Using DBT to Support Deaf People and Their Families

By Joy Plote, Coda Counselor | The Space Between

Emotional dysregulation is a challenge many individuals face, but for members of the Deaf community and their families, unique cultural and linguistic barriers can intensify this struggle. Dialectical Behavior Therapy (DBT), a highly structured and evidence-based therapeutic approach, offers a powerful tool for addressing these challenges. Using the skills deficit framework, DBT can be adapted to help Deaf individuals and their families develop the emotional regulation and interpersonal skills they need to thrive.

The Skills Deficit Framework in DBT

DBT operates on the premise that many behavioral problems stem from a lack of skills, such as emotion regulation, distress tolerance, mindfulness, or interpersonal effectiveness. This framework assumes that individuals engage in maladaptive behaviors (e.g., self-harm, substance use, or emotional outbursts) because they do not have effective alternatives or lack the ability to use those alternatives when needed (Linehan, 1993).

For Deaf individuals, skill deficits may be compounded by factors such as:

• Language deprivation: Limited early exposure to language can impair emotional development and the ability to identify, label, and express feelings.

• Cultural isolation: Navigating both the Deaf and hearing worlds often creates stress and confusion, particularly for Codas (Children of Deaf Adults) and other family members.

• Systemic barriers: Discrimination, ableism, and lack of access to culturally competent mental health services contribute to emotional dysregulation.

By teaching concrete, actionable skills, DBT equips clients to replace maladaptive behaviors with healthier responses. For Deaf families, these skills can bridge gaps in communication, foster mutual understanding, and reduce conflict.

DBT’s Core Components

DBT consists of four key modules that align well with the needs of the Deaf community:

1. Mindfulness

   • Encourages present-moment awareness and reduces impulsive reactions.

   • Visual and experiential techniques in ASL make mindfulness practices accessible and engaging for Deaf clients.

2. Emotion Regulation

   • Helps individuals identify, understand, and manage intense emotions.

   • This is particularly vital for Deaf clients who may have had limited exposure to emotional vocabulary or expression.

3. Distress Tolerance

   • Provides tools to navigate crises without resorting to harmful behaviors.

   • Strategies like radical acceptance and grounding exercises can be adapted for visual learning styles.

4. Interpersonal Effectiveness

   • Teaches skills for asserting needs, setting boundaries, and managing relationships.

   • These skills are crucial for Deaf individuals who may face communication barriers in both personal and professional settings.

Adapting DBT for the Deaf Community

While DBT is inherently structured, adapting it to the cultural and linguistic needs of the Deaf community enhances its effectiveness. Key adaptations include:

• Visual Materials: Creating ASL-based videos, worksheets, and role-playing scenarios ensures accessibility.

• Language: Modifying DBT concepts into ASL metaphors that resonate with Deaf culture (e.g., using visual imagery to explain abstract ideas).

• Group Settings: Conducting skills groups with Deaf participants fosters community and shared understanding, reducing feelings of isolation.

Evidence Supporting DBT for Deaf Populations

Research underscores DBT’s potential for addressing emotional dysregulation in diverse populations:

• Neacsiu et al. (2010, 2014): Found that DBT skills improve emotion regulation, reduce anxiety and depression, and decrease maladaptive behaviors.

• Axelrod et al. (2011): Highlighted the importance of emotion regulation skills in achieving positive treatment outcomes.

• Deaf Wellness Center (University of Rochester): Successfully implemented DBT with Deaf clients, emphasizing culturally and linguistically tailored interventions.

While specific studies on DBT’s application in the Deaf community remain limited, these findings demonstrate its efficacy in building emotional resilience across varied populations.

Compatible Models of Support

To maximize the impact of DBT, integrating complementary models of support can provide holistic care for Deaf individuals and their families:

1. Family Systems Therapy

   • Addresses intergenerational patterns of behavior and communication challenges within Deaf families.

   • Supports Codas and hearing family members in understanding Deaf culture and fostering inclusivity.

2. Trauma-Informed Care

   • Recognizes the impact of language deprivation and systemic discrimination as trauma.

   • Ensures that interventions are sensitive to these experiences and prioritize safety and empowerment.

3. Community-Based Programs

   • Group workshops or support groups conducted in ASL can reinforce DBT skills and build a sense of belonging.

   • Collaboration with Deaf organizations and advocacy groups ensures cultural competence.

Practical Applications for Deaf Families

In practice, DBT can help Deaf families:

• Develop shared emotional language to improve communication.

• Build distress tolerance skills to navigate systemic barriers and daily stressors.

• Foster healthier relationships by teaching assertiveness and boundary-setting.

For instance, a Deaf parent and their hearing child (Coda) might use DBT’s interpersonal effectiveness skills to address misunderstandings, while both benefit from mindfulness practices to stay present and reduce reactivity.

Conclusion

DBT’s skills deficit framework offers a powerful means to address emotional dysregulation due to language and information deprivation in the Deaf community. By adapting DBT’s core principles to align with Deaf culture and communication styles, therapists can provide accessible, effective care that fosters resilience and connection. With further research and collaboration, DBT has the potential to transform the emotional well-being of Deaf individuals and their families, bridging gaps in understanding and building healthier, more harmonious relationships.

References

• Axelrod, S. R., et al. (2011). Emotion regulation as a mechanism of change in DBT.

• Linehan, M. M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder.

• Neacsiu, A. D., et al. (2010, 2014). The role of skills use in DBT outcomes.

• University of Rochester Deaf Wellness Center: Website link.