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

Abstract

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.

Community brief

Why is this topic important?

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.

What is the purpose of this article?

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.

What personal or professional perspectives do the authors bring to this topic?

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.

What is already known about this topic?

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.

What do the authors recommend?

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.

How will these recommendations help autistic adults now or in the future?

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.

The Perspectives of This Article

I, Elliot Gavin Keenan, am an individual with autism and co-occurring pediatric-onset rapid-cycling Bipolar 1 disorder, as well as traits of borderline personality disorder (BPD), and attention-deficit hyperactivity disorder (ADHD) combined type. I am a PhD candidate at the University of California, Los Angeles (UCLA) in Human Development and Psychology, where my research has focused on autism and bipolar disorder. A number of scholars endorse the use of lived experience in clinical research and believe that sharing these experiences enrich the field.¹ I received dialectical behavior therapy (DBT)² in an intensive outpatient format. I wrote the initial draft of this article, completely of my own inspiration and volition, and not by suggestion of any person. I then (and only then) sought written and verbal feedback from each of the other authors, as well as relevant background writing in key substantive domains (e.g., historical and contemporary DBT development and practice).

I struggle with unexpected changes in daily routine, transitions, and activities of daily living. My psychiatrist at the UCLA describes my bipolar disorder as “brittle,” rapidly alternating between severe depression and dysphoric mixed episodes characterized by insomnia, lack of appetite or thirst (leading to dehydration and anemia), meltdowns, transient visual hallucinations, and somatic delusions. I have been treated with many medications, including mood stabilizers, all atypical antipsychotics approved in the United States (except for clozapine), typical antipsychotics, and other drugs including benzodiazepines. I currently take lithium, risperidone, amphetamine salts, diazepam, and olanzapine as needed. I was enrolled in an intensive DBT outpatient program that was highly adherent to Linehan's model of DBT (which is, DBT that follows the formula set forth by its original creator, Linehan, and includes all four treatment modalities: individual therapy, skills group, phone coaching, and therapist participation in a DBT treatment team) after seeing only limited improvement from medication alone.

Ava N. Gurba is an autistic graduate student at Stony Brook University working in autism research and disability advocacy. Dr. Catherine Faith Kappenberg is a cognitive behavioral therapist, autism specialist, school consultant, and intensively trained in DBT. Dr. Brittain Mahaffey is a clinical psychologist and Linehan Board Certified Dialectical Behavior Therapist. She directs the DBT Program at Stony Brook University Department of Psychiatry and Behavioral Health. Matthew D. Lerner, PhD, Associate Professor of Psychology, Pediatrics, and Psychiatry, is Director of the Social Competence and Treatment Laboratory and Co-Founder and Research Director of the Autism Initiative at Stony Brook University.

This article is a synthesis of my professional, academic, and personal expertise, augmented by the expertise of all coauthors. I (Elliot) came up with the strategies that will be elaborated on. All decisions about person- or identity-first language throughout the article, as well as usage of specific medical terminology, were ultimately made by Elliot (me). Decisions regarding language may not reflect the individual preferences of my co-authors.

Introduction

Dialectical behavior therapy (DBT)^2,3 was developed by Marsha Linehan for individuals with high emotion dysregulation. These individuals may also exhibit target behaviors such as self-harm or chronic suicidality^4,5—this often maps onto borderline personality disorder (BPD), yet DBT has been found to be helpful for addressing an array of diagnoses beyond BPD,^6,7 including chronic depression, substance use disorders, and some eating disorders. DBT features an integration of change and acceptance skills (some of which are drawn from Zen Buddhism)³ that have been regarded as effective for treating chronic suicidality⁸ and has long been held as the most effective treatment for BPD, although few randomized controlled trials have been performed due to the vulnerable nature of the patients DBT is designed for.⁸

Little work, however, has been performed examining the applications of Linehan's DBT among autistic people. This is surprising given the prevalence of mood dysregulation^9,10 and high rates of co-occurrence with mood and anxiety disorders.^11,12 Dysregulated emotional reactions are common among autistic people^13,14 and likely an important antecedent to the increased rate of suicide¹⁵ observed in the autistic community. Despite the prevalence of co-occurring emotion dysregulation and elevated rates of self-harm and suicidality in autistic people,^11,14,15 DBT as originally formulated by Marsha Linehan⁷ has not been systematically evaluated as a primary support in this community.

