McCauley, E., Berk, M. S., Asarnow, J. R., Adrian, M., Cohen, J., Korslund, K., Avina, C., Hughes, J., Harned, M., Gallop, R., & Linehan, M. M. (2018). Efficacy of Dialectical Behavior Therapy for adolescents at high risk for suicide: A randomized clinical trial. JAMA Psychiatry, 75(8), 777–785. https://doi.org/10.1001/jamapsychiatry.2018.1109

Type of Study: Randomized controlled trial
Number of Participants: 173

Population:

• Age — 12–18 years
• Race/Ethnicity — 56% White
• Gender — 95% Female
• Status — Participants were adolescents with suicidal ideation, history of suicide attempt, and meeting three or more criterions for borderline personality disorder.

Location/Institution: Behavior Research and Therapy Clinic, University of Washington, Seattle; Department of Psychiatry, Seattle Children's Hospital, Seattle, Washington; Los Angeles Biomedical Research Institute at Harbor–University of California Los Angeles Medical Center, Los Angeles; and Ronald Reagan UCLA Medical Center, Los Angeles, California

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare Dialectical Behavior Therapy (DBT) to individual and group supportive therapy (IGST) on adolescents with high risk for suicide. Participants were randomly assigned to DBT or IGST. Measures utilized include the Suicide Attempt Self-Injury Interview. Results indicated that significant advantages were found for DBT on all primary outcomes after treatment. The rates of self-harm decreased through the 1-year follow-up. The advantage of DBT decreased, with no statistically significant between-group differences from 6 to 12 months. The results of this trial support the efficacy of DBT for reducing self-harm and suicide attempts in highly suicidal self-harming adolescents. Limitations include having a primarily female sample, as well as generalizability with routine practice conditions.

Length of controlled postintervention follow-up: 1 year.

Adrian, M., McCauley, E., Berk, M. S., Asarnow, J. R., Korslund, K., Avina, C., Gallop, R., & 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. https://doi.org/10.1111/jcpp.13099

Type of Study: Randomized controlled trial
Number of Participants: 173

Population:

• Age — 12–18 years
• Race/Ethnicity — 56% White
• Gender — 95% Female
• Status — Participants were adolescents with suicidal ideation, history of suicide attempt, and meeting three or more criterions for borderline personality disorder.

Location/Institution: Behavior Research and Therapy Clinic, University of Washington, Seattle; Department of Psychiatry, Seattle Children's Hospital, Seattle, Washington; Los Angeles Biomedical Research Institute at Harbor–University of California Los Angeles Medical Center, Los Angeles; and Ronald Reagan UCLA Medical Center, Los Angeles, California

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as McCauley et al. (2018). The purpose of the study was to examine predictors and moderators of treatment outcomes for suicidal adolescