DNA Inc. Position Statement: The Neurodivergent Friendly Workbook of DBT Skills
You may have seen some discussion yesterday about this book, and DNA Inc. has been asked for our thoughts/position on it.You don't have to read our entire post. It is lengthy and detailed, but we have broken it into 3 sections for those who want a broader view or to do their own further research. We will also post this on our DNA Inc. website blog.So, let's talk about it. The book in question is 'The Neurodivergent Friendly Workbook of DBT Skills', now in its second edition, written by Sonny Jane Wise. We recognise that this workbook is becoming increasingly popular within neurodivergent communities and professional spaces. The author reports that more than 100,000 copies have been sold worldwide, and the second edition explicitly describes itself as reimagining DBT skills, including interpersonal effectiveness, through a neurodiversity-affirming lens. It includes material addressing sensory regulation, meltdowns, shutdowns, capacity, self-advocacy, stimming and accessible mindfulness.We also recognise that Sonny Jane Wise is an Autistic ADHDer and that lived experience matters.But here's where DNA Inc. is going to be very clear:DNA Inc. does not endorse CBT, DBT, or adaptations or derivatives of CBT or DBT as neuroaffirming frameworks.That includes resources that describe themselves as 'neurodivergent-friendly', 'neurodiversity-affirming' or 'neuroaffirming' when they are fundamentally derived from CBT or DBT.This is not because we believe that every person who has ever used CBT or DBT has been harmed.It isn't because we believe every DBT skill is inherently useless.And it isn't because we believe that an Autistic person who says, "This helped me," is lying.People's experiences are real. Some people genuinely find these approaches useful.Our position is about something broader:DNA Inc. does not believe that modifying, adapting or neurodiversity-proofing an existing therapeutic framework necessarily makes the underlying framework neuroaffirming.The bottom line:The evidence does not support the simplistic claim that DBT is inherently harmful to autistic people.It does support the fact that DBT has a documented behavioural foundation, including reinforcement, shaping and extinction.It also now provides evidence that DBT can help some autistic people, including autistic adults experiencing severe emotional dysregulation and suicidal behaviour.Those facts can all be true simultaneously.DNA Inc.'s position therefore isn't:"The research proves DBT is bad."It is:"We have examined the research, the history, the theoretical foundations, the adaptations and the neuroaffirming claims, and we do not endorse CBT, DBT or CBT/DBT-derived adaptations as neuroaffirming frameworks."And we think neurodivergent people deserve the freedom to critically examine resources created by anyone, including people within our own community.Because being neurodivergent can give someone valuable lived experience.It does not give anyone a lifetime exemption from scrutiny.Read on to hear more from us, gain some background info, and deepen your enquiry:The history of DBT is important to acknowledge. There is sometimes a tendency to talk about DBT as though its behavioural foundations are a misconception created by critics.They aren't.Marsha Linehan, the creator of DBT, has explicitly described DBT as developing from early attempts to apply standard behaviour therapy to people who were highly suicidal. She describes behaviour-change procedures as part of DBT's development and specifically discusses positive reinforcement, negative reinforcement and shaping as behavioural components of DBT.And this isn't merely historical. Contemporary DBT training materials themselves explicitly teach concepts including:- reinforcement;- negative reinforcement;- shaping;- extinction;- punishment;- behavioural consequences; and- reinforcing alternative behaviours.Linehan's published DBT training materials define extinction as reducing behaviour by removing ongoing reinforcement and describe punishment as an aversive consequence intended to decrease behaviour. They also explicitly describe shaping as reinforcing successive steps towards a larger behavioural goal.We don't need to exaggerate this history. The behavioural lineage is documented by DBT's own creator and its own training materials.That matters to us because DNA Inc. is fundamentally concerned with what happens when a framework developed around behavioural change is brought into neurodivergent lives and presented as neuroaffirming.And yes, CBT has a behavioural history too. However, we reject the simplistic claim that CBT is literally identical to ABA.It isn't.CBT developed through the integration of cognitive therapy and behaviour therapy, and its theoretical model is considerably broader than operant conditioning alone. The historical literature explicitly describes the merging of behavioural and cognitive approaches into cognitive-behavioural therapy.Aaron Beck's cognitive therapy was specifically concerned with cognition, interpretation, automatic thoughts and cognitive schemas.So DNA Inc. isn't going to pretend that CBT and ABA are interchangeable words.But that distinction does not change our organisational position: We do not endorse CBT in any form as a neuroaffirming framework for neurodivergent people."But this isn't traditional DBT"We know. And we think it is important to acknowledge that fairly.The second edition of Wise's workbook explicitly says that it is not a traditional DBT workbook. It states that conventional DBT resources are not neurodivergent-friendly and deliberately incorporates sensory regulation, meltdown support, capacity, self-advocacy, stimming, accessible mindfulness and communication needs.So we aren't going to pretend that the author simply copied a conventional DBT framework for this workbook, changed the cover and added the word "neurodivergent". That would not be an accurate description of what the book actually claims to do.Our concern is different. We question whether adapting the content and delivery of a DBT-derived framework is sufficient to make that framework genuinely neuroaffirming. For DNA Inc., that is a much bigger question than whether the worksheets are gentler, more accessible or more inclusive.We want to know what assumptions remain underneath them.What is being changed?Why is it being changed?Who decided that it needed changing?Who benefits from the change?What counts as "successful"?And, perhaps most importantly:Whose behaviour is being changed, and for whose benefit? "Adaptive" for whom?This is where our concerns become particularly important. A neurodivergent person experiencing sensory overload may not have an "emotion regulation problem". They may have an environment that is intolerably overwhelming.A person having a meltdown may not need better techniques for suppressing their response. They may need safety, reduced demands, sensory accommodation, communication support, recovery time and an environment that does not repeatedly push their nervous system beyond capacity.A person who communicates differently may not need to become more socially conventional. They may need communication partners who understand them.A person who avoids demands may not simply need better strategies for complying with those demands. The demand itself may need to be examined.A person experiencing distress may not have distorted thinking. Their interpretation of their circumstances may be completely understandable.So one of the questions DNA Inc. asks of any therapeutic framework is: Adaptive for whom?If the person is repeatedly taught how to tolerate an inaccessible, overwhelming or oppressive environment without that environment being examined, we have to ask whether we are supporting the person or simply making the person better able to endure what is harming them.Identifying these matters enormously in neuroaffirming practice. "Does it work?" is not the only questionWe also want to be intellectually honest here. There is emerging evidence that DBT can help some autistic people.For example, a 2024 pragmatic randomised controlled trial included 123 autistic adults with suicidal behaviour. Sixty-three participants received DBT and 60 received treatment "as usual". At the end of treatment, the DBT group had statistically significant reductions in suicidal ideation and suicide attempts compared with treatment as usual. Those effects were no longer statistically significant at the 12-month follow-up, although reductions in depression remained significant.A 2025 randomised controlled trial involving 63 autistic adults experiencing emotional dysregulation and self-harm and/or suicidal behaviour also found improvements in emotional dysregulation, depression and quality of life following DBT, with some improvements maintained at six-month follow-up.A further 2025 study involving 26 autistic adults who completed a five-month standard DBT program found improvements in identified emotions, positive emotions and perceived emotion control, although not all measured emotional outcomes changed.And a 2026 systematic review and meta-analysis of four randomised controlled trials involving 375 autistic participants found statistically significant pooled improvements in emotional regulation and reductions in suicidal ideation and depressive symptoms. However, the authors explicitly cautioned that the evidence base remains limited, heterogeneous and in need of larger, higher-quality trials.So no, DNA Inc. is not going to pretend the evidence says: "DBT never helps autistic people."It doesn't.Some autistic people benefit.Some people strongly dislike it.Some people find individual skills useful.Some people may find the entire framework harmful or invalidating.Those experiences can coexist.And acknowledging evidence that doesn't fit our preferred conclusion is part of being serious about evidence. But efficacy and neuroaffirmation are not the same question. Something can produce a measurable clinical outcome without DNA Inc. considering the underlying framework neuroaffirming."Does it work?" is one question. We also ask:- What is it working to achieve?- How is it achieving it?- What does the person have to change to achieve that outcome?- Who defines the outcome as successful?- What assumptions does the intervention make about normality?- What happens when the person's environment is the actual source of distress?- Does the intervention increase autonomy, or primarily increase adaptation to existing expectations?