There have been several adaptations of DBT that differ from Linehan's DBT because they are aimed at individuals with developmental differences (including autism but not specifically autism). One is Julie Brown's Skills System for emotion dysregulation.⁹ It teaches emotion regulation skills in a prescribed stepwise, almost gamified manner with a specific number of skills recommended for use based on the level of emotion dysregulation the individual is experiencing. It also appears to enhance the teaching of interpersonal effectiveness skills. It may do little, however, to address issues related to flexibility and openness to novel experiences. Thus, it might do a poorer job of addressing the issues of overcontrol (insistence on sameness, social and cognitive rigidity, obsessive-compulsive disorder-like symptoms) seen in autistic clients.

Also, it is designed for individuals with cognitive challenges and may not be the most appropriate adaptation for individuals without intellectual disability. In contrast, radically open dialectical behavior therapy (RO-DBT)¹⁶ is designed for disorders of overcontrol (including obsessive-compulsive personality disorder and autism). This is designed to clearly address the needs of autistic individuals but loses the laser-like focus of Linehan's DBT on managing emotional dysregulation, as it focuses more on social signaling. Finally, DBT-autism+ is an additional example of an adapted curriculum that simplifies and makes more concrete the core concepts of DBT while maintaining a high level of adherence to Linehan's model.

The primary targets of these therapies (except for DBT-autism+) are developmental differences, not co-occurring emotional dysregulation. For autistic people, problems with emotional dysregulation may have to be dealt with before problems with social interaction can be fully addressed, as the emotion dysregulation interferes with social connection.¹⁷ As such, there remains a critical need to adapt and evaluate supports, which are appropriate for autistic people with co-occurring emotional disorders. See Table 1 for a comparison of DBT adaptations. Although adaptations for autism have been proposed, little published work has examined specific recommendations on how to do so.¹⁸

Table 1.

Comparison of Dialectical Behavior Therapy Adaptations

Name of adaptation	Target	Description	Notes
Linehan's DBT	Personality disorders; emotion dysregulation; chronic suicidality	Four modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness	The original DBT
Lynch's RO-DBT	Overcontrol disorders (e.g., autism, obsessive-compulsive personality disorder)	Reduced focus on emotion regulation and increased focus on social signaling
Julie Brown's Skills System	Developmental differences and individuals with cognitive challenges	Emotion regulation skills are delivered in a stepwise manner
Rathus and Miller's DBT Skills Manual for Adolescents	Adolescents	Visual aids and simplified language; adherent to Linehan's model
Walsh-Bender's DBT-autism+	Autism without intellectual disability	Highly adherent to Linehan's model with a simplified, streamlined, and visual approach	Not published

The first author's recommendations outlined in this article are not drawn from the above approaches; the first author has not been treated with these approaches. They are listed for context of the literature.

DBT, dialectical behavior therapy; RO-DBT, radically open dialectical behavior therapy.

Some preliminary work has looked at DBT (and variants such as RO-DBT) in autistic people with co-occurring emotion dysregulation and found it to be feasible,¹⁹ acceptable to clients, and potentially effective at reducing emotion dysregulation²⁰ and reducing global distress.²¹ While there are ongoing studies,^19,22 there are still little empirical data on the effectiveness of DBT for emotional dysregulation in autistic people.

Autism and emotion dysregulation

Evidence suggests that autistic people can benefit from DBT skills such as mindfulness and distress tolerance²³ to cope with emotion dysregulation and improve interpersonal relationships. Autistic people commonly have problems with mood dysregulation.^10,14 Some autistic people have problems related to thought disorder (e.g., overthinking, getting “stuck,” and cognitive rigidity).

