Many autistic adults experience mental health difficulties. Research shows that autistic people are more likely than neurotypical people to experience emotion dysregulation, having trouble feeling and managing one’s emotions [1]. This emotional dysregulation likely contributes to autistic adults’ high rates of various mental health struggles, including suicidal thoughts and behavior [2].

Researchers, clinicians, and advocates have long known that autistic people are at higher risk for suicide, though there’s been debate about what treatments and interventions are most appropriate. Luckily, new research offers hope that dialectical behavior therapy (DBT) is an effective choice for helping autistic people with suicidal behaviors and emotion dysregulation.

What is DBT?

DBT is an evidence-based therapy for a variety of mental health struggles characterized by emotion dysregulation [3]. Originally researched in borderline personality disorder, DBT is specifically helpful for treating suicidal behaviors [4]. DBT’s primary goal is to help each client “build a life worth living”—to create and live a life that is most fulfilling for them based on their personal values, desires, and needs.

Traditional DBT is a fairly complex therapy that provides clients with lots of support, including individual therapy, a weekly skills group, and as-needed phone coaching. In DBT skills groups, clients learn dozens of skills in four main areas: emotion regulation, distress tolerance, interpersonal effectiveness, and mindfulness. These skills can help people with the types of problems common in depression, PTSD, generalized anxiety, social anxiety, and general life stressors.

While “Radically Open DBT” has previously been shown to be useful for autistic people, “traditional DBT” for autistic people is a newer exploration. In the past few years, more DBT clinicians have started to recognize the importance of making DBT more neuroaffirmative for neurodivergent clients. Autistic DBT therapists have shared their expertise and experiences of how traditional DBT has successfully helped their autistic clients. And now, there’s research to back up their claims.

Review of Research on DBT for Autistic Adults

In one pilot study with 7 autistic adults, 18 weeks of DBT significantly reduced the participants’ ratings of emotional dysregulation [5]. Most participants also experienced fewer suicidal thoughts and less self-harm as treatment progressed. Importantly, the autistic adults in the study expressed liking DBT. They found it to be “useful” and “applicable” to their lives, offering them concrete skills for working toward their personal values and helping them “accept themselves and [being autistic] more.” In another pilot study, 16 autistic adults participated in a 24-week-long DBT skills group [6]. Again, participants reported liking the group and believing it would be able to help other autistic people.

Earlier this year, a new study came out examining the effectiveness of comprehensive DBT for treating suicidal behaviors in 123 autistic adults [7]. This study was a randomized controlled trial, directly comparing 6 months of DBT to “treatment as usual.” It found that autistic clients in DBT experienced significantly reduced suicidal thoughts and behaviors, as well as lower depression, as compared to the clients in the control condition. This difference between groups did not last until a 12-month follow-up, however, so it’s possible that more than 6 months of DBT would be needed to sustain its positive impact for autistic adults. More research is needed.

Notably, to make the treatment as neuroaffirmative as possible, these research studies included adaptations to typical DBT. Some examples of these modifications include:

• incorporating illustrations into written teaching materials for DBT skills
• paying special attention to and accommodating for clients’ sensory needs within therapy rooms/sessions
• incorporating special interests into skills teaching and homework assignments
• problem-solving and providing accommodations as needed for clients’ social anxiety, language preferences, or executive functioning differences

Study participants reported liking these adaptations, and clinicians should continue to consider what changes would enable their autistic clients to get the most out of DBT [8].

Final Thoughts

While more research is needed, we now can say more confidently that DBT is an appropriate treatment option for autistic people struggling with self-harm or emotion dysregulation. Of course, finding a well-trained and neuroaffirmative DBT therapist is likely very important! If you are autistic and trying to find a DBT therapist, consider asking potential therapists these 7 questions to help you find “real” DBT. And, don’t hesitate to ask any potential DBT therapist about their willingness to make accommodations for you, based on your needs and preferences, including the neuroaffirmative modifications listed above!

To find a therapist, visit the Psychology Today Therapy Directory.