- Does it help the person understand and advocate for their needs, or teach them to tolerate having those needs unmet?Those are neuroaffirming questions.Someone might say:"But mindfulness is useful."Sure.Someone else might say:"Learning to recognise my emotions helped me."Great.Another person might say:"This therapy helped me communicate a boundary."That's entirely possible. However, skills are not the same thing as frameworks and DNA Inc. does not need to argue that every technique associated with DBT is inherently bad.A useful technique does not require us to endorse the entire theoretical framework from which it originated. Likewise, finding value in one technique does not prove that the framework itself is appropriate for every neurodivergent person. We can acknowledge useful components without endorsing the package.Neuroaffirmation is not just accessibility added to an existing therapy. This is probably the biggest philosophical distinction for us.We don't think neuroaffirmation means:Take an existing therapeutic model - change the language - add sensory regulation - mention stimming - add self-advocacy - make the worksheets prettier and more accessible - call it neuroaffirming.Those changes may be valuable. They may make a resource considerably less harmful or more accessible. But DNA Inc. believes the deeper question is whether the underlying understanding of the person, distress, behaviour, difference, autonomy and change has actually changed.Neuroaffirmation cannot simply mean making a conventional therapeutic framework more comfortable for neurodivergent people. Sometimes the framework itself needs to be questioned.We also reject neurodivergent tokenism and we want to say something else very clearly:- Being Autistic does not automatically make someone right.- Being ADHD does not automatically make someone right.- Being AuDHD does not automatically make someone right.- Being neurodivergent does not automatically make someone right.That includes people we like.It includes people we respect.It includes people with large audiences.It includes people with lived experience.And yes, it includes us.We recognise that Sonny Jane Wise has become an influential voice within neurodivergent communities. We recognise the value of lived experience and the importance of neurodivergent people creating resources for our own communities.But DNA Inc. will not blindly follow information, interventions, organisations or individuals simply because they are Autistic, ADHD or otherwise neurodivergent. That would simply replace one form of authority with another.An Autistic person can have valuable lived experience and still produce something we disagree with.A non-Autistic researcher can produce useful evidence without automatically being right.Neither professional status nor neurodivergent identity is an epistemic trump card.Our standard has to be more demanding than that.- We look at the evidence.- We look at the assumptions.- We look at history.- We look at power.- We look at whose interests are being served.- We listen to lived experience.- We examine limitations.And we ask what the consequences might be.That standard applies to clinicians.It applies to researchers.It applies to advocates.It applies to organisations.It applies to authors.And it applies to Autistic and otherwise neurodivergent people too.Our position is not that neurodivergent people should be prevented from accessing CBT, DBT or any other intervention. Ensuring autonomy is part of being neurodivergent-affirming. People have the right to make their own choices.Someone can choose DBT.Someone can choose CBT.Someone can choose this workbook.Someone can decide that a particular skill works brilliantly for them.We don't need to take that choice away from them.DNA Inc. is not claiming the right to decide what individual neurodivergent people are allowed to do. Our position concerns what DNA Inc. itself endorses, recommends, promotes or describes as neuroaffirming.And our organisational position is clear:We do not endorse CBT.We do not endorse DBT.We do not endorse neurodivergent adaptations or derivatives of CBT or DBT as neuroaffirming frameworks.That does not mean nobody can benefit from them. It means DNA Inc. does not consider benefit alone sufficient reason for us to endorse the framework.So, where does DNA Inc. land on this particular book? We don't consider 'The Neurodivergent Friendly Workbook of DBT Skills' equivalent to a conventional DBT workbook.We acknowledge that it makes a substantial effort to address neurodivergent experiences and that its author is explicitly attempting to move away from rigid, compliance-oriented and neuronormative applications of DBT.We also acknowledge that emerging research provides evidence that DBT can produce beneficial outcomes for some autistic adults.But none of that changes DNA Inc.'s position. We do not endorse DBT-derived interventions as neuroaffirming.We don't believe putting 'neurodivergent-friendly' or 'neurodiversity-affirming' in a title is sufficient to settle the question. We want to know what is underneath the label.We want to know whether the intervention is helping a person become more themselves, or simply becoming better at surviving expectations that were never designed with them in mind.We want to know