Autism is a heterogeneous condition at times consistent with both overcontrol (an attempt to exert excessive levels of control, exemplified by insistence on sameness, social and cognitive rigidity, and obsessive-compulsive disorder-like symptoms) and undercontrol (which includes disinhibited behaviors such as attention-deficit hyperactivity disorder [ADHD]-like symptoms, meltdowns, “stimming” or repetitive motor behaviors—since stimming is a disinhibited behavior,²⁴ or a behavior which top-down control can be exerted over—not that it is always helpful to do so, yet this is an idea which is often mentioned in discussions about “masking” autistic behaviors^25,26). Moreover, autism frequently co-occurs with mood and personality disorders, which may be understood as undercontrolled such as ADHD and BPD. All these disorders co-occur at rates higher than the non-autistic population mean rate, meaning that they are all more common in autism.²⁷

Some autistic people meet criteria for BPD, an overlap that may be attributable to trauma; one study of women with BPD found that 15% met criteria for autism, and this co-occurrence was associated with lower global functioning and more frequent suicide attempts.²⁸ A meta-analysis found that 4% of adults with autism had BPD (pooled prevalence)²⁹; however, the samples from which this pooled estimate was drawn were small and most of them were at risk of bias.

Bipolar disorder is also prevalent in the autistic community. One study found that 30% of pediatric bipolar 1 patients met criteria for autism; co-occurrence was associated with more severe bipolar disorder, and the mean age of onset for bipolar disorder was younger in those who had autism.³⁰ A meta-analysis estimated that 7% of autistic individuals have bipolar disorder³¹ while this number drops to 2% of the general population.³² A case–control birth cohort study in Sweden found elevated risk of bipolar disorder among those who were diagnosed with autism before age 28.³³

Another disorder that can feature emotion dysregulation is ADHD; it is frequently co-occurring with autism and shares overlapping features to the extent that it is still debated whether they form a single continuum.³⁴ Interestingly, hyperactivity is predictive of severe mood problems in autistic adolescents.¹⁰ Other neurotypes may impact regulatory abilities, especially among the frontostriatal developmental disorders (including obsessive-compulsive disorder and Tourette's).³⁵

Foundational components of DBT

Typical comprehensive DBT consists of three main treatment modalities: weekly skills group, weekly individual therapy, and phone coaching.^3,7 During phone coaching calls, which are limited in their duration, the therapist counsels clients on how to implement the skills in situations in their daily life²; this component of the therapy helps to bridge the gap between knowledge and practice. Diary cards (where clients log information about their mood, target behaviors such as suicidality or self-harm, and skills used) also help address this, and daily completion of the diary card is a requirement of DBT and a valuable self-monitoring experience.⁷

DBT has four modules. The first is mindfulness. Practice of mindfulness is built into DBT to address potential alexithymia^36,37 (difficulty identifying or describing one's own emotions). The second module is distress tolerance, which teaches strategies for preventing and surviving emotional crises in the moment. The DBT Skills Training Manual (by Linehan)² defines Distress Tolerance and Crisis Survival Skills as “when faced with a difficult situation” or “solutions to painful situations.” (For an autistic person, this may include situations such as a change in daily routine or transitions between activities.) One strategy is TIP, which stands for Temperature (cold), Intense exercise, and Paced breathing (4-in-8-out); this skill changes one's physiology to change one's level of distress. The counterpart to distress tolerance is the third module, emotional regulation.

