Citation

Asarnow JR, Berk M, Bedics J, Adrian M, Gallop R, Cohen J, Korslund K, Hughes J, Avina C, Linehan M, McCauley E. J. Am. Acad. Child Adolesc. Psychiatry 2021; ePub(ePub): ePub.

Copyright

(Copyright © 2021, American Academy of Child Adolescent Psychiatry, Publisher Lippincott Williams and Wilkins)

DOI

10.1016/j.jaac.2021.01.016

PMID

unavailable

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), expanding on previously reported results indicating a DBT advantage at post-treatment 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: 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=0.019) and 12-month study-period (t(498)=2.93, p=.004). Their parents reported using more DBT skills: post-treatment (t(497)=4.12, p<0.001); 12-month follow-up (t(497)=3.71, p<0.001). Mediation analyses predicted to self-harm remission during the 6-12-month follow-up, the pre-specified outcome because this was the 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= 0.045). Youth in DBT reported lower substance misuse, externalizing behavior, and total problems at post-treatment/6-months, and externalizing behavior through 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 youth in DBT achieving self-harm remission during follow-up.

Language: en

Keywords

suicide; self-harm; dialectical behavior therapy; nonsuicidal self-injury