New study examines dialectical behavior therapy for reducing suicide attempts

A new study published in JAMA Psychiatry, investigates the effectiveness of dialectical behavior therapy for reducing suicide attempts.

DBT consists of individual therapy, group skills training, between-session telephone coaching and a therapist consultation team.

A multicomponent therapy, Dialectical Behavior Therapy (DBT) is targeted at individuals who are considered to be at high risk for suicide or for people with difficulty regulating emotions who have multiple severe mental disorders.

DBT consists of individual therapy, group skills training, between-session telephone coaching and a therapist consultation team.

The skills training group component is run like a class and involves homework. The homework is for patients to practice using the behavioral skills they are taught in class in their everyday lives. The four main behavioral skills are:

• Mindfulness - being fully aware and present in the moment
• Distress tolerance - how to tolerate pain and difficult situations
• Interpersonal effectiveness - being assertive while maintaining self-respect and relationships with others
• Emotion regulation - how to change problematic emotions.

Below is a video explaining DBT from Dr. Marsha Linehan of the Lineman Institute in Seattle, WA, a developer of the cognitive behavioral treatment.

How effective is the training component of DBT?

The researchers behind the new study were particularly interested in examining how effective the training component of DBT is. To do so, they compared three treatment groups:

• Skills training plus case management to replace individual therapy (DBT-S)
• DBT individual therapy plus activities group to replace skills training so therapists instead focused on the skills patients already had (DBT-I)
• Standard DBT, which included skills training and individual therapy.

The 99 female participants in the study all had borderline personality disorder and had made either at least two suicide attempts or nonsuicidal self-injury (NSSI) acts in the last 5 years, an NSSI act or suicide attempt in the 8 weeks prior to screening and a suicide attempt in the past year. The participants had an average age of 30.

The subjects were evenly randomized into groups that received either DBT, DBT-S or DBT-I.

The researchers predicted that standard DBT would be significantly better than DBT-S and DBT-I at reducing suicide attempts, NSSI episodes, depression, anxiety and inpatient and emergency department admissions. The researchers were not sure what the difference in effectiveness between DBT-S and DBT-I might be.

However, the study found that all three treatment types reduced suicide attempts, suicide ideation, severity of self-injury and use of crisis services, while also improving reasons for living.

"Contrary to our expectations," conclude the authors, "standard DBT was not superior to either comparison condition for any suicide-related outcome, and no significant differences were detected between DBT-S and DBT-I. 

Thus, all three versions of DBT were comparably effective at reducing suicidality among individuals at high risk for suicide. [...] More research is needed before strong conclusions can be made as to what is the best DBT intervention for highly suicidal individuals."

References:

1.  Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: a randomized clinical trial and component analysis, Marsha M. Linehan, et al., JAMA Psych, doi: 10.1001/jamapsychiatry.2014.3039, published online 25 March 2015,abstract.
2.  JAMA news release, accessed 24 March 2015.
3.  Additional source: The Lineman Institute Behavioral Tech, What is DBT?, accessed 24 March 2015.