# DBT Reduces Risk in Suicidal Youth



## David Baxter PhD (Jun 27, 2018)

*Therapy Reduces Risk in Suicidal Youth*
_NIMH_
June 27, 2018

*Clinical trial shows dialectical behavior therapy effectiveness of DBT*

                         Preventing suicide has proven to be a difficult public  health challenge. The suicide rate has climbed in recent years across  age groups. In adolescents, suicide is the second leading cause of death.  For every young person who dies by suicide, many more have suicidal  thoughts, attempt suicide, or deliberately injure themselves without  intending suicide.

To date, there have not been any research-validated  treatments for preventing suicide among youth. And research has found  that it’s hard to get adolescents with suicidal thoughts to start and  stay with existing treatments.

Researchers at the University of Washington, Seattle  Children’s Research Institute, and collaborators at the Los Angeles  Biomedical Research Institute at Harbor- University of California, Los  Angeles (UCLA) Medical Center, and the David Geffen School of Medicine  at UCLA are addressing the treatment void for adolescents. A recent  clinical trial of a psychotherapy called dialectical behavior therapy  (DBT) — which has been shown to be effective in reducing suicide-related  behavior in adults — showed that DBT can also reduce suicide attempts and  suicidal behavior in adolescents.

“We have a real need for more evidence-based interventions  to help suicidal youth,” said Jane Pearson, Ph.D., chair of the Suicide  Research Consortium in NIMH’s Division of Services and Intervention  Research. “This study is significant because it reinforces previous DBT  studies with adolescents. DBT shows clear promise for helping at-risk  youth develop skills that will set them on a “life preserving” path.”  

For this study, Elizabeth McCauley, Ph.D.,  and colleagues enrolled youth ages 12-18 who were at risk for suicide.  The adolescents entering the study had attempted suicide at least once,  had a history of repeated self-injury, and had trouble with emotional  control — for example, unstable, intense, and often negative moods. Youth  entering the trial were randomly assigned to either DBT or a comparison  treatment, individual and group-supported therapy (IGST).

             By the end of the first six months of the trial, suicide  attempts and non-suicidal self-injury (NSSI) were significantly less  likely in youth receiving DBT than those receiving IGST. Self-harm,  which combines both suicide attempts and NSSI, was about a third as  likely in DBT recipients compared with those in IGST. Of 65 youth  randomly assigned to IGST who completed the end of treatment assessment,  9 had one suicide attempt and 5 had two or more; out of 72 assigned to  DBT, 6 had one suicide attempt and 1 had two or more.

Twelve months after the trial began, rates of self-harm  had declined in both groups; the rate was still lower in the DBT group,  but the difference was not great enough — given the number of participants  in the trial — to be statistically significant. Nonetheless, the benefit  seen in the first months potentially saved lives; the authors point out  that clinical trials of greater size or length may demonstrate a more  sustained advantage to DBT and may assess whether altering components of  the therapy could increase its effectiveness.

             Another finding of the study was that youth receiving DBT  attended more treatment sessions and were more likely to complete DBT  treatment (attend at least 24 individual sessions) than youth receiving  IGST. The greater success in this respect of DBT may have been an  element in the difference in treatment effectiveness relative to IGST.

DBT was developed by Marsha Linehan, Ph.D., senior author  on this report, for treatment of people who are suicidal and have  symptoms of borderline personality disorder,  which is marked by a pattern of unstable moods, self-image, and  behavior. The risk of suicide among those with borderline personality  disorder is high; recurrent suicidal behavior is among the diagnostic  criteria for the disorder. Among the essential elements of DBT are  skills training aimed at helping a person regulate emotions, for  example, their reactions to stresses; and developing coping strategies  to deal with life challenges, including social interactions and  relationships with friends and family. The therapy includes individual  psychotherapy, multi-family group skills training, youth and parent  telephone coaching, and weekly therapist team coaching.

Comparing DBT with another therapy that has some of the  general elements common to psychotherapy provides an opportunity to  evaluate the effectiveness of the specific components that set DBT apart  from other therapies. Comparing DBT with no treatment or treatment as  usual would not offer the same insight into the elements that contribute  to effectiveness.

The paper reporting this study is online June 20 in _JAMA Psychiatry_.
*Reference*

             McCauley E et al. Efficacy of dialectical behavior therapy for adolescents at high risk for suicide: a randomized clinical trial. JAMA Psychiatry. 2018 June 20. doi: 10.1001/jamapsychiatry.2018.1109. [Epub ahead of print]


----------

