Impact Factor 1.0
Volume 33, 12 Issues, 2023
  Letter to the Editor     September 2023  

Dialectal Behavioural Therapy: Is it an Answer to Difficult Questions Posed on Mental Health Professionals by Gen Z?

By Usama Bin Zubair


  1. Pakistan Institute of Mental Health, Rawalpindi, Pakistan
doi: 10.29271/jcpsp.2023.09.1078

Gen Z constitutes people born in mid-90s to 2010s. They are different in various life perspectives from the earlier generations which sometimes may lead to conflict within themselves and with their environment resulting in different types of mental health problems.1 Some of the differences include the excessive use of social media, gadgets and the differences in lifestyle. Usually, the presentation of mental health problems is not conventional in adolescents, and mental health professionals sticking to a set criteria during an assessment or treatment may not be very successful in the management. Depression, anxiety, loneliness, emotional problems, self-harm, substance use, impulsivity, interpersonal issues, and chronic feeling of boredom are some of the commonly reported symptoms, problems or mental health issues by Gen Z in various clinical settings, especially during the difficult COVID-19 era.2     

A gap in the management of temperament and personality issues leading to the various interpersonal and emotional problems including self-harm in adolescents compelled the author of this letter to do certification in dialectal behaviour therapy (DBT). The author got promising results after incorporating these skills and offering full worksheet-based therapy alongside the standard psychiatric treatment for adolescents in the last 8 months. Patients between the ages of 14 and 35 years with emotionally unstable traits leading to depression, anxiety, dissociation, substance use, and self-harm were offered structured DBT. Out of 26 individuals who accepted the therapy, 14 (53.8%) completed the therapy, 8 (30.7%) prioritised issues and took partial need-based sessions while 4 (15.3%) left in between without any intimation. After 12 weeks, 19 (73.1%) had a significant improvement (either remission or more than 50% improvement in respective scale) in depression or anxiety. After 12 weeks, 13 (50%) patients had significant reduction in problem behaviours (self-harm, acting out, and substance use) as compared to baseline. At 24 weeks, 17 (65.3%) patients had a significant reduction in problem behaviours.

Deliberate self-harm, suicidal ideation, substance use, emotional dysregulation, mood swings and interpersonal problems were common presentations in most of the patients who were offered DBT. This pattern has been consistent with the patients who were enrolled in this therapy in other parts of the world, especially the patients from Gen Z.3 Offering different medications to these patients without understanding that the source of these symptoms is their personality traits (thinking and behaviour patterns) and their interaction with the environment may be counter-therapeutic in most of the cases; rather, it may cause iatrogenic harm. A lack of training of psychiatrists and clinical psychologists in this domain and a lack of proper time allocation to patients may be some of the reasons for not providing targeted help to these individuals.4

Temperamental and personality-related issues leading to the major mental illnesses, substance use, and self-harm among Gen Z could only be dealt with the non-judgmental and empathetic approach in a holistic manner. DBT revolves around making them mindful of what exactly is going in their head and the outside world and making them more effective in their tasks. It helps them to recognise and manage their emotions and steer them in the right way. It also imparts skills for making their relationships better and shedding unwanted relationships in less troublesome ways. This therapy helps them to deal with the tide of emotional crisis which ultimately results in problem behaviour and gives skills to use the existing resources to make their lives less miserable.5 More psychiatrists and mental health professionals getting trained in this therapy would bridge the gap in a better way without over-medicating the patients.

The author declared no competing interest.

UBZ: Conception of the idea of the work, manuscript writing, and accountable for the accuracy and integrity of the work.


  1. Harari TT, Sela Y, Bareket-Bojmel L. Gen Z during the COVID-19 crisis: A comparative analysis of the differences between Gen Z and Gen X in resilience, values and attitudes. Curr Psychol 2022; 3(3):1-10. doi: 10.1007/s12144-022-03501-4.
  2. Brafman J, Lubin R, Naor-Ziv R, Rosenberg S, Dwolatzky T. Loneliness, depression, and anxiety experienced by the Israeli population during the first COVID-19 Lock-down: A cross-sectional survey. Rambam Maimonides Med J 2021; 12(4):e0030. doi: 10.5041/RMMJ.10449.
  3. Chen SY, Cheng Y, Zhao WW, Zhang YH. Effects of dialectical behaviour therapy on reducing self-harming behaviours and negative emotions in patients with borderline personality disorder: A meta-analysis. J Psychiatr Ment Health Nurs 2021; 28(6):1128-39. doi:10.1111/jpm.12797
  4. Carmel A, Rose ML, Fruzzetti AE. Barriers and solutions to implementing dialectical behavior therapy in a public behavioral health system. Adm Policy Ment Health 2014; 41(5):608-14. doi: 10.1007/s10488-013-0504-6.
  5. May JM, Richardi TM, Barth KS. Dialectical behavior therapy as treatment for borderline personality disorder. Ment Health Clin 2016; 6(2):62-67. doi: 10.9740/mhc. 2016.03.62.