Appunti di Neuropsichiatria
La terapia dialettico-comportamentale per adolescenti “multiproblematici”
Dialectical Behavior Therapy for “Multiproblem” Adolescents
Maria Giuseppina Ledda1, Giuliana Casti2, Sara Carucci1,3
1Clinica di Neuropsichiatria dell’Infanzia e Adolescenza, ARNAS G. Brotzu, Cagliari
2Psicologa, Psicoterapeuta in Analisi Transazionale, Psicoterapeuta EATA in Analisi Transazionale, Co-fondatrice dell’ASPIC Counselor Sardegna. Psicoterapeuta nel team DBT Cagliari
3Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari
Giugno 2026 - pagg. 380 -385 | DOI: 10.53126/MEB45380
Abstract
Dialectical Behavior Therapy (DBT) is an evidence-based, multimodal psychotherapy developed by Marsha Linehan for adults with borderline personality disorder and chronic suicidal behaviour, integrating cognitive-behavioural strategies, dialectical principles, mindfulness and acceptance to target pervasive emotional, cognitive and behavioural dysregulation. Its adolescent adaptation (DBT-A) streamlines the protocol, actively involves caregivers and family processes, and addresses self-harm, suicidal ideation and high-risk impulsive behaviours. Grounded in the biosocial theory, DBT-A combines individual psychotherapy, group skills training, telephone coaching, a consultation team and environmental structuring, organised across staged treatment goals. Skills are taught in five modules: mindfulness (the core), emotion regulation, distress tolerance, interpersonal effectiveness and the adolescent-specific middle path, centred on the dialectic between acceptance and change. A clinical case of a 13-year-old boy with severe emotional dysregulation, post-traumatic symptoms, hypersexualised behaviours and suicidal ideation in a highly compromised family context illustrates the application of the model. DBT-A is presented as a validated, first-line intervention for developmental-age patients at high risk.
Riassunto
La terapia dialettico-comportamentale (DBT), sviluppata da Marsha Linehan per adulti con disturbo borderline di personalita e comportamento suicidario cronico, e una psicoterapia multimodale basata sull'evidenza che integra strategie cognitivo-comportamentali, principi dialettici, mindfulness e accettazione per trattare la disregolazione emotiva, cognitiva e comportamentale. La variante per adolescenti (DBT-A) snellisce il protocollo, coinvolge i caregiver e le dinamiche familiari e affronta autolesionismo, ideazione suicidaria e condotte impulsive ad alto rischio. Fondata sulla teoria biosociale, si articola in psicoterapia individuale, skills training di gruppo, coaching telefonico, team di consultazione e strutturazione dell'ambiente, secondo stadi e obiettivi gerarchici. Lo skills training comprende cinque moduli: mindfulness (nucleo centrale), regolazione emotiva, tolleranza della sofferenza, efficacia interpersonale e cammino di mezzo, con al centro la dialettica tra accettazione e cambiamento. Un caso clinico di un ragazzo di 13 anni con grave disregolazione emotiva, sintomi post-traumatici, comportamenti ipersessualizzati e ideazione suicidaria in un contesto familiare fortemente compromesso illustra l'applicazione del modello. La DBT-A si conferma un intervento d'elezione validato per pazienti in eta evolutiva ad alto rischio.
Classificazione MeSH
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Corrispondenza: sara.carucci@gmail.com