Youth at high risk of suicide may be less likely to engage in self-harm following dialectical behavior therapy (DBT) compared with individual and group supportive therapy (IGST) due to improvements in their ability to regulate emotions, suggests a report published yesterday in the Journal of the American Academy of Child & Adolescent Psychiatry. The findings expand on previously reported results indicating the efficacy of DBT for reducing self-harm and suicide attempts in highly suicidal self-harming adolescents.
“These data suggest that DBT may be particularly beneficial for changing behavior to a point where youth refrain from self-harm,” wrote Joan Rosenbaum Asarnow, Ph.D., of the University of California, Los Angeles, and colleagues.
The authors analyzed data from a previous trial of 173 youth aged 12 to 18 years who had elevated past-month suicidal ideation and a history of prior suicide attempts and repeated self-harm episodes. They received either six months of weekly and individual DBT or IGST. Whereas DBT aims to strengthen skills that lead to improved emotion regulation (including sensitivity to emotional stimuli and the ability to regulate negative affective responses), IGST emphasizes acceptance, validation, and feelings of connectedness and belonging, the authors noted.
Participants in the DBT group received weekly individual psychotherapy, multifamily group skills training, youth and parent telephone coaching, and weekly therapist team consultation. Parents were also seen in the first session, and families were offered up to seven additional family sessions. Participants in the IGST group received individual sessions and adolescent supportive group therapy, as-needed parent sessions (up to seven sessions), and weekly therapist team consultation.
The participants were evaluated at baseline, three months, 6 months, 9 months, and 12 months using several measures, including the Suicide Attempt Self-Injury Interview (SASII) and Difficulties in Emotion Regulation Scale (DERS). A total of 84 participants in the DBT group and 80 in the IGST group completed the six-month treatment, and 77 in the DBT group and 69 in the IGST group completed 12-month follow-up.
As previously reported, participants in the DBT group were significantly less likely to self-harm during the treatment and follow-up period. Youth in the DBT group showed greater improvements in emotion regulation during the active treatment and follow-up. The “improvements in emotion regulation at post-treatment significantly predicted greater self-harm remission at 12 months … and mediated the effect of DBT on self-harm remission at 12 months,” the authors added.
“Our results … suggest that improvements in emotion regulation contributed to the DBT effect on self-harm remission, perhaps due to increased DBT-skill use—a healthy safe way to manage painful emotions,” they continued. “These findings support the significance of emotion regulation as a therapeutic target in treatments for self-harming youth and improvements in emotion regulation as a therapeutic change mechanism in DBT.”
For related information, see the American Journal of Psychiatry article “Suicide Attempt Prevention: A Technology-Enhanced Intervention for Treating Suicidal Adolescents After Hospitalization.”
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