How effective is dialectical behavior therapy in teens at high risk of suicide?

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A recent study evaluated the efficacy of dialectal behavior therapy is in reducing suicide attempts compared to individual and group supportive therapy.

Between 2007 and 2015, suicide rates among teenagers have hiked up. Identifying effective intervention methods are crucial for decreasing suicide and non-suicidal self-injury (NSSI). However, Ban unwillingness to adhere to treatment plans is a common issue among individuals considering suicide.

It has been seen that therapeutic treatment is a good option to consider when working with youth with histories of self-harm. But which therapeutic treatment is the most effective for these individuals? A recent study published in JAMA Psychiatry compared the effectiveness of dialectical behaviour therapy (DBT) and individual and group supportive therapy (IGST) on reducing suicide attempts.  They conducted the randomized control trial on teenagers between 12 and 18 years of age across the United States.

They recruited a total of 173 participants from 2012 to 2014. Persons with increased thoughts about suicide, one suicide attempt in their lifetime, and repeated self-injury attempts were included.

Dialectal behavior therapy vs. Individual group supportive therapy

Dialectical behavioral therapy includes variables such as group training in skills for multiple families, individual therapy, weekly consultation with the therapist, and telephone support or coaching for parents and youth. The focus was on increasing parent participation in the treatment while also increasing trust between the parent and teens.

IGST focuses on validation, acceptance, feelings of belonging and connectedness. There are also individual and group therapy sessions. Parent participation was in sessions which were collateral. Crisis numbers were provided as were numbers to call therapists on, for everyday coverage.

Over a six-month period, participants were randomly assigned to either dialectal behavior therapy or individual group supportive therapy, and both groups had individual and group therapy, parent meetings as necessary, and consultations with a therapist. The researchers completed assessments before the treatment, at three months, at the end of the treatment, with follow-up at nine months, and at 12 months. Measurements were done to assess suicide attempts, self-harm, and non-suicidal self-injury. The tool used measured the severity and frequency of suicide attempts and non-suicidal self-injury as well as suicidal ideations.

Dialectal behavior therapy was effective in reducing suicide attempts

The results demonstrated that dialectal behavior therapy was effective in reducing suicide attempts among the adolescent population.  This study is the first randomised control trial which demonstrates the effectiveness of DBT to decrease suicide attempts.

The control conditions further demonstrated the effectiveness of this tool. Both the groups undergoing DBT and IGST demonstrated improvements over 12 months. However additional research is necessary to determine clinically significant changes. The youth in the DBT group did attend more treatment sessions than the group in IGST. While parents were involved in both groups, they had a higher involvement in the DBT sessions. This would have perhaps led to better participation in treatment and hence better outcomes.

One study limitation is the largely female sample. While a higher rate of suicide attempts is seen in females, it is also seen that males are more likely to die by suicide. Further research is necessary to test these interventions considering other factors in the risk of suicide.

Written by Sonia Leslie Fernandez, Medical News Writer

Reference: McCauley, E., Berk, M. S., Asarnow, J. R., Adrian, M., Cohen, J., Korslund, K., … & Linehan, M. M. (2018). Efficacy of dialectical behavior therapy for adolescents at high risk for suicide: a randomized clinical trial. JAMA Psychiatry.

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