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
Meta-Analysis
. 2021 May;51(7):1057-1067.
doi: 10.1017/S0033291721001355. Epub 2021 Apr 20.

Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis

Oswald D Kothgassner  1 , Andreas Goreis  2   3 , Kealagh Robinson  4 , Mercedes M Huscsava  1 , Christian Schmahl  5 , Paul L Plener  1   6
Affiliations
Meta-Analysis

Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis

Oswald D Kothgassner et al. Psychol Med. 2021 May.

Abstract

Background: Given the widespread nature and clinical consequences of self-harm and suicidal ideation among adolescents, establishing the efficacy of developmentally appropriate treatments that reduce both self-harm and suicidal ideation in the context of broader adolescent psychopathology is critical.

Methods: We conducted a systematic review and meta-analysis of the Dialectical Behaviour Therapy for Adolescents (DBT-A) literature on treating self-injury in adolescents (12-19 years). We searched for eligible trials and treatment evaluations published prior to July 2020 in MEDLINE/PubMed, Scopus, Google Scholar, EMBASE, and the Cochrane Library databases for clinical trials. Twenty-one studies were identified [five randomized-controlled trials (RCTs), three controlled clinical trials (CCTs), and 13 pre-post evaluations]. We extracted data for predefined primary (self-harm, suicidal ideation) and secondary outcomes (borderline personality symptoms; BPD) and calculated treatment effects for RCTs/CCTs and pre-post evaluations. This meta-analysis was pre-registered with OSF: osf.io/v83e7.

Results: Overall, the studies comprised 1673 adolescents. Compared to control groups, DBT-A showed small to moderate effects for reducing self-harm (g = -0.44; 95% CI -0.81 to -0.07) and suicidal ideation (g = -0.31, 95% CI -0.52 to -0.09). Pre-post evaluations suggested large effects for all outcomes (self-harm: g = -0.98, 95% CI -1.15 to -0.81; suicidal ideation: g = -1.16, 95% CI -1.51 to -0.80; BPD symptoms: g = -0.97, 95% CI -1.31 to -0.63).

Conclusions: DBT-A appears to be a valuable treatment in reducing both adolescent self-harm and suicidal ideation. However, evidence that DBT-A reduces BPD symptoms was only found in pre-post evaluations.

Keywords: Adolescence; DBT-A; borderline personality disorder; self-harm; self-injury; suicidal ideation.

PubMed Disclaimer

Conflict of interest statement

None of the authors declare any conflict of interest with regard to this manuscript. Paul Plener has received research funding from the German Federal Institute for Drugs and Medical Devices (BfArM), German Federal Ministry of Education and Research (BMBF), VW-Foundation, Baden-Württemberg Foundation, Lundbeck, and Servier. He received a speaker's honorarium from Shire.

Figures

Fig. 1.
Fig. 1.
PRISMA flowchart showing the screening, exclusion, and inclusion criteria.
Fig. 2.
Fig. 2.
Forest plot of trials comparing the effect of DBT-A and controls on symptoms of self-harm.
Fig. 3.
Fig. 3.
Forest plot of trials comparing the effect of DBT-A and controls on symptoms of suicidal ideation.
See this image and copyright information in PMC

References

    1. Adrian, M., McCauley, E., Berk, M. S., Asarnow, J. R., Korslund, K., Avina, C. & Linehan, M. M. (2019). Predictors and moderators of recurring self-harm in adolescents participating in a comparative treatment trial of psychological interventions. Journal of child psychology and psychiatry, 60(10), 1123–1132. 10.1111/jcpp.13099. - DOI - PMC - PubMed
    1. American Psychiatric Association (2006). American Psychiatric Association practice guidelines for the treatment of psychiatric disorders. Washington DC: American Psychiatric Pub.
    1. Ammerman, B. A., Jacobucci, R., Kleiman, E. M., Uyeji, L. L., & McCloskey, M. S. (2018). The relationship between nonsuicidal self-injury age of onset and severity of self-harm. Suicide Life-Threatening Behavior, 48(1), 31–37. doi:10.1111/sltb.12330. - DOI - PMC - PubMed
    1. *Apsche, J. A., Bass, C. K., & Siv, A. (2006). A treatment study of mode deactivation therapy in an out patient community setting. International Journal of Behavioral Consultation and Therapy, 2(2), 277–285. doi: 10.1037/h0100782. - DOI
    1. Bedics, J. D., Atkins, D. C., Harned, M. S., & Linehan, M. M. (2015). The therapeutic alliance as a predictor of outcome in dialectical behavior therapy versus nonbehavioral psychotherapy by experts for borderline personality disorder. Psychotherapy, 52(1), 67. doi:10.1037/a0038457. - DOI - PubMed

Publication types