Dialectical behavior therapy reduces suicide attempts in adolescents

A form of behavioral therapy that focuses on enhancing emotion regulation, distress tolerance, and improving quality of life has shown promise in reducing self-harm and suicide attempts in adolescents, according to new research.

In a paper published in JAMA Psychiatry, researchers reported the outcomes of a randomized trial of dialectical behavior therapy (DBT) versus individual and group supportive therapy in 173 adolescents with a history of suicide attempts.

DBT, developed by Marsha Linehan, PhD, as a team-based intervention for chronically suicidal patients with borderline personality disorder, is aimed at getting patients to focus on changing their behaviors so that they are able to meet their long-term goals. The use of DBT with adults has been tied to low dropout rates, and has been effective at reducing suicide attempts and self-harm.

In the study, the DBT consisted of weekly individual psychotherapy, multifamily group skills training, youth and parent telephone coaching, and a weekly therapist team consultation. The control group took part in individual sessions, group therapy, as-needed parent sessions, and a weekly therapist team consultation.

Researchers saw a 70% lower rate of suicide attempts, 68% lower rate of nonsuicidal self-injury, and 67% lower rate of self-harm in the DBT group, compared with the control group at the end of the 6-month treatment course. However, at 12 months, the differences between the two groups were no longer statistically significant.

“This is the first adolescent RCT [randomized, controlled trial] to our knowledge to demonstrate that DBT is effective at decreasing suicide attempts,” Elizabeth A. McCauley, PhD, of the Seattle Children’s Research Institute, and her coauthors.

At 6 months, 46.5% of the DBT group showed an absence of self-harm, compared with 27.6% of the control group. At 12 months, those figures were 51.2% and 32.2% respectively.

Significantly, more participants in the DBT group completed the treatment, compared with those in individual and group supportive therapy (75.6% vs. 55.2%), although this did not appear to be responsible for the difference in outcomes.

“Although results of pattern-mixture models found no evidence of an informative attrition mechanism, we cannot rule out the possibility that differential treatment exposure is a mechanism that leads to the DBT outcomes,” the authors wrote. “Stronger DBT treatment retention is, however, an important finding given prior research that found difficulties with treatment engagement, and adherence among suicidal and self-harming youths.”

Parents were involved in both treatments, but “DBT included greater family involvement,” Dr. McCauley and her coauthors wrote. “This difference may have contributed to both greater retention and treatment effects, particularly because stronger family components are associated with treatment benefits for adolescent self-harm.”

The authors said the fact that both groups improved after 12 months provided support for the individual and group supportive therapy in these patients.

“Our findings add to data supporting other promising treatment approaches, including cognitive-behavioral therapy, mentalization-based therapy, and family-based treatments,” they concluded

The study was supported by the National Institutes of Mental Health. Eight authors declared grant support from NIMH, and two authors declared other funding unrelated to the study.

SOURCE: McCauley EA et al. JAMA Psychiatry. 2018 Jun 20. doi:10.1001/jamapsychiatry.2018.1109.
 

A form of behavioral therapy that focuses on enhancing emotion regulation, distress tolerance, and improving quality of life has shown promise in reducing self-harm and suicide attempts in adolescents, according to new research.

In a paper published in JAMA Psychiatry, researchers reported the outcomes of a randomized trial of dialectical behavior therapy (DBT) versus individual and group supportive therapy in 173 adolescents with a history of suicide attempts.

DBT, developed by Marsha Linehan, PhD, as a team-based intervention for chronically suicidal patients with borderline personality disorder, is aimed at getting patients to focus on changing their behaviors so that they are able to meet their long-term goals. The use of DBT with adults has been tied to low dropout rates, and has been effective at reducing suicide attempts and self-harm.

In the study, the DBT consisted of weekly individual psychotherapy, multifamily group skills training, youth and parent telephone coaching, and a weekly therapist team consultation. The control group took part in individual sessions, group therapy, as-needed parent sessions, and a weekly therapist team consultation.

Researchers saw a 70% lower rate of suicide attempts, 68% lower rate of nonsuicidal self-injury, and 67% lower rate of self-harm in the DBT group, compared with the control group at the end of the 6-month treatment course. However, at 12 months, the differences between the two groups were no longer statistically significant.

“This is the first adolescent RCT [randomized, controlled trial] to our knowledge to demonstrate that DBT is effective at decreasing suicide attempts,” Elizabeth A. McCauley, PhD, of the Seattle Children’s Research Institute, and her coauthors.

