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Dialectical behavior therapy benefits suicidal teens

Dialectical behavior therapy showed advantage over individual and group supportive therapy in the reduction of suicide attempts and self-harm among adolescents at high-risk for suicide, according to findings published in JAMA Psychiatry.

“Research on [dialectical behavior therapy] with adults has demonstrated low dropout and efficacy in reducing suicide attempts and [nonsuicidal self-injury],” Elizabeth McCauley, PhD, Seattle Children’s Research Institute, and the department of psychiatry at University of Washington, and colleagues wrote. “Given its effectiveness with adults, [dialectical behavior therapy] has been used for the treatment of suicidal youths with promising results.”

Researchers conducted a randomized clinical trial to compare the efficacy of dialectical behavior therapy (DBT) vs. individual and group supportive therapy in the reduction of suicide attempts, nonsuicidal self-injury and overall self-harm among 173 high-risk teens aged 12 to 18 years who previously attempted suicide. Follow-up was 1 year. The investigators randomly allocated participants to receive 6 months of DBT (n = 84) or individual and group supportive therapy (n = 80), with weekly psychotherapy, therapist consultation meetings and parent contact.

Patients who received DBT saw significant advantages over individual and group supportive therapy on all primary outcomes after treatment, according to the results. From baseline to 6 months, 9.7% of teens in the DBT group reported suicide attempts while 21.5% of those in the supportive therapy group reported suicide attempts (OR = 0.3; 95% CI, 0.1-0.91). Rates reported between the 6-month and 1-year evaluations were 7% among youth receiving DBT vs. 10.3% among those receiving supportive therapy.

McCauley and colleagues found that rates of self-harm dropped through 1-year follow-up. The results of secondary analyses indicated that DBT resulted in higher rates of self-harm absence. Overall, 46.5% of participants in the DBT group vs. 27.6% of those in the individual and group supportive therapy group showed no self-harm at 6 months, and 51.2% of youth in the DBT group vs. 32.2% of those in the supportive therapy group showed no self-harm at 1 year.

“These cross-study results support DBT as the first well-established, empirically supported treatment for decreasing self-harm in youths at high suicide risk,” McCauley and colleagues wrote. “Our findings add to data supporting other promising treatment approaches, including cognitive-behavioral therapy, mentalization-based therapy and family-based treatments. Ongoing research is needed to advance the goal of reducing suicide deaths.”

Two major limitations of this study were its generalizability and whether DBT was effective for youth with emerging personality disorder traits or just for those with nonsuicidal self-injury, Paul Oliver Wilkinson, MD, MRCPsych, from the department of psychiatry at the University of Cambridge in the U.K., wrote in an accompanying editorial. About 95% of the participants were adolescent girls, so it remains largely unknown whether DBT works for teenaged boys, he wrote.

“Overall, we now have two well-conducted randomized clinical trials demonstrating that DBT is an effective treatment at reducing self-harm in adolescent girls with emerging borderline personality disorder,” Wilkinson concluded. “Investment in training and delivery of DBT is now justified for this important population. Further research is needed on boys and self-harming adolescents without emerging personality disorders and on the cost-effectiveness of DBT.” – by Savannah Demko

Disclosures : McCauley reports grant support from the National Institute of Mental Health. Please see the study for all other authors’ relevant financial disclosures. Wilkinson reports consulting for Lundbeck and Takeda and grant funding from Collaborations for Leadership in Applied Health Research and Care–East of England, National Institute for Health Research, and Cambridgeshire and Peterborough National Health Services Foundation Trust.