Dialectical Behavior Therapy for Suicidal Self-Harming Youth: Emotion Regulation, Mechanisms, and Mediators - 19/08/21
, Michele S. Berk, PhD b, Jamie Bedics, PhD a, c, Molly Adrian, PhD d, Robert Gallop, PhD e, Judith Cohen, MD f, Kathryn Korslund, PhD d, Jennifer Hughes, PhD g, Claudia Avina, PhD a, Marsha M. Linehan, PhD d, Elizabeth McCauley, PhD, ABPP dAbstract |
Objective |
This study evaluated mechanisms, mediation, and secondary/exploratory outcomes in our randomized controlled trial evaluating dialectical behavior therapy (DBT) compared to individual and group supportive therapy (IGST). We expand on previously reported results indicating a DBT advantage at posttreatment on planned suicide/self-harm outcomes, and greater self-harm remission (absence of self-harm, post hoc exploratory outcome) during active-treatment and follow-up periods.
Method |
This was a multi-site randomized trial of 173 adolescents with prior suicide attempts, self-harm, and suicidal ideation. Randomization was to 6 months of DBT or IGST, with outcomes monitored through 12 months. Youth emotion regulation was the primary mechanistic outcome.
Results |
Compared to IGST, greater improvements in youth emotion regulation were found in DBT through the treatment-period [t(498) = 2.36, p = .019] and 12-month study period (t(498) = 2.93, p = .004). Their parents reported using more DBT skills: posttreatment t(497) = 4.12, p < .001); 12-month follow-up t(497) = 3.71, p < .001). Mediation analyses predicted to self-harm remission during the 6- to 12-month follow-up, the prespecified outcome and only suicidality/self-harm variable with a significant DBT effect at follow-up (DBT 49.3%; IGST 29.7%, p = .013). Improvements in youth emotion regulation during treatment mediated the association between DBT and self-harm remission during follow-up (months 6−12, estimate 1.71, CI 1.01−2.87, p = .045). Youths in DBT reported lower substance misuse, externalizing behavior, and total problems at posttreatment/6 months, and externalizing behavior throughout follow-up/12 months.
Conclusion |
Results support the significance of emotion regulation as a treatment target for reducing self-harm, and indicate a DBT advantage on substance misuse, externalizing behavior, and self-harm-remission, with 49.3% of youths in DBT achieving self-harm remission during follow-up.
Clinical trial registration information |
Collaborative Adolescent Research on Emotions and Suicide; www.clinicaltrials.gov/; NCT01528020
Le texte complet de cet article est disponible en PDF.Key words : suicide, self-harm, nonsuicidal self-injury, dialectical behavior therapy
Plan
| This article was reviewed under and accepted by ad hoc editor Lawrence Scahill, MSN, PhD. |
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| This research was supported by grants from the National Institute of Mental Health (NIMH; R01MH090159 and R01MH93898). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. |
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| Dr. Gallop served as the statistical expert for this research. |
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| Author Contributions Conceptualization: Asarnow, Berk, Bedics, Gallop, Cohen, Linehan, McCauley |
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| Data curation: Asarnow, Berk, Bedics, Adrian, Gallop, Korslund, Hughes, Avina, Linehan, McCauley |
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| Formal analysis: Asarnow, Bedics, Gallop |
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| Fundingacquisition: Asarnow, Berk, Gallop, Linehan, McCauley |
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| Investigation: Asarnow, Berk, Bedics, Adrian, Gallop, Cohen, Korslund, Hughes, Avina, Linehan, McCauley |
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| Methodology: Asarnow, Berk, Bedics, Adrian, Gallop, Cohen, Korslund, Hughes, Avina, Linehan, McCauley |
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| Project administration: Asarnow, Berk, Linehan, McCauley |
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| Resources: Cohen, Korslund, Linehan, McCauley |
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| Software: Gallop |
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| Supervision: Asarnow, Berk, Gallop, Cohen, Korslund, Hughes, Avina, Linehan, McCauley |
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| Validation: Berk, Adrian, Gallop, Cohen, Korslund, McCauley |
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| Visualization: Bedics, Gallop |
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| Writing – original draft: Asarnow, Bedics, Gallop, McCauley |
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| Writing – review and editing: Asarnow, Berk, Bedics, Adrian, Gallop, Cohen, Korslund, Hughes, Avina, McCauley |
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| Disclosure: Dr. Asarnow has reported receiving grant support from NIMH, the Substance Abuse and Mental Health Services Administration (SAMHSA), the American Foundation for Suicide Prevention (AFSP), and the American Psychological Foundation. She has reported receiving support from the Association for Child and Adolescent Mental Health, the Society of Clinical Child and Adolescent Psychology, and consulting on quality improvement interventions for depression and suicidal/self-harm behavior. She has served on the Scientific Council for AFSP and the Scientific Advisory Board for the Klingenstein Third Generation Foundation. Dr. Berk has reported receiving grant money from NIMH and AFSP. Dr. Adrian has reported receiving grant money from NIMH and AFSP. She has reported receiving support from the Seattle Children's Hospital Foundation. Dr. Gallop has reported receiving grant money from NIMH and AFSP. Dr. Cohen has reported receiving grant money from NIMH, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and SAMHSA. She has reported receiving royalties from Guilford Press, UpToDate, and the Medical University of South Carolina. Dr. Korslund has reported receiving a salary for her role as Clinical Director of THIRA Health, LLC, a DBT-based partial hospital and intensive outpatient treatment program. She has reported holding shares in MODRE, Inc., which owns THIRA Health, LLC. She has reported receiving consulting fees for DBT and DBT adherence consultation on federally and internationally funded research. She has been a trainer for Behavioral Tech, LLC, a training company providing DBT training for mental health professionals. Dr. Hughes has served as Youth Aware of Mental Health (YAM) trainer, has consulted for Mental Health in Mind International, and has served as a board member for the American Psychological Association (APA) Division 53, Society for Clinical Child and Adolescent Psychology (SCCAP). She has received a stipend for publishing the newsletter as part of her appointed position as the Chair and is current Past-Chair of the Association for Behavioral and Cognitive Therapies (ABCT) Child and Adolescent Depression Special Interest Group (unpaid position). She has reported receiving royalties from Guilford Press. Dr. Avina has reported receiving grant money from NIMH for her role on the study. Dr. Linehan has reported receiving grant money from NIMH and AFSP. She has reported receiving royalties from Guilford Press for books that she has written on dialectical behavior therapy, royalties for training materials from Behavioral Tech LLC, and compensation for dialectical behavior therapy online programs and books. Dr. McCauley has received grant or research support from NIMH, the Institute of Education Sciences - US Department of Education, AFSP, the Scooty Fund, and the University of Washington. She has served as a consultant to King County Public Health—School-Based Mental Health Programs, School Mental Health, Ontario. She has received honoraria for trainings on Behavioral Activation with Adolescents and for school-based mental health providers on a Brief Intervention for School Clinicians (BRISC). She has received book royalties from Guilford Press for Behavioral Activation with Adolescents: A Clinician's Guide and Academic Media Solutions for a psychiatry textbook. She has served on the speakers’ bureau of the University of Washington/Seattle Children's Hospital. Dr. Bedics has reported no biomedical financial interests or potential conflicts of interest. |
Vol 60 - N° 9
P. 1105 - septembre 2021 Retour au numéro
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