This looks at how to regulate mood prophylactically, including self-care skills such as balanced eating, sleeping, caring for illness, and avoidance of mind-altering drugs. The fourth module is interpersonal effectiveness. In this module, the “dialectic” of DBT comes to the forefront as clients consider how to balance their values with their interpersonal goals, relationship effectiveness, and the contradictions of everyday life. Interpersonal effectiveness skills may seem superficially similar to social skills interventions for autism, but—having experienced both DBT and PEERS (a prominent social skills intervention for autism)³⁸ for myself (Elliot)—they are substantially different. Interpersonal effectiveness does not teach basic social skills in the same way an intervention like PEERS does. It does not teach you how to make friends—what it does teach you is how to identify your own personal priorities in a relationship, how to maintain your self-respect, and when it is time to end unhealthy relationships. The goals of interpersonal effectiveness are tied closely to emotion dysregulation, not a generalized social deficit.

“Wise mind” refers to a state that is neither overly emotional or hot (“emotion mind”) nor overly rational or cold (“rational mind”). The “wise mind” skill can put a visual understanding to a core competency in emotion regulation that is critical in mastering DBT. It also may be helpful in reducing alexithymia.^36,37 To be in wise mind, to make wise choices to reach one's “life worth living,” is a goal of DBT.^3,7

How I Adapted DBT

I was diagnosed with PDD-NOS (pervasive developmental disorder—not otherwise specified) when I was 6 years old. It was only a matter of time (and 18 inpatient hospitalizations) before I was enrolled in a comprehensive DBT program while living in California for graduate school. I adapted DBT naturalistically, tinkering with it to make it work for me. I remember being very confused by the idea of opposite action. In using opposite action, you are acting “opposite” to how your emotion mind is telling you to act (e.g., taking a walk if you are feeling depressed). This is now an important skill for me—what I did not understand at first is that you are not trying to find what emotion is “opposite” the emotion you are currently experiencing. I also struggled with the environment of the program because I was at home (due to the COVID-19 pandemic), but I was not allowed to use my nicotine vaporizer, and the group session went on for just a little bit longer than my ADHD could handle. I made ample use of fidget objects during skills group. During DBT, my medication regimen was largely stable and included treatment for my bipolar disorder and ADHD.

When adapting evidence-based practices (i.e., those that integrate high-quality research with clinical expertise against the backdrop of the personal characteristics of the individual),³⁹ it is important to meet the needs of your target community without losing the core active ingredients of the therapy. All four core domains of DBT remain important for autistic individuals, but reasonable accommodations based on lived experiences of and best practices for supporting autistic individuals may help to promote client engagement, retention, and use of core skills.

Selection of appropriate materials and group

The nature of DBT is for clients to become experts in the therapy. My therapist at CBT California asked me to come up with this list of recommendations; DBT is the only support I have experienced where being a client is explicitly compatible with being a collaborator. In fact, collaboration is one of Linehan's defining principles, and she came up with DBT after having had BPD herself.⁴⁰ A hyperlexic, highly educated participant (like myself) can read the skills training manual instead of the regular book. The skills manual is publicly available by design. The spirit of DBT treats clients as collaborators and students, and autistic participants should be treated with the same respect. I struggled when I was approached in a way that was below my level.

The standard DBT skills manual offers several choices of activities and explanations for every skill, some of which are quite concrete. The choice of which activities and explanations from those that are provided in the book might be the first step in making DBT effective for autistic individuals. Nevertheless, autistic adults who struggle with theory of mind, pragmatic language, and/or social anxiety are likely to benefit from more adaptations and a carefully selected, smaller skills group, perhaps even beginning with individual therapy before attending group sessions.

Our co-author, Dr. Kappenberg, has found in her own clinical practice that the Rathus and Miller DBT Skills Manual for Adolescents⁴¹ is effective for autistic and non-autistic adolescents and adults. The section on “Distress Tolerance and Crisis Survival Skills” (pp. 26–49) is a good example of more visual structure (see the Visual Aids for Abstract Ideas section) and simplified content without sacrificing adherence. It can be taught as comprehensive, adapted, or used in a more limited manner (as “informed by” DBT), for example, watered-down DBT with fewer meetings and no coaching, or DBT as a single component of a heterogeneous group of intervention approaches (a structure often found in inpatient and intensive outpatient programs).

