For Suicide Prevention Month: Studies Continue to Demonstrate that Full, Comprehensive Dialectical Behavior Therapy (DBT) is Superior in Treating Teens with Suicidality and Self-harm

THERE IS NO QUESTION THAT FULL COMPREHENSIVE DBT IS THE GOLD STANDARD TREATMENT FOR SUICIDE AND SELF HARM FOR ADOLESCENTS AND ADULTS!

In addition to all the Randomly Controlled Trials (RCT’s) showing that DBT is superior to other treatments with Adults over the years, (well over 45 of them) we are now seeing more RCT’s showing the same thing with teens. (see summary and links below) There are all kinds of therapists providing all kinds of therapies out there, including many clinicians who market themselves as DBT therapists who have had partial training and don’t do the treatment with full fidelity to the researched model. “DBT-informed” therapy can be helpful for some people. Adding in some skills to “standard therapy” (or as we call it….”Treatment as Usual”), is not DBT. If you or your loved one is struggling with suicidal or self harm thoughts or behaviors, please educate yourselves on what constitutes adherent DBT to get the best results. I could post all the adherence studies showing that the more adherent the therapist is in providing DBT, the better the outcomes, but I’ll save that for a different post. In honor of National Suicide Prevention Month, stay tuned for more information on a FREE webinar we, at the Florida Borderline Personality Disorder Association are working on that will be held on Friday, Sept. 29th (time to be determined) especially geared to families to help educate them on treatment and strategies to support their suicidal loved-ones. Please feel free to contact me at nancy@tbcforcbt.com for more information.

The Journal of the American Academy of Child & Adolescent Psychiatry published “Dialectical Behavior Therapy for Adolescents With Repeated Suicidal and Self-harming Behavior: A Randomized Trial” in 2014 which is the first RCT (randomized clinical trial) that shows that DBT is superior to “Treatment as Usual” in reducing Suicide Ideation and Self harm.

Results: Treatment retention was generally good in both treatment conditions, and the use of emergency services was low. DBT-A was superior to EUC in reducing self-harm, suicidal ideation, and depressive symptoms. Effect sizes were large for treatment outcomes in patients who received DBT-A, whereas effect sizes were small for outcomes in patients receiving EUC. Total number of treatment contacts was found to be a partial mediator of the association between treatment and changes in the severity of suicidal ideation, whereas no mediation effects were found on the other outcomes or for total treatment time.

In 2018, JAMA published this study, “Efficacy of Dialectical Behavior Therapy for Adolescents at High Risk for Suicide“, which cites a second RCT showing the effectiveness of DBT in treating teens who struggle with suicidality and self harm compared to individual and group supportive therapy.

Question  Is dialectical behavior therapy more effective than individual and group supportive therapy in reducing suicide attempts and nonsuicidal self-injury in suicidal adolescents?

Findings  This multisite randomized clinical trial of 173 adolescents indicated a significant advantage for dialectical behavior therapy compared with individual and group supportive therapy for reducing repeat suicide attempts, nonsuicidal self-injury, and total self-harm after treatment. Although the dialectical behavior therapy advantage weakened over time, secondary analyses indicated that youths receiving dialectical behavior therapy were more likely to respond to treatment, indexed by the absence of any self-harm, after treatment and at 12-month follow-up.

Meaning  Dialectical behavior therapy is effective for reducing repeat suicide attempts among highly suicidal adolescents, underscoring the value of dialectical behavior therapy in suicide prevention initiatives.

2 Days ago, on September 13th, 2023 JAMA published another RCT on Dialectical Behavior Therapy for Adolescents With Bipolar Disorder.

Question  Is dialectical behavior therapy (DBT) effective in treating mood symptoms, states, and suicidal behavior among adolescents with bipolar spectrum disorder?

Findings  In this randomized clinical trial of 100 adolescents with bipolar spectrum disorder, compared with those who received standard of care psychotherapy, youth who received 1 year of DBT had fewer suicide attempts over 1 year. The groups displayed similar improvement in depression and hypomania and mania.

Meaning  These findings support DBT as the first psychosocial intervention with demonstrated effects on suicidal behavior for adolescents with bipolar spectrum disorder.