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DELIVERING DBT TO AUTISTIC CLIENTS

ALANA MCVEY, PHD |APRIL 24, 2025 | ECHO UKRAINE

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ABOUT ME

  • Involved in Autism Research since 2012
  • PhD in Clinical Psychology Marquette University 2020
    • Clinical Pre-doctoral Internship at UCLA
  • Postdoctoral Training at University of British Columbia 2021
  • Postdoctoral Training and Faculty at University of Washington/Seattle Children’s Autism Center 2021-2024
  • Joined CBM in July 2024

Alana McVey | 2025

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DISCLOSURES

  • Dr. McVey is currently employed by the private practice, the Center for Behavioral Medicine, where she delivers full-model DBT and offers training and consultation on adaptations to DBT for Autistic clients.

Alana McVey | 2025

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PROJECT ACKNOWLEDGEMENTS

  • Henry Boeh, PhD, DBT-LBC
  • Casey Wilson, OT
  • Adora Du, BS
  • Samantha Seaver, BA
  • Rene Niessner, MA
  • Jill Locke, PhD
  • Gary Stobbe, MD
  • Shannon Schoonover, LMHC
  • Amara Brook, PhD
  • Rachel Kraus, LCSW-C
  • Charity Chaney, LPCC-S
  • Aaron Lyon, PhD
  • Philippa Hood, MS

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FUNDING ACKNOWLEDGEMENT

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under the Autism Intervention Research Network on Physical Health (AIR‐P) grant, UT2MC39440. The information, content and/or conclusions are those of the authors and should not be construed as the official position or policy.

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FOUNDATIONAL CONTEXT

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MEDICAL VS. SOCIAL MODEL OF DISABILITY

Alana McVey | 2025

Individual is flawed and must be “fixed”

Environment determines whether a person struggles or succeeds

Kapp (2020)

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NEURODIVERSITY MOVEMENT

  • Applies the social model of disability to reframe Autism as an aspect of human diversity
  • Defined as “variation in neurocognitive functioning” (Huges as cited by Kapp)
  • “Advocates for the rights of neurodivergent people, applying a framework or approach that values the full spectra of differences and rights such as inclusion and autonomy” (Kapp, 2020, pg. 2)
  • From Autism as pathology to Autistic people as a marginalized group that experiences discrimination

Alana McVey | 2025

Kapp (2020); McVey et al. (2023)

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DOUBLE EMPATHY PROBLEM

  • Theory put forth by an Autistic academic
  • Autistic people do not lack empathy
  • Autistic communication, display emotions, interact with others, and form relationships differently from neurotypical people
  • Difficult for neurotypical people to understand and empathize with autistic people AND for autistic people to understand and empathize with neurotypical people

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Milton (2012)

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SUICIDALITY IN AUTISTIC ADULTS

  • Suicidal thoughts and behavior (STB)
    • 34.2-37.2% suicidal thoughts
    • 21.9% suicide plans
    • 15.3-24.3% suicidal behaviors and suicide attempts
  • Non-suicidal self-injury (NSSI)
    • 2.26x more likely
    • Autistic women show an 83% higher risk
    • Autistic men show a 47% increased risk
    • 6% of autistic people have a self-injury-related ED visit

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Alana McVey | 2025

Blanchard et al. (2021); Giannouchos et al. (2023); Huntjens et al. (2024), Lai et al. (2023); Newell et al. (2023)

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DIALECTICAL BEHAVIOR THERAPY (DBT)

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WHAT IS DIALECTICAL BEHAVIOR THERAPY?

  • Evidence-based psychotherapy
  • Integration of Zen into behaviorism
  • Treats suicidality

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Acceptance

Change

DeCou et al. (2019)

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DBT FOR ADOLESCENTS (DBT-A)

  • Downward adaptation for teens
  • Streamlined skills
  • Addition of Walking the Middle Path skills
  • Includes visuals
  • Parents/caregivers included in skills group

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Kothgassner et al. (2021)

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FULL MODEL DBT-A MODES

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Individual Therapy

Family Therapy (as needed)

Skills Training

Phone Coaching (teen and parent)

Consultation Team

Linehan (1993); Rathus & Miller (2015)