Gamification of diary card, target behaviors, and skills

The system that worked for me was a visually presented “behavioral whiteboard” (actually constructed in Google Slides, to be accessible from my mobile phone) where I check off having done certain things over the course of a day, a week (Fig. 1), or a month. I created a more complex system where multiple blue boxes could score one value and additional green boxes scored a different value per-box; this was to ensure that, for example, I had to do cat litter twice per week to receive any points. Also, you can make the first task completion worth more points than subsequent completions. Tasks can vary from household chores (in mine, Cat Litter) to hygiene (in mine, Shower) to specific target skills (in mine, the ACCEPTS skill), and you can reference other lists of activities (in mine, To-Do List). Completion of the diary card should be a daily task. These tasks not only facilitate executive functioning, but they can serve as distress tolerance skills to redirect attention, distract, and regulate emotion.

FIG. 1.

Whiteboard for weekly tasks.

I implemented an exchange system that would reward saving up points, as poor financial skills are an issue for me. A wide variety of areas can be targeted using rewards. Further role-playing elements can be brought into the intervention, when appropriate. Although this article focuses on adults, my coauthors have agreed that this might be especially appropriate with children and teens. In my chart, I chose all the images based on my intense interest in Pokémon.

Visual aids for abstract ideas

It is well recognized that visual cues can benefit autistic people, for example, when undergoing transitions,⁴² and these cues can also be helpful in delivering psychosocial intervention. Visual aids can be of great use when working with autistic individuals, and I think the concepts of “emotion mind” and “rational mind” can quickly be established with a visual scale using a color gradient (e.g., red-to-blue) accessible to the individual. The goal is to stay within the bounds of “wise mind” in the center of the scale. Participants can be asked to point to where they are on the visual scale, instead of giving only a verbal numerical rating (which is more difficult for some autistic clients, who may struggle with giving an answer). Numbers can be added as a visual guide, if appropriate. It is important for the client to understand that “attacking emotion mind” is not necessarily “attacking my emotions.” Thus, framing the attack and defense spells in the context of the dialectic of emotion mind versus rational mind is crucial.

Visual concepts can foster meaning. The use of visual aids is a hallmark of the evidence-based TEACCH Structured Training approach⁴³ and Valerie Gaus' Cognitive Behavior Therapy for Adult Asperger Syndrome.⁴⁴ Visuals can make abstract concepts more accessible. They also help individuals with spatial processing deficits organize information properly. DBT-autism+ uses the image of an airplane whose flight can only be steady when the wings (emotion wing and reason wing) remain in relative balance.⁴⁵ Other skills and principles in the DBT modules are similarly broken down using visual supports and modified language.⁴⁶

Incorporating intense interests

One of my primary intense interests is Pokémon. Despite having read the skills training manual twice, my first real “aha!” moment with DBT came only when I started to conceptualize the skills as “moves” like Pokémon have. Different moves have different types; some moves are supereffective against certain situations, and others are not-very-effective. Just like in Pokémon, you must know when to use the right move for the right situation. After thinking about this, I created a more generalized formula for gamifying DBT skills. I call the skills “spells”—depending on the person's interests, you can call them moves, powers, or really anything along those lines. They fall into different categories, which align with the purpose of using those spells (Table 2). Incorporating intense interests into therapy has already become popular in adaptations of cognitive-behavioral therapy for autistic individuals.⁴⁷ I recommend discovering the client's intense interests as soon as possible. Ask them what they are interested in, or how they spend their free time.

Table 2.

