In 2019, Molly Adrian and colleagues examined the predictors and moderators of treatment outcomes for suicidal adolescents who participated in a randomized controlled trial evaluating Dialectical Behaviour Therapy (DBT) versus Individual/Group Supportive Therapy (IGST). The study included 173 adolescents in an intent-to-treat sample, who were randomized to receive 6 months of either treatment. The primary outcomes were suicide attempts and non-suicidal self-injury at baseline, mid-treatment, and at the end of the treatment and various cohort demographics, severity markers, parental psychopathologies, and psychosocial variables were considered as potential moderators or predictors of these outcomes.
Aligning with the DBT theory of self-harm, Adrian et al. found that adolescents with higher levels of emotion dysregulation responded better to DBT than IGST. Interestingly, DBT also produced a better rate of improvement for adolescents who identified as Latino/a. Contrary to the researcher’s hypotheses, adolescents who presented with a more severe history of self-harm and co-morbidities did not seem to differentially benefit from DBT compared to IGST. Going forward, the researchers hope that their findings will inform salient treatment targets and guide treatment planning. Specifically, triaging youth with high levels of emotional dysregulation, and those who have parents with psychopathology, to DBT programs, might maximize positive treatment outcomes.
Adrian, M. et al. (2019), Predictors and moderators of recurring self-harm in adolescents participating in a comparative treatment trial of psychological interventions. J. Child Psychol. Psychiatr. doi:10.1111/jcpp.13099
Dialectical Behaviour Therapy (DBT): A multi-component cognitive-behavioural treatment, in which the patient learns to manage difficult emotions by experiencing, recognizing and accepting them. DBT therapies use a balance of acceptance (accepting yourself as you are) and change (making positive changes in your life) techniques. Once the patient has learnt to accept and regulate emotions, they are then more able to change a harmful behaviour, such as self-harming. In general, DBT includes individual psychotherapy, family group skills training, telephone coaching, and therapist team consultations.
Individual/Group Supportive Therapy (IGST): IGST emphasizes acceptance, validation, and feelings of connectedness and belonging. Treatment typically comprises individual and adolescent support group-based therapy sessions, as-needed parent sessions, and weekly therapist team consultations.
This paper forms part of the JCPP Special issue 2019 – Suicide and self-harm: Pathways for Minimizing Suicide & Premature Deaths and Maximizing Hope and Wellbeing.