Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jul;74(7):1071-1091.
doi: 10.1002/jclp.22588. Epub 2018 Feb 19.

A dialectical behavior therapy skills intervention for women with suicidal behaviors in rural Nepal: A single-case experimental design series

Megan K Ramaiya  1   2 , Caitlin McLean  3 , Upasana Regmi  4 , Devika Fiorillo  5 , Clive J Robins  6 , Brandon A Kohrt  2   4   7
Affiliations

A dialectical behavior therapy skills intervention for women with suicidal behaviors in rural Nepal: A single-case experimental design series

Megan K Ramaiya et al. J Clin Psychol. 2018 Jul.

Abstract

Background: Suicide in low- and middle-income countries (LMICs) accounts for 75% of the world's burden of suicide mortality and is the leading single cause of death among Nepali reproductive age women. To advance treatment for suicidal behaviors in LMICs, a single-case experimental design (SCED) was conducted of a culturally adapted Dialectical Behavior Therapy skills intervention for Nepali populations (DBT-N).

Method: Ten Nepali women with histories of suicidality participated in the 10-session intervention. Outcomes of emotion regulation, suicidal ideation, depression, anxiety, resilience, and coping skills use were measured at multiple time points pre-intervention, during, and at follow-up. Qualitative interviewing assessed DBT-N's feasibility and acceptability.

Results: Participants showed improvements in emotion regulation over the course of treatment, which were associated with increased skills use. Rapid, sustained reductions in suicidal ideation and improvements in resilience were observed after DBT-N initiation.

Conclusion: This SCED supports conducting further evaluation of DBT-N through controlled trials with emotion regulation as a target mechanism of action for reducing suicidal behaviors in LMICs.

Keywords: Nepal; dialectical behavior therapy; emotion regulation; global mental health; single-case experimental design; suicidality.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Individual change profiles (standardized scores) Note. All instrument total scores were standardized using Z-transformation to allow for visual comparison across individuals. DERS = Difficulties in emotion regulation scale; BAI = Beck Anxiety Inventory; BDI = Beck Depression Inventory; RES = Resilience Scale; DBT-WCCL = DBT Ways of Coping Checklist, skills use subscale; SI = Suicidal Ideation, Beck Depression Inventory Item #9
Figure 1
Figure 1
Individual change profiles (standardized scores) Note. All instrument total scores were standardized using Z-transformation to allow for visual comparison across individuals. DERS = Difficulties in emotion regulation scale; BAI = Beck Anxiety Inventory; BDI = Beck Depression Inventory; RES = Resilience Scale; DBT-WCCL = DBT Ways of Coping Checklist, skills use subscale; SI = Suicidal Ideation, Beck Depression Inventory Item #9
Figure 1
Figure 1
Individual change profiles (standardized scores) Note. All instrument total scores were standardized using Z-transformation to allow for visual comparison across individuals. DERS = Difficulties in emotion regulation scale; BAI = Beck Anxiety Inventory; BDI = Beck Depression Inventory; RES = Resilience Scale; DBT-WCCL = DBT Ways of Coping Checklist, skills use subscale; SI = Suicidal Ideation, Beck Depression Inventory Item #9
Figure 1
Figure 1
Individual change profiles (standardized scores) Note. All instrument total scores were standardized using Z-transformation to allow for visual comparison across individuals. DERS = Difficulties in emotion regulation scale; BAI = Beck Anxiety Inventory; BDI = Beck Depression Inventory; RES = Resilience Scale; DBT-WCCL = DBT Ways of Coping Checklist, skills use subscale; SI = Suicidal Ideation, Beck Depression Inventory Item #9
Figure 2
Figure 2
Group change profiles (raw scores) *Clinical cut-off scores for caseness validated in Nepal. Beck Depression Inventory (BDI) depression caseness ≥ 20 total score (Kohrt et al., 2002). Beck Anxiety Inventory (BAI) anxiety caseness ≥ 17 total score (Kohrt et al., 2003). Note. DERS = Difficulties in Emotion Regulation Scale; BDI = Beck Depression Inventory; SI = Suicidal Ideation (Beck Depression Inventory Item #9); BAI = Beck Anxiety Inventory; RES = Resilience Scale; DBT-WCCL = DBT Ways of Coping Checklist
See this image and copyright information in PMC

References

    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4 2000.
    1. Barlow DH, Nock MK. Why can’t we be more idiographic in our research? Perspectives on Psychological Science. 2009;4(1):19–21. - PubMed
    1. Barlow DH, Nock M, Hersen M. Single-Case Experimental Designs. 3. Boston, MA: Pearson Education; 2009.
    1. Beckstead DJ, Lambert MJ, DuBose AP, Linehan M. Dialectical behavior therapy with American Indian/Alaska Native adolescents diagnosed with substance use disorders: Combining an evidence based treatment with cultural, traditional, and spiritual beliefs. Addictive Behaviors. 2015;51:84–87. - PubMed
    1. Carter GL, Willcox CH, Lewin TJ, Conrad AM, Bendit N. Hunter DBT project: Randomized controlled trial of dialectical behaviour therapy in women with borderline personality disorder. Australian and New Zealand Journal of Psychiatry. 2010;44(2):162–173. - PubMed

Publication types

LinkOut - more resources