Leveling Up Dialectical Behavior Therapy for Autistic Individuals with Emotion Dysregulation: Clinical and Personal Insights

Autistic people may experience high emotion and sensory sensitivities and a slow return to baseline emotional state. Dialectical behavior therapy (DBT) was developed to address reactivity, impulsivity, and mood dysregulation in individuals with mood and personality disorders. DBT may be therapeutically beneficial to autistic individuals struggling with these or similar emotional and sensory challenges. This article is a synthesis of the first author's experiences of DBT as an autistic person and professional insights from all authors. We provide an overview of the development of DBT, its foundational components, and adaptations. Using this basis, the first author describes the benefits DBT has had, the modifications that have helped him, and how those modifications may enhance DBT for autistic people. Modifications include visuals, graphics, and a gaming format that target the client's personal interests. The essence of these alterations is to transform life skills and DBT skills into something meaningful and functional. Receptivity of the therapist to the modifications and neurodivergent problem solving may be foundational to therapeutic success. Client-initiated contributions in collaborative therapy may improve autistic participants' understanding, validation, and adherence with DBT. The authors suggest expanding work on DBT modifications for autism in the areas of daily self-monitoring, assessing for preferred visual and gaming formats, and utilizing personal interests. Many autistic people struggle with their emotions. There are few therapies that assist autistic people with these challenges. Dialectical behavior therapy (DBT) is a therapy that teaches skills for coping with emotions and forming healthy bonds with others. DBT may provide benefits to autistic people. This article uses personal insights with DBT from the first author. The article combines the professional expertise of all authors. We talk about the strengths DBT may have for autistic people. We recommend changes to make DBT a more helpful therapy. The first author is an autistic researcher in psychology. He has other mental health disabilities. He has been in DBT. The second author is an autistic person working in autism research and advocacy. The remaining authors are non-autistic. They do research and therapy with autistic people. DBT is used to help people manage their emotions and engage with others successfully. Many autistic people struggle with these skills. There is not a lot of research on how DBT can benefit autistic people. Early work has shown that it might be effective for autistic people. We outline several changes to DBT that might make it more helpful to autistic people. One change included is using images to help autistic people keep track of therapy skills. Another suggested change is making therapy into a game. More research is needed to test if these changes work in larger groups of autistic people. We hope therapists use these changes to DBT to better support autistic people. We hope that this encourages more research into how DBT can better help autistic people. Autistic people may also benefit from DBT skills in their own lives.