@article{ref1,
title="Dialectical behavior therapy for suicidal self-harming youths: emotion regulation, mechanisms, and mediators",
journal="Journal of the American Academy of Child and Adolescent Psychiatry",
year="2021",
author="Asarnow, Joan Rosenbaum and Berk, Michele and Bedics, Jamie and Adrian, Molly and Gallop, Robert and Cohen, Judith and Korslund, Kathryn and Hughes, Jennifer and Avina, Claudia and Linehan, Marsha and McCauley, Elizabeth",
volume="ePub",
number="ePub",
pages="ePub-ePub",
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. <br><br>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. <br><br>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. <br><br>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.<p /> <p>Language: en</p>",
language="en",
issn="0890-8567",
doi="10.1016/j.jaac.2021.01.016",
url="http://dx.doi.org/10.1016/j.jaac.2021.01.016"
}