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

Course overview

This course is based upon material published in the Journal of the American Academy of Child and Adolescent Psychiatry and is available as an open-access article. 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)1/4 2.36, p1/4 .019] and 12-month study period (t(498) 1/4 2.93, p1/4 .004). Their parents reported using more DBT skills: posttreatment t(497)1/4 4.12, p less than .001); 12-month follow-up t(497) 1/43.71, p less than .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 percent; IGST 29. 7percent, p 1/4 .013). Improvements in youth emotion regulation during treatment mediated the association between DBT and self-harm remission during follow-up (months 612, estimate 1.71, CI 1.012.87, p1/4 .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 percent of youths in DBT achieving self-harm remission during follow-up. This course on suicidal self-harming youth is designed for social workers, professional counselors, psychologists, nurses, and substance abuse counselors, who do clinical work. In addition, this course is appropriate for beginning, intermediate and advanced level practitioners who wish to develop their knowledge of suicidal self-harming youth. The course material includes a literature review of dialectical behavior therapy may also be useful for licensed clinicians who require continuing clinical education courses for license renewal. The course is based on a journal article that includes research. It contains statistical analysis and data that some clinicians enjoy reading and others do not. A significant benefit of reading research-based articles for continuing education is they provide practitioners with the latest findings in their field. Authors: Asarnow, Berk, Bedics, Adrian, Gallop, Cohen, Korslund, Hughes, Avina, Linehan, McCauley Learning Objectives: This course will provide the practitioner with detailed information regarding suicidal self-harming youth. Specifically, a professional will: Identify effective traits of DBT and how they compare to one another Distinguish between which intervention is most effective in treating suicidal self harming youth, DBT or IGST Explain how emotion regulation can be an effective treatment for reducing self-harm Citation: Asarnow, J. R., Berk, M. S., Bedics, J., Adrian, M., Gallop, R., Cohen, J., ... and McCauley, E. (2021). Dialectical behavior therapy for suicidal self-harming youth: emotion regulation, mechanisms, and mediators. Journal of the American Academy of Child and Adolescent Psychiatry, 60(9), 1105-1115.