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DBT-A SKILLS TRAINING

Alana McVey | 2025

Skills to Increase

Behaviors to Decrease

Mindfulness

Not aware of feelings

Unsure of goals

Difficulty focusing

Distress Tolerance

Acting without thinking things through

Escaping or avoiding emotions

Emotion Regulation

Fast and intense mood changes

Steady negative mood

Mood-dependent behavior

Interpersonal Effectiveness

Difficulty maintaining relationships

Difficulties with self-respect

Loneliness

Walking the Middle Path

Extreme thinking, feeling, and acting

Lack of flexibility

Difficulty navigating family conflict

Linehan (2015); Rathus & Miller (2015)

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SKILLS TRAINING GROUP

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Core Mindfulness

Distress Tolerance

Emotion Regulation

Interpersonal Effectiveness/Walking the Middle Path

Acceptance

Change

Linehan (2015); Rathus & Miller (2015)

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DBT FOR AUTISTIC CLIENTS

Alana McVey | 2025

Authors

n

Age

DBT Modes (length)

DBT Adherence

Treatment Comparison Group

Feasibility (carried out)

Acceptability (palatable)

Effectiveness (reduces suicidality/emotion dysregulation

Bemmouna et al. (2022)

7

Adult

Brief full-model (18 weeks)

Not reported

None

Yes

Yes

​

Yes

​

Ritschel et al. (2022)

16

Adult

Skills training only (24 weeks)

Not obtained

None

Yes

​

Yes

​

Not assessed

Huntjens et al. (2024)

123

Adult

Shortened full-model (26 weeks)

Low-to-moderate

Community TAU

Not assessed

Yes

Yes

Phillips et al. (2024)

242

Adolescent

Full-model (8-12 months)

Not reported

None

N/A (community sample)

Yes

Yes

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ADAPTATIONS FOR AUTISTIC CLIENTS

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MINDSHIFT

  • Reframing goals
  • Viewing supports and accommodations as a human right
  • Valuing Autistic people’s lied experience
  • Using affirming language
  • Working within ableist systems
  • Leveraging systems change

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Alana McVey | 2025

McVey et al. (2023)

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INDIVIDUAL THERAPY

  • Relationship between equals
  • Integrate Autism-specific factors and disability into case conceptualization
  • Behavioral chain and missing links analysis, commitment strategies, therapy interfering behavior, and consultation to the client
    • Integrate Autism-specific considerations

Alana McVey | 2025

McVey et al. (in preparation)

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INDIVIDUAL THERAPY

  • Follow through on agenda items from one session to the next
  • Build in time for skills worksheets
  • Offer visual session agenda
  • When possible, provide a schedule of planned sessions
  • Offer flexibility in session length and frequency (as able)
  • Offer written communication options in session (handwritten, text-based; non-spoken)

Alana McVey | 2025

McVey et al. (in preparation)

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Alana McVey | 2025

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DIARY CARD ADAPTATIONS

  • Streamline/simplify the number of items required
  • Offer a digital and/or app-based version
  • Use collaboration, commitment, and motivational strategies to increase use
  • Welcome questions—make sure it is working for the client
  • Get creative, if needed!

Alana McVey | 2025

McVey et al. (in preparation)

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PHONE COACHING ADAPTATIONS

  • Offer guided skills
  • Lessen the expectation to uphold a conversation
  • Set very clear expectations and guidelines
    • Spoken and in writing (orientation handout)
  • Practice reaching out when not in crisis
  • Collaboratively discuss needed speed of skills coaching delivery
    • Speaking more slowly
  • Offer an entirely text-based option
    • Set parameters
  • Offer the option to request a call by text

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McVey et al. (in preparation)

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Alana McVey | 2025

McVey et al. (in preparation)

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SKILLS TRAINING GROUP ADAPTATIONS

  • Consider Autism-specific factors and disability for therapy interfering behaviors
  • Provide additional pages for tracking skills use
    • E.g., use a binder with printouts so clients can add extra pages in between
  • Provide plain language versions of handouts and worksheets*
  • Consider color coding the modules like in the Neurodivergent Workbook
  • Integrate Neurodivergent Affirmations from Neurodivergent Workbook
  • Integrate special interests into skills such as Accumulating Positives, Build Mastery
  • Consider offering standalone skills training (plus consultation team) to increase access to treatment

Alana McVey | 2025

McVey et al. (in preparation)

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DISCUSSION/QUESTIONS

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THANK YOU!

Alana J. McVey, PhD

alana.mcvey@cbm-dbt.com

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Dr. McVey is available for training and consultation. Visit www.cbm-dbt.com for more information.

Alana McVey | 2025