whether distress is being understood in context rather than automatically located inside the individual.We want to know whether environmental change is considered alongside individual change.We want autonomy, accommodation, communication, sensory needs, relationships, identity and context to matter.And we want neurodivergent people to be able to critically examine resources created by other neurodivergent people without being accused of betraying our own community.We can respect a person without endorsing everything they produce.We can acknowledge evidence without surrendering our values.We can recognise that something helps some people without deciding it is right for everyone.And we can be deeply committed to lived experience without turning lived experience into unquestionable authority.That's the standard DNA Inc. intends to apply.Not:"An Autistic person wrote it, therefore it must be neuroaffirming."Not:"The title says neurodivergent-friendly, therefore it must be neuroaffirming."And not:"Research says it can work, therefore we must endorse it."Instead:- What is the model?- What are its foundations?- What assumptions does it make?- What is being changed?- Why?- For whose benefit?- What does the evidence actually show?- What does lived experience tell us?- What are the limitations?And does the whole thing align with what we mean when we say neuroaffirming?For DNA Inc., those questions matter more than the label on the cover.Want to investigate further?We encourage people to read the evidence themselves rather than simply accepting DNA Inc.'s position, or anyone else's.Importantly, some of the sources below support concerns about DBT's behavioural foundations, while others provide evidence that DBT can be effective for some autistic people. We are including both because cherry-picking only the research that agrees with us would defeat the point.1. Linehan & Wilks (2015)- The history and development of DBT:Linehan, M. M., & Wilks, C. R. (2015). The course and evolution of dialectical behavior therapy. American Journal of Psychotherapy, 69(2), 97-110.This is one of the most important sources for understanding DBT's origins because it comes from DBT's creator. It explicitly states that DBT developed from attempts to apply standard behaviour therapy to highly suicidal individuals and discusses behavioural change procedures including reinforcement and shaping.Read the Linehan & Wilks paper here: https://doi.org/10.1176/appi.psychotherapy.2015.69.2.972. Linehan's own DBT training materials:Linehan's published DBT training materials explicitly discuss:- positive and negative reinforcement;- shaping;- extinction;- punishment;- behavioural consequences; and- reinforcing alternative behaviour.This is useful for anyone wanting to investigate the behavioural mechanisms in DBT rather than relying on descriptions from critics or supporters.Read Linehan's DBT Skills Training materials here: https://www.guilford.com/add/linehan6_old/lin-c-handouts.pdf?t=1&utm3. Linehan's DBT Skills Training Manual:The manual provides particularly direct examples of reinforcement, shaping and extinction. It describes shaping as reinforcing successive steps towards a larger behavioural goal and discusses extinction as reducing behaviour by removing reinforcement.Read Linehan's DBT Skills Training Manual materials here: https://www.guilford.com/add/linehan7_old/lin-p-all-teaching.pdf?t=1&utm4. Huntjens et al. (2024)- DBT and suicidality in autistic adults:Huntjens, A., van den Bosch, W., Sizoo, B., Kerkhof, A., Smit, F., & van der Gaag, M. (2024). The effectiveness and safety of dialectical behavior therapy for suicidal ideation and behavior in autistic adults: A pragmatic randomized controlled trial. Psychological Medicine, 54(10), 2707-2718.Participants: 123 autistic adults- DBT: n = 63- Treatment as usual: n = 60- Six Dutch mental-health centres- Participants aged 18-65- Significant reduction in suicidal ideation at end of treatment: p = .025Significant reduction in suicide attempts at end of treatment: p = .002- Effects on suicidal ideation and attempts were no longer statistically significant at 12 months- Depression improvements remained significant at 12 monthsThis is particularly important because it directly contradicts any simplistic claim that DBT necessarily increases suicidality or is inherently harmful to autistic people.Read more about the studies here: https://pubmed.ncbi.nlm.nih.gov/38606582/?utmRead the full Cambridge University Press article here: https://www.cambridge.org/core/journals/psychological-medicine/article/effectiveness-and-safety-of-dialectical-behavior-therapy-for-suicidal-ideation-and-behavior-in-autistic-adults-a-pragmatic-randomized-controlled-trial/4464CA3C0D3DDEF5F3A4BD45415B9B50?utm5. Bemmouna et al. (2025)- DBT for emotional dysregulation in autistic adults:Bemmouna, D., Rabot, E., Coutelle, R., Lefebvre, F., Weibel, S., & Weiner, L. (2025). Dialectical Behaviour Therapy to Treat Emotion Dysregulation in Autistic Adults without Intellectual Disability: A Randomised Controlled Trial. Psychotherapy and Psychosomatics, 94(4), 247-262.Participants: 63 autistic adultsParticipants had emotional dysregulation and self-harm and/or suicidal behaviour.The study reported significant improvements in emotional