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. 2024 Jun 14;24(1):447.
doi: 10.1186/s12888-024-05876-z.

Evaluation of dialectical behavior therapy for adolescents in routine clinical practice: a pre-post study

Anne Mari Syversen  1 , Viktor Schønning  2 , Gro Sydnes Fjellheim  3 , Irene Elgen  2   4 , Gro Janne Wergeland  2   4
Affiliations

Evaluation of dialectical behavior therapy for adolescents in routine clinical practice: a pre-post study

Anne Mari Syversen et al. BMC Psychiatry. .

Abstract

Background: Self-harm and suicidal ideation are prevalent among adolescents, cause physical and psychosocial disability, and have potentially life-threatening consequences. Dialectical behavioral therapy for Adolescents (DBT-A) is an evidence-based intervention for reducing self-harm. However, few studies have investigated the effectiveness of DBT-A when delivered in routine clinical practice.

Methods: A follow-up cohort study, based on data from a quality assessment register of DBT-A in child and adolescent mental health services including seven outpatient clinics. Inclusion criteria were ongoing or a history of self-harming behavior the last 6 months; current suicidal behavior; at least 3 criteria of DSM-IV Borderline personality disorder (BPD), or at least the self-destruction criterion of DSM-IV BPD, in addition to minimum 2 subthreshold criteria; and fluency in Norwegian. Participants received 20 weeks of DBT-A consisting of multifamily skills training groups and individual therapy sessions. Outcomes from 41 participants included frequency of self-harm, suicide attempts and hospitalizations caused by self-harm or suicide attempts, assessed pre-, during, and post-treatment by self-report and reviews of the patient's medical records. Suicidal ideation, urge to self-harm and perceived feelings of happiness and sadness were assessed by the patients' diary cards at week 1, 5, 10, 15 and 20 of the treatment program.

Results: Participants attended an average of 17.9 (SD = 4.7) individual sessions, 14.7 (SD = 3.4) group-based skills training sessions and 4.6 (SD = 4.1) brief intersession telephone consultations. Moderate to large within-group effect sizes (ES) were found in self-harm from pre-treatment to 1-5 weeks (d = 0.64), 6-10 weeks (d = 0.84), 11-15 weeks (d = 0.99), 16-20 weeks (d = 1.26) and post-treatment (d = 1.68). Nine participants were admitted to hospitalization during DBT-A, whereas five had attempted suicide, but no suicides were completed. No statistically significant changes were found in suicidal ideation, urge to self-harm or perceived feelings of happiness or sadness from pre to post treatment.

Conclusion: The findings of the current study are promising as the participants reported considerably reduced self-harm behavior after DBT-A treatment in a child and adolescent mental health outpatient setting.

Keywords: Adolescents; DBT-A; Emotional dysregulation; Routine clinical practice; Self-harm; Suicidal ideation.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart for the recruitment process of participants in Dialectical Behavioral Therapy for adolescents in an outpatient clinic. Note. n: Number of participants; DBT-A: Dialectical Behavior therapy for Adolescents
Fig. 2
Fig. 2
Frequency of self-harming episodes during DBT-A (N = 41)
See this image and copyright information in PMC

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