Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis

Abstract

Background Given the widespread nature and clinical consequences of self-harm and suicidal ideation among adolescents, establishing the efficacy of developmentally appropriate treatments that reduce both self-harm and suicidal ideation in the context of broader adolescent psychopathology is critical. Methods We conducted a systematic review and meta-analysis of the Dialectical Behaviour Therapy for Adolescents (DBT-A) literature on treating self-injury in adolescents (12–19 years). We searched for eligible trials and treatment evaluations published prior to July 2020 in MEDLINE/PubMed, Scopus, Google Scholar, EMBASE, and the Cochrane Library databases for clinical trials. Twenty-one studies were identified [five randomized-controlled trials (RCTs), three controlled clinical trials (CCTs), and 13 pre-post evaluations]. We extracted data for predefined primary (self-harm, suicidal ideation) and secondary outcomes (borderline personality symptoms; BPD) and calculated treatment effects for RCTs/CCTs and pre-post evaluations. This meta-analysis was pre-registered with OSF: osf.io/v83e7. Results Overall, the studies comprised 1673 adolescents. Compared to control groups, DBT-A showed small to moderate effects for reducing self-harm (g = −0.44; 95% CI −0.81 to −0.07) and suicidal ideation (g = −0.31, 95% CI −0.52 to −0.09). Pre-post evaluations suggested large effects for all outcomes (self-harm: g = −0.98, 95% CI −1.15 to −0.81; suicidal ideation: g = −1.16, 95% CI −1.51 to −0.80; BPD symptoms: g = −0.97, 95% CI −1.31 to −0.63). Conclusions DBT-A appears to be a valuable treatment in reducing both adolescent self-harm and suicidal ideation. However, evidence that DBT-A reduces BPD symptoms was only found in pre-post evaluations.

High Rates of Anxiety Among Adolescents in a Partial Hospitalization Program

“…The common deficits associated with both anxiety and depression, including difficulty regulating affect, tolerating distress, and controlling behavior, could be treated with evidence based, transdiagnostic interventions (e.g., Chu et al, 2016 ; Ehrenreich-May et al, 2017 ). Moreover, directly targeting anxiety using CBT for anxiety disorders has been shown to decrease the rate of reported suicidal ideation in clinical settings (Brown et al, 2018 ), and DBT has a growing evidence base for decreasing suicidal ideation and behaviors in adolescents (for a systematic review, see Kothgassner et al, 2021 ).…”

How early can an upcoming critical transition be detected?

“…The only study which proposes using EWSs within a change-point framework is Carpenter et al ., [24] who implement an online change-point analysis (called Quickest Detection) by detecting the statistical signatures of CSD. The Quickest Detection method calculates the likelihood ratio for each data point and the ratio is updated as each data point becomes available, this is known as the Shiryaev–Roberts (SR) Procedure [25, 26]. To be implemented it requires the users to specify two probability distributions which describe the data pre- and post-critical transition, as well as specifying the detection threshold [27].…”

A clinical follow-up study of dialectical behavior therapy skills groups among female adolescents diagnosed with depressive disorder

“…The approach also helps them to report more positive interactions with their parents and strengthens their general sense of well-being (Neece, 2014; Neece et al, 2013; Pardo et al, 2020). Although DBT was designed for adults in the beginning, DBT-A has been shown to be a particularly competent therapeutic approach for adolescents with a tendency toward self-harm (Chugani et al, 2021; Fleischhaker et al, 2011; Kothgassner et al, 2021; Ratnaweera et al, 2021).…”