How does DBT work differently from other evidence-based practices regarding self-harm and suicidal ideation?
March 2, 2022
Statement of Topic and Research Question
From research and evidence-based practices there are different treatment to help individuals that struggle with suicidal ideation and self-harming behaviors. In many populations individuals may struggles with this, such as teens and young adults. Some of the treatments could be individual therapy or group therapy where Cognitive-Behavior Therapy (CBT) is the main use of treatment. But there is evidence to show that Didactical Behavior Therapy (DBT) helps decrease suicidal ideation and self-harming behaviors. DBT was mainly used to treat women who have Borderline Personality Disorder (BPD) who were at risk of suicide but in recent years it has been modified helped individuals who struggle with suicidal ideation and self-harming behaviors, like teens or young adults (Kothgassner et al., 2021). In DBT, individuals are taught techniques that include awareness of self, mindfulness, and managing emotions. Studies have revealed that DBT can reduce self-harming behaviors, psychiatric symptoms, and hospitalizations (Rosendahl-Santillo et al., 2021). This paper will focus on the differences between other evidence-based practices in comparison of DBT treatment for teens and young adults.
Literature Search Process
In searching for material related to the effectiveness of DBT compared to other treatments for the population between ages 12 to 25 there were some challenges. Most of the search was completed on ProQuest that were journal articles. The main search was for articles related to DBT. This type of treatment led to multiple results, including populations with BPD, depression, autism, and individual with suicidal tendencies. To minimize the search results, I included the terms “DBT,” “self-harm,” and “suicidal ideation.” By using these terms, it helped finding relevant results that included research on teens to young adults who struggle with self-harm and suicidal ideation. When reading over the literature, many of the articles were similar by the results of the studies. This made it difficult to find articles that showed different results but had different study methods. Lastly, many of the articles stated that more research should be done to gain more insight on how DBT treatment is effective for this population.
History of DBT and its effectiveness
In the recent literature meta-analyses of longitudinal studies say about 22.9% of teens/youth have participated in self-harm in the absence of thoughts of suicide and about 4.27 of individuals have greater odds of attempting suicide (Kothgassner et al., 2021). Research on biological and environmental factors have shown that it could have an impact on individual on how they regulate their emotions. When humans have traumatic experiences, they create a way to cope and to regulate their emotions. This would explain why some individuals use self-harming behaviors or might experience suicidal ideation. The types of treatment could be Cognitive-Behavior Therapy (CBT), Didactical Behavior Therapy (DBT), and other evidence-based treatments. Recently, DBT is a source of treatment for individuals who have self-harming behaviors and suicidal ideation. The founder of DBT, Marsha Linehan, originally used the treatment for women with borderline personality disorder (BPD). Some individuals with BPD were suicidal and had emotional dysregulation (Budak et al., 2020). Overtime, DBT has been adapted to help other individuals with emotion regulation and reducing self-harming behaviors or suicidal ideation. DBT interventions use self-reflecting core modules such as “mindfulness, emotional regulation, distress tolerance and interpersonal effectiveness” (Rosendahl-Santillo et al., 2021).
In many articles, DBT is one of the treatments that has been effective for individual who issues with suicidal ideations and self-harming behaviors. Since DBT has been used for adult individuals with BPD, there has been many research studies to provide evidence of effectiveness. In one of the articles, Kothgassner et al. (2021) discussed that the researchers created DBT for adolescents that focused on self-harm and suicidal ideation for the therapeutic intervention through a meta-analysis. They used a randomized controlled treatment and compared it to their adaptive DBT for adolescents. By using the techniques from the DBT intervention they found that there was a “small-to-medium improvement in reducing self-harm compared to control interventions (Kothgassner et al., 2021). The researchers also found that the longer the participants where in the DBT treatment the larger the reduction in their pre to post test of symptoms (Kothgassner et al., 2021).
In another study, researchers found similar results with the effectiveness of DBT interventions. The article “Efficacy of Dialectical Behavior Therapy for Adolescent at High Risk of Suicide: A Randomized Clinical Trial,” the authors discuss the effectiveness of DBT interventions compared to their randomized clinical trials (RCTs). The authors “focused on suicide attempts separately from overall self-harm because of the need to identify treatment that are effective for youths at the highest risk” (Kothgassner et al., 2021). By doing this it made it like compare data between the DBT intervention and the randomized clinical trials with other interventions. After the study, researchers followed up with participants a one year later to evaluate the effectiveness of DBT interventions. The results of the study showed that there was reduction in suicidal ideation and self-harm with DBT interventions. But in this study, there were limitations that should be consider in future studies. For example, the sample population was mostly females. Researchers found that there are higher rates of suicide attempts in females compared to males who are more likely to commit and successfully die by suicide (McCauley et al, 2018). With this information, it will help future studies to focus on getting sample sizes that have more males included in studies.
