Dialectical Behavior Therapy for Suicidal Self-Harming Youth: Emotion Regulation, Mechanisms, and Mediators

Joan Rosenbaum Asarnow; Michele S Berk; Jamie Bedics; Molly Adrian; Robert Gallop; Judith Cohen; Kathryn Korslund; Jennifer Hughes; Claudia Avina; Marsha M Linehan; Elizabeth McCauley

doi:10.1016/j.jaac.2021.01.016

Dialectical Behavior Therapy for Suicidal Self-Harming Youth: Emotion Regulation, Mechanisms, and Mediators

J Am Acad Child Adolesc Psychiatry. 2021 Sep;60(9):1105-1115.e4. doi: 10.1016/j.jaac.2021.01.016. Epub 2021 Feb 1.

Authors

Affiliations

¹ University of California, Los Angeles. Electronic address: jasarnow@mednet.ucla.edu.
² Stanford University, California.
³ University of California, Los Angeles; California Lutheran University, Thousand Oaks, California.
⁴ University of Washington, Seattle.
⁵ West Chester University of Pennsylvania, West Chester.
⁶ Drexel University College of Medicine, Philadelphia, Pennsylvania.
⁷ University of Texas Southwestern, Dallas.
⁸ University of California, Los Angeles.

PMID: 33539915
DOI: 10.1016/j.jaac.2021.01.016

Abstract

Objective: This study evaluated mechanisms, mediation, and secondary/exploratory outcomes in our randomized controlled trial evaluating dialectical behavior therapy (DBT) compared to individual and group supportive therapy (IGST). We expand on previously reported results indicating a DBT advantage at posttreatment on planned suicide/self-harm outcomes, and greater self-harm remission (absence of self-harm, post hoc exploratory outcome) during active-treatment and follow-up periods.

Method: This was a multi-site randomized trial of 173 adolescents with prior suicide attempts, self-harm, and suicidal ideation. Randomization was to 6 months of DBT or IGST, with outcomes monitored through 12 months. Youth emotion regulation was the primary mechanistic outcome.

Results: Compared to IGST, greater improvements in youth emotion regulation were found in DBT through the treatment-period [t(498) = 2.36, p = .019] and 12-month study period (t(498) = 2.93, p = .004). Their parents reported using more DBT skills: posttreatment t(497) = 4.12, p < .001); 12-month follow-up t(497) = 3.71, p < .001). Mediation analyses predicted to self-harm remission during the 6- to 12-month follow-up, the prespecified outcome and only suicidality/self-harm variable with a significant DBT effect at follow-up (DBT 49.3%; IGST 29.7%, p = .013). Improvements in youth emotion regulation during treatment mediated the association between DBT and self-harm remission during follow-up (months 6-12, estimate 1.71, CI 1.01-2.87, p = .045). Youths in DBT reported lower substance misuse, externalizing behavior, and total problems at posttreatment/6 months, and externalizing behavior throughout follow-up/12 months.

Conclusion: Results support the significance of emotion regulation as a treatment target for reducing self-harm, and indicate a DBT advantage on substance misuse, externalizing behavior, and self-harm-remission, with 49.3% of youths in DBT achieving self-harm remission during follow-up.

Clinical trial registration information: Collaborative Adolescent Research on Emotions and Suicide; https://www.clinicaltrials.gov/; NCT01528020.

Keywords: dialectical behavior therapy; nonsuicidal self-injury; self-harm; suicide.

Publication types

Randomized Controlled Trial
Research Support, N.I.H., Extramural

MeSH terms

Adolescent
Behavior Therapy
Dialectical Behavior Therapy*
Emotional Regulation*
Humans
Self-Injurious Behavior* / therapy
Suicidal Ideation
Suicide, Attempted
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT01528020

Abstract

Publication types

MeSH terms

Associated data

Grants and funding