

The DBT STEPS-A manual is available in English.

Other supporting materials

Overview of DBT STEPS-A

DBT STEPS-A Training Information

For More Information

Website: https://www.dbtinschools.com/ 

Email: Info@DBTinSchools.com 

Note: The details on Dosage; Location; Education, Certifications, and Training; Other Supporting Materials; and For More Information sections above are provided to website users for informational purposes only. This information is not exhaustive and may be subject to change.

Results of Search and Review Number of Studies Identified and Reviewed for Dialectical Behavior Therapy Skills Training for Emotional Problem Solving for Adolescents
Identified in Search 2
Eligible for Review 2
Rated High 0
Rated Moderate 0
Rated Low 2
Reviewed Only for Risk of Harm 0
Sometimes study results are reported in more than one document, or a single document reports results from multiple studies. Studies are identified below by their Prevention Services Clearinghouse study identification numbers. To receive a rating of supported or well-supported, the favorable evidence for a program or service must have been obtained from research conducted in a usual care or practice setting.

Studies Rated Low

Study 13241

Flynn, D., Joyce, M., Weihrauch, M., & Corcoran, P. (2018). Innovations in Practice: Dialectical Behaviour Therapy — Skills training for emotional problem solving for adolescents (DBT STEPS-A): Evaluation of a pilot implementation in Irish post‐primary schools. Child and Adolescent Mental Health, 23(4), 376-380. https://doi.org/10.1111/camh.12284

This study received a low rating because it did not meet design confound standards.
Study 15130

Martinez, R. R., Jr., Marraccini, M., Knotek, S. E., Neshkes, R. A., & Vanderburg, J. (2021). Effects of Dialectical Behavioral Therapy Skills Training for Emotional Problem Solving for Adolescents (DBT STEPS-A) program of rural ninth-grade students. School Mental Health, 14, 165-178. https://doi.org/10.1007/s12310-021-09463-5

This study received a low rating because it did not meet the statistical model standards.