TY  - JOUR
PY  - 2021//
TI  - Dialectical behavior therapy for suicidal self-harming youths: emotion regulation, mechanisms, and mediators
JO  - Journal of the American Academy of Child and Adolescent Psychiatry
A1  - Asarnow, Joan Rosenbaum
A1  - Berk, Michele
A1  - Bedics, Jamie
A1  - Adrian, Molly
A1  - Gallop, Robert
A1  - Cohen, Judith
A1  - Korslund, Kathryn
A1  - Hughes, Jennifer
A1  - Avina, Claudia
A1  - Linehan, Marsha
A1  - McCauley, Elizabeth
SP  - ePub
EP  - ePub
VL  - ePub
IS  - ePub
N2  - 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>
LA  - en
SN  - 0890-8567
UR  - http://dx.doi.org/10.1016/j.jaac.2021.01.016
ID  - ref1
ER  -