None listed
Conditions
Brief summary
This study looked at the feasibility of conducting a trial of dialectical behaviour therapy (DBT) for suicidal adolescents in New Zealand. We wanted to know whether patients and clinicians would accept random assignment rather than having a choice of treatment, how adolescents would cope with the research assessments, the impact of DBT, and how many participants would stay in treatment, and do the research assessments. Adolescents receiving care from a child & adolescent mental health service aged 13-19 years with a history of self-harm (n=29) were randomly assigned to either DBT or usual care. DBT consisted of weekly individual therapy, weekly multi-family skills training group attended by adolescents and parents/caregivers, after-hours telephone coaching (for teens and caregivers), and family sessions as needed during the 6 month treatment course. Treatment as usual was an eclectic approach variously consisting of case management, individual cognitive-behaviour therapy, narrative family therapy, substance abuse counselling and medication management. Independent evaluators blind to treatment assessed self-harm, substance abuse, and emotional difficulties before, during, and after treatment, and across the following 12-months. Emergency department and hospital admissions were also tracked during treatment and follow-up.
Interventions
The experimental intervention was 6 months of Dialectical Behavior Therapy (DBT). DBT is a cognitive–behavioral treatment originally developed for suicidal adults who meet criteria for Borderline Personality Disorder. DBT targets, in hierarchical order, life-threatening behaviors (e.g., suicide attempts and NSSI), behaviors that interfere with treatment delivery (e.g., noncompliance), and severe quality of life interfering behaviors (e.g. depression, not attending school, substance use). Adapte
The experimental intervention was 6 months of Dialectical Behavior Therapy (DBT). DBT is a cognitive–behavioral treatment originally developed for suicidal adults who meet criteria for Borderline Personality Disorder. DBT targets, in hierarchical order, life-threatening behaviors (e.g., suicide attempts and NSSI), behaviors that interfere with treatment delivery (e.g., noncompliance), and severe quality of life interfering behaviors (e.g. depression, not attending school, substance use). Adapted for adolescents in the current study, DBT consisted of (a) weekly individual psychotherapy (of approximately 1 hour); (b) weekly multi-family skills training (2 hours across a 26 week schedule) attended by adolescents and parents; (c) phone consultation (as needed); (d) family sessions (occurring 1-2 times/month) and (e) weekly therapist consultation team meetings. DBT included the 24-hour rule (a rule which states that patients may not have unscheduled contact with their individual therapist for 24 hours following self-harm), however parents could access the DBT team for phone coaching in such instances. The treatment protocol used an early draft of the 2nd edition of the skills manual, with minor adaptations for adolescents. Individual DBT psychotherapy sessions with adolescents involved a blend of validation and behavior therapy. Sessions usually began with a review of their diary card (a self-monitoring form completed daily which recorded ratings or urges and actions related to therapy targets described above), the collaborative assessment of instances of target behaviors, and problem-solving alternative responses to stressful events, as well as a focus on other problems in the adolescents' life, and the application of DBT skills to these problems. Sessions typically included practicing the application of skills via role play and/or imaginal rehearsal. For both conditions, treatment included risk assessment and management, and access to crisis services, medication, respite and hospital admissions as required.
Sponsors
Emily Cooney
Study design
Allocation
Randomised controlled trial
Primary purpose
Treatment
Masking
Blinded (masking used) (Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
13 Years to 19 Years
Healthy volunteers
No
Inclusion criteria
Adolescents aged 13-19 years with a history of at least one suicide attempt or self-injury in the 3 months prior to the pretreatment assessment, and who are proficient in spoken English. Adolescents aged 19 years provided they are still living at home, can attend group accompanied by an adult who is an ongoing presence in their lives, and are attending some form of secondary education.
Exclusion criteria
Psychotic disorder, intellectual disability, life threatening eating disorder requiring hospital admission for weight restoration
Outcome results
None listed