In many of the articles there is a limitation in the sample size of studies. One of the main limitations is the sample size. Some of the articles have a small sample size and had participants that were dominantly females. This was addressed in the limitations of the article by Rosendahl-Santillo et al., 2021. Also, when researching for articles about DBT studies there were not many articles about adults in DBT interventions. This may be due to DBT was originally created for adult individuals with BPD. BPD was not included in researching the effectiveness of DBT for individuals with suicidal ideation and self-harm.
Another limitation that could have affected results in studies with DBT is the duration of the study and demanding requirements. This was not mentioned in the articles, but in the articles by Kothgassner et al. (2021) and McCauley et al. (2018) discussed dropouts from the study. They did not explain why individuals dropped out of the study. Taking consideration, the length of the studies, some participants may not be able to complete the study due to time restrictions. Future studies should mention the length of the study and the demanding requirements. This may help reduce the number of dropouts from future studies.
Implications for Clinical Practice and Research
There is a connection between DBT and its treatment effects on individuals who have suicidal ideation and/or self-harming behaviors. In many articles there is proof that shows that the DBT technique can help aid individuals who have suicidal ideation and/or self-harming behaviors. This is important for clinicians to have information about because it can be another source of support for these individuals who do not have progress in regular therapy. In DBT interventions there is many techniques that an individual can use as coping skills. Also, DBT has shown to be affective for BPD individuals who have similar symptoms and was specifically created to reduce these types of symptoms. With this there needs to be more research done to obtain information on how these DBT techniques are effective. With this goal in mind, this study will answer the research question: how does DBT work differently from other evidence-based practices regarding self-harm and suicidal ideation?
There is research available that shows evidence of the effectiveness of DBT in adults with BPD and youth who have suicidal ideation or self-harming behavior. This study will collect data that compare the effectiveness of DBT and CBT, or other controlled treatments that are evidenced-based. This will be qualitative approaches will be used in this randomized and cluster-method study.
The participants for this study will be recruited voluntarily. In clinical settings, therapist will be approached to ask clients that they know have a history of suicidal ideation or self-harming behaviors and asked if they would like to participate in a study. The inclusion criteria for this study include: the participants who are the ages in between age 12 to age 25 and parents if under the age of 18, at least 1 suicide attempt, current self-harming behaviors or at least two events in the past 6 months. The exclusion criteria for this study include: no primary problems of psychosis, mania, life-threatening conditions, and substance abuse. Participants will be aware that they will have to sign a consent form, if under the age of 18 parents must give consent as well. Also, participants need to be aware of rules of participating in the whole duration of the study.
Participants will fill out surveys/assessments that would show that they meet criteria for DBT. The types of assessments would be the Behavior Registration Form (BRF), the Short-Term Assessment of Risk and Treatability (START), and others that would assess for depressed mood, suicidal ideation/attempts, and history of self-harm. After assessing participant to see if they meet requirements for the study, participants will be randomly put into two different groups: regular DBT groups or the other evidence-based group that is structured with CBT techniques. Participants would participate in these groups for 3 months and will be evaluated at the beginning, middle, and end of the study.
In the above-mentioned measures for collecting of qualitative data, the researcher will develop a structured interview and evaluation for the collection of the data. Within the interview/evaluation it will include views on self, awareness, reduction in symptoms of depressed mood, suicidal ideation/attempts, and self-harming behavior. The interview will take about 30 to 60 minutes for each interview/evaluation.
The qualitative data collected will be analyzed by reviewing answers regarding in reduction of symptoms. Once analyzed and reviewed, the researcher will share with each participant their progress from the start of the study to the end and give feedback on the information gathered. After this, the researcher will be able to develop a narrative to determine the themes of the study. The qualitative data will be evaluated across statistical analysis and then compared between both groups.
Budak, A. Meltem Üstündağ, et al. “Dialectical Behavioral Therapy from the Lifespan Perspective.” Psikiyatride Guncel Yaklasimlar: Current Approaches in Psychiatry, Vol. 12, no. 2, 2020, pp. 287–298., https://doi.org/http://dx.doi.org/10.18863/pgy.598548.
Kothgassner, Oswald D., et al. “Efficacy of Dialectical Behavior Therapy for Adolescent Self Harm and Suicidal Ideation: A Systematic Review and Meta-Analysis.” Psychological Medicine, 2021, pp. 1–11., https://doi.org/10.1017/s0033291721001355. Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis – ProQuest
McCauley, Elizabeth, et al. “Efficacy of Dialectical Behavior Therapy for Adolescents at High Risk for Suicide.” JAMA Psychiatry, vol. 75, no. 8, 2018, p. 777., https://doi.org/10.1001/jamapsychiatry.2018.1109.
Rosendahl-Santillo, Alexandra, et al. “DBT-Skills System for Cognitively Challenged Individuals with Self-Harm: A Swedish Pilot Study.” International Journal of Developmental Disabilities, 2021, pp. 1–13., https://doi.org/10.1080/20473869.2021.1965825.