dysregulation, depression and quality of life in the DBT group compared with the waiting-list condition.Read more about the study here: https://pubmed.ncbi.nlm.nih.gov/40203811/?utmRead the open-access paper here: https://pmc.ncbi.nlm.nih.gov/articles/PMC12083952/?utm6. Costache et al. (2025)- DBT examined using real-time measures:Costache, M. E., Gioia, F., Vanello, N., et al. (2025). Dialectical behavior therapy in autistic adults: effects on ecological subjective and physiological measures of emotion dysregulation. Borderline Personality Disorder and Emotion Dysregulation, 12, 14.26 autistic adults completed the pre/post assessment.The study used ecological momentary assessment, with participants completing 12 assessments per day for seven days, alongside continuous physiological monitoring.The researchers found increases in identified emotions, positive emotions and emotion control following DBT, although not every emotional or physiological measure changed.Read more about the study here: https://pubmed.ncbi.nlm.nih.gov/40270009/?utmRead the full open-access study here: https://link.springer.com/article/10.1186/s40479-025-00288-1?utm7. Fan et al. (2026)- Systematic review and meta-analysis:Fan, G., Wang, P., Zhang, W., & Chen, X. (2026). Efficacy of dialectical behavior therapy-based interventions for individuals with autism spectrum disorder: A systematic review and meta-analysis. BMC Psychology, 14, 732.This is currently one of the most important sources to know about.The researchers searched six English and Chinese databases and identified 137 records, ultimately including four RCTs involving 375 participants.Compared with control conditions, DBT-based interventions were associated with:- emotional regulation: SMD = −0.89, 95% CI −1.67 to −0.10- suicidal ideation: SMD = −1.97, 95% CI −3.02 to −0.91- depressive symptoms: SMD = −2.23, 95% CI −4.35 to −0.11No significant effect was found for anxiety.Importantly, the authors caution that the evidence is limited by the small number of trials and substantial heterogeneity, and they call for larger, higher-quality RCTs.Read more about the study here: https://pubmed.ncbi.nlm.nih.gov/42104500/?utmRead the full BMC Psychology paper here: https://link.springer.com/article/10.1186/s40359-026-04729-6?utm8. Weiner et al. (2025)- Review of DBT in autism:Weiner, L., Bemmouna, D., Costache, M. E., & Martz, E. (2025). Dialectical Behavior Therapy in Autism. Current Psychiatry Reports, 27(5), 307-318.This review discusses the emerging evidence concerning DBT for autistic people and is useful for understanding where the research currently sits rather than relying exclusively on either DBT advocates or critics.Read more on the study here: https://pubmed.ncbi.nlm.nih.gov/40048080/?utm9. Moore, Larkin & Foley (2024)- Adapting mental-health interventions for autistic adults:Moore, L., Larkin, F., & Foley, S. (2024). Mental Health Professionals' Experiences of Adapting Mental Health Interventions for Autistic Adults: A Systematic Review and Thematic Synthesis. Journal of Autism and Developmental Disorders, 54, 2484-2501.This systematic review examined 13 studies concerning professionals' experiences of adapting mental-health interventions for autistic adults.It is particularly relevant to the broader question of whether adapting an existing therapy for autistic people is straightforward. The review found that adaptation is highly individualised and involves both facilitators and challenges at individual, professional, systemic and service levels.Read the systematic review here: https://link.springer.com/article/10.1007/s10803-023-06006-6?utm10. CBT's historical development:For people interested in the CBT side of the discussion, Rachman's historical review is useful because it describes the development of behaviour therapy and the subsequent infusion of cognitive concepts and procedures that contributed to modern CBT.Rachman, S. (2015). The evolution of behaviour therapy and cognitive behaviour therapy. Behaviour Research and Therapy, 64, 1-8.Read more here: https://pubmed.ncbi.nlm.nih.gov/25462876/?utmFor a history of Beck's cognitive therapy and CBT:Beck, A. T., & Dozois, D. J. A. (2011). Cognitive Therapy- Current Status and Future Directions. Annual Review of Medicine, 62, 397-409.Read the Annual Review article here: https://www.annualreviews.org/content/journals/10.1146/annurev-med-052209-100032?utm11. The workbook itselfAnyone forming an opinion about Wise's book or deciding if they are going to invest time and money in it, should ideally read the author's own description rather than relying on someone else's characterisation.The second edition explicitly states that it:- is not a traditional DBT workbook;- reimagines DBT skills through a neurodiversity-affirming lens;- contains 166 pages of worksheets and information;- addresses sensory regulation;- addresses meltdowns;- addresses capacity;- addresses self-advocacy;- includes stimming;- includes accessible mindfulness;- includes interpersonal effectiveness; and- is written by an Autistic ADHDer.The author also reports more than 100,000 copies sold worldwide.Read the author's description of the second edition or buy it here: https://www.livedexperienceeducator.com/store/p/neurodivergent-friendly-workbook-of-dbt-skills?utm