Dialectical Behavior Therapy Skills Modules as “Spells” and Other Recommended Adaptations

DBT skills module	“Spell” type	Function of “Spells”	Other adaptations
Mindfulness	Mana	Enables you to use other spells (it is a resource that must be managed to use skills).	Allowing the use of fidgets, stims, or movement during mindfulness practice; allowing individuals to choose between mindfulness exercises.
Distress tolerance	Attack	If your emotion mind is too strong, you can fight it back with these spells to try and get back to Wise Mind.	Using external reminders to try these skills when in a crisis, such as a caregiver or a visual reminder. Stimming as a regulation strategy.
Emotion regulation	Defense	Defend your position in Wise Mind and prevent emotion mind from getting too strong with these spells.	Many of these skills are habits; you can build habits with reinforcement. Make them part of an autistic person's daily routine. Stimming as a regulatory strategy.
Interpersonal effectiveness	Effect	Causes “effects” in other people (e.g., causing effects that are aligned with your interpersonal goals).	Some skills may have to be modified (e.g., eye contact can be de-emphasized).

We refer to DBT skills as “Spells” to give them the flavor of a role-playing game such as Dungeons & Dragons.

Although my generalized system is based around an RPG (Role Playing Game, such as Dungeons & Dragons; which is appropriate for many autistic adults, especially young adults, being a common interest), it can be adapted to suit a wide range of interests. Incorporation of intense interests makes autistic clients more motivated, as well as increasing learning of the material.⁴⁸ This incorporation of an autistic person's interests is validating to a person who may have felt marginalized and criticized often. The essence is to transform the skills into something with equivalent functionality, but with the “flavor” of the client's interest.

Use stimming as a tool

Clinicians may also incorporate stimming into their clients' practice of mindfulness and even distress tolerance and emotion regulation skills, as it falls under self-soothing. This may be a useful regulatory strategy²⁴ for autistic people who are trying to figure out how to manage difficult situations and remain in “wise-mind.”

Selection of concrete activities and explanations

As a general principle, autistic adults are likely to prefer and more readily understand concepts that are presented in a concrete way, rather than an abstract way.⁴⁹ This should inform your choice from the training manual of what activities and what explanations you include in your teaching of the skills. The skills themselves are the same, and perhaps, all of them can be taught in a concrete way. In fact, some of the skills really benefit from concreteness: to perform the skill called T(IP) you hold an ice pack over the top half of your face and hold your breath (if you can—I also use paced breathing if I can't, 4-in-8-out) for 30 seconds. There is nothing abstract about these instructions. The client knows exactly what to do. However, autistic clients may need to walk through using these skills in session before they can try to use them in the real world, as novelty can be very intimidating and form a barrier to using the skill.

However, there are some mindfulness exercises that I do not recommend for autistic individuals—for example, I do recommend asking oneself “Is this wise mind?” but I do not recommend “breathe Wise in and breathe Mind out.” The former will make sense to autistic clients; the latter will likely confuse since it does not logically compute to anything if taken literally (it requires abstract thinking). It is much easier to understand “Is this wise mind?” That said, each individual will find which different skills and implementations work best for them.

Conclusions

Future research may show that DBT is at least as effective in autistic people as it is in non-autistic people and that it can be a great tool to use in individuals with severe emotion dysregulation, regardless of their diagnosis. However, just as we have in CBT, we may find that slight modifications to Linehan's original protocol will boost accessibility and effectiveness for autistic clients.

We believe that adapting DBT for autistic people is not mutually exclusive from building more universally designed DBT approaches. By adapting DBT for autistic people, we are building more inclusive and universally designed therapies. However, each group has its own needs and those need to be assessed individually. What works for autistic individuals may or may not work for those with other conditions. As the scope of the article and the journal pertains to autism, we wrote from that perspective. This article is based on the first author's lived and professional experience and may not generalize directly for every autistic person. Future work needs to ensure that we continue to expand on ensuring DBT is accessible for all people.

Modifications such as careful selection of materials and groups, gamification of skills and diary cards, visual supports for abstract concepts, and opting for concreteness, when possible, may make DBT more accessible to the autistic community. Too many autistic people have lived with enduring stress and hopelessness, and many suffer with suicidality and non-suicidal self-injury. DBT and best practices in autism intervention share DBTs signature goal of helping individuals create a life worth living.

Author Disclosure Statement

No competing financial interests exist.

Funding Information

No funding was received for this article.