At 6 months, 46.5% of the DBT group showed an absence of self-harm, compared with 27.6% of the control group. At 12 months, those figures were 51.2% and 32.2% respectively.

Significantly, more participants in the DBT group completed the treatment, compared with those in individual and group supportive therapy (75.6% vs. 55.2%), although this did not appear to be responsible for the difference in outcomes.

“Although results of pattern-mixture models found no evidence of an informative attrition mechanism, we cannot rule out the possibility that differential treatment exposure is a mechanism that leads to the DBT outcomes,” the authors wrote. “Stronger DBT treatment retention is, however, an important finding given prior research that found difficulties with treatment engagement, and adherence among suicidal and self-harming youths.”

Parents were involved in both treatments, but “DBT included greater family involvement,” Dr. McCauley and her coauthors wrote. “This difference may have contributed to both greater retention and treatment effects, particularly because stronger family components are associated with treatment benefits for adolescent self-harm.”

The authors said the fact that both groups improved after 12 months provided support for the individual and group supportive therapy in these patients.

“Our findings add to data supporting other promising treatment approaches, including cognitive-behavioral therapy, mentalization-based therapy, and family-based treatments,” they concluded

The study was supported by the National Institutes of Mental Health. Eight authors declared grant support from NIMH, and two authors declared other funding unrelated to the study.

SOURCE: McCauley EA et al. JAMA Psychiatry. 2018 Jun 20. doi:10.1001/jamapsychiatry.2018.1109.
 

A form of behavioral therapy that focuses on enhancing emotion regulation, distress tolerance, and improving quality of life has shown promise in reducing self-harm and suicide attempts in adolescents, according to new research.

In a paper published in JAMA Psychiatry, researchers reported the outcomes of a randomized trial of dialectical behavior therapy (DBT) versus individual and group supportive therapy in 173 adolescents with a history of suicide attempts.

DBT, developed by Marsha Linehan, PhD, as a team-based intervention for chronically suicidal patients with borderline personality disorder, is aimed at getting patients to focus on changing their behaviors so that they are able to meet their long-term goals. The use of DBT with adults has been tied to low dropout rates, and has been effective at reducing suicide attempts and self-harm.

In the study, the DBT consisted of weekly individual psychotherapy, multifamily group skills training, youth and parent telephone coaching, and a weekly therapist team consultation. The control group took part in individual sessions, group therapy, as-needed parent sessions, and a weekly therapist team consultation.

Researchers saw a 70% lower rate of suicide attempts, 68% lower rate of nonsuicidal self-injury, and 67% lower rate of self-harm in the DBT group, compared with the control group at the end of the 6-month treatment course. However, at 12 months, the differences between the two groups were no longer statistically significant.

“This is the first adolescent RCT [randomized, controlled trial] to our knowledge to demonstrate that DBT is effective at decreasing suicide attempts,” Elizabeth A. McCauley, PhD, of the Seattle Children’s Research Institute, and her coauthors.

At 6 months, 46.5% of the DBT group showed an absence of self-harm, compared with 27.6% of the control group. At 12 months, those figures were 51.2% and 32.2% respectively.

Significantly, more participants in the DBT group completed the treatment, compared with those in individual and group supportive therapy (75.6% vs. 55.2%), although this did not appear to be responsible for the difference in outcomes.

“Although results of pattern-mixture models found no evidence of an informative attrition mechanism, we cannot rule out the possibility that differential treatment exposure is a mechanism that leads to the DBT outcomes,” the authors wrote. “Stronger DBT treatment retention is, however, an important finding given prior research that found difficulties with treatment engagement, and adherence among suicidal and self-harming youths.”

Parents were involved in both treatments, but “DBT included greater family involvement,” Dr. McCauley and her coauthors wrote. “This difference may have contributed to both greater retention and treatment effects, particularly because stronger family components are associated with treatment benefits for adolescent self-harm.”

The authors said the fact that both groups improved after 12 months provided support for the individual and group supportive therapy in these patients.

“Our findings add to data supporting other promising treatment approaches, including cognitive-behavioral therapy, mentalization-based therapy, and family-based treatments,” they concluded

The study was supported by the National Institutes of Mental Health. Eight authors declared grant support from NIMH, and two authors declared other funding unrelated to the study.

SOURCE: McCauley EA et al. JAMA Psychiatry. 2018 Jun 20. doi:10.1001/jamapsychiatry.2018.1109.