Molly Adrian1,2, Elizabeth McCauley1,2, Michele S Berk3, Joan R Asarnow4, Kathryn Korslund5, Claudia Avina6, Robert Gallop7, Marsha M Linehan5. 1. Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA. 2. Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA. 3. Department of Psychiatry and Behavior Sciences, Stanford University, Stanford, CA, USA. 4. David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA. 5. Department of Psychology, University of Washington, Seattle, WA, USA. 6. Department of Mathematics, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, West Carson, CA, USA. 7. West Chester University of Pennsylvania, West Chester, PA, USA.
Abstract
BACKGROUND: In primary analyses, dialectical behavior therapy (DBT) was associated with greater reduction in self-harm during treatment than individual/group supportive therapy (IGST). The objective of this paper was to examine predictors and moderators of treatment outcomes for suicidal adolescents who participated in a randomized controlled trial evaluating DBT and IGST. METHODS:Adolescents (N = 173) were included in the intent-to-treat sample and randomized to receive 6 months of DBT or IGST. Potential baseline predictors and moderators were identified within four categories: demographics, severity markers, parental psychopathology, and psychosocial variables. Primary outcomes were suicide attempts (SA) and nonsuicidal self-injury evaluated at baseline, midtreatment (3 months), and end of treatment (6 months) via the Suicide Attempt and Self-Injury Interview (Psychological Assessment, 18, 2006, 303). For each moderator or predictor, a generalized linear mixed model was conducted to examine main and interactive effects of treatment and the candidate variable on outcomes. RESULTS:Adolescents with higher family conflict, more extensive self-harm histories, and more externalizing problems produced on average more reduction on SH frequency from baseline to post-treatment. Adolescents meeting BPD diagnosis were more likely to have high SH frequency at post-treatment. Analyses indicated significant moderation effects for emotion dysregulation on NSSI and SH. DBT was associated with better rates of improvement compared to IGST for adolescents with higher baseline emotion dysregulation and those whose parents reported greater psychopathology and emotion dysregulation. A significant moderation effect for ethnicity on SA over the treatment period was observed, where DBT produced better rate of improvement compared to IGST for Hispanic/Latino individuals. CONCLUSIONS: These findings may help to inform salient treatment targets and guide treatment planning. Adolescents that have high levels of family conflict, externalizing problems, and increased level of severity markers demonstrated the most change in self-harm behaviors over the course of treatment and benefitted from both treatment interventions. Those with higher levels of emotion dysregulation and parent psychopathology may benefit more from the DBT.
RCT Entities:
BACKGROUND: In primary analyses, dialectical behavior therapy (DBT) was associated with greater reduction in self-harm during treatment than individual/group supportive therapy (IGST). The objective of this paper was to examine predictors and moderators of treatment outcomes for suicidal adolescents who participated in a randomized controlled trial evaluating DBT and IGST. METHODS: Adolescents (N = 173) were included in the intent-to-treat sample and randomized to receive 6 months of DBT or IGST. Potential baseline predictors and moderators were identified within four categories: demographics, severity markers, parental psychopathology, and psychosocial variables. Primary outcomes were suicide attempts (SA) and nonsuicidal self-injury evaluated at baseline, midtreatment (3 months), and end of treatment (6 months) via the Suicide Attempt and Self-Injury Interview (Psychological Assessment, 18, 2006, 303). For each moderator or predictor, a generalized linear mixed model was conducted to examine main and interactive effects of treatment and the candidate variable on outcomes. RESULTS: Adolescents with higher family conflict, more extensive self-harm histories, and more externalizing problems produced on average more reduction on SH frequency from baseline to post-treatment. Adolescents meeting BPD diagnosis were more likely to have high SH frequency at post-treatment. Analyses indicated significant moderation effects for emotion dysregulation on NSSI and SH. DBT was associated with better rates of improvement compared to IGST for adolescents with higher baseline emotion dysregulation and those whose parents reported greater psychopathology and emotion dysregulation. A significant moderation effect for ethnicity on SA over the treatment period was observed, where DBT produced better rate of improvement compared to IGST for Hispanic/Latino individuals. CONCLUSIONS: These findings may help to inform salient treatment targets and guide treatment planning. Adolescents that have high levels of family conflict, externalizing problems, and increased level of severity markers demonstrated the most change in self-harm behaviors over the course of treatment and benefitted from both treatment interventions. Those with higher levels of emotion dysregulation and parent psychopathology may benefit more from the DBT.
Authors: Lars Mehlum; Maria Ramberg; Anita J Tørmoen; Egil Haga; Lien M Diep; Barbara H Stanley; Alec L Miller; Anne M Sund; Berit Grøholt Journal: J Am Acad Child Adolesc Psychiatry Date: 2016-01-27 Impact factor: 8.829
Authors: Elizabeth McCauley; Michele S Berk; Joan R Asarnow; Molly Adrian; Judith Cohen; Kathyrn Korslund; Claudia Avina; Jennifer Hughes; Melanie Harned; Robert Gallop; Marsha M Linehan Journal: JAMA Psychiatry Date: 2018-08-01 Impact factor: 21.596
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Authors: David A Brent; Laurence L Greenhill; Scott Compton; Graham Emslie; Karen Wells; John T Walkup; Benedetto Vitiello; Oscar Bukstein; Barbara Stanley; Kelly Posner; Betsy D Kennard; Mary F Cwik; Ann Wagner; Barbara Coffey; John S March; Mark Riddle; Tina Goldstein; John Curry; Shannon Barnett; Lisa Capasso; Jamie Zelazny; Jennifer Hughes; Sa Shen; S Sonia Gugga; J Blake Turner Journal: J Am Acad Child Adolesc Psychiatry Date: 2009-10 Impact factor: 8.829
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Authors: Katrina G Witt; Sarah E Hetrick; Gowri Rajaram; Philip Hazell; Tatiana L Taylor Salisbury; Ellen Townsend; Keith Hawton Journal: Cochrane Database Syst Rev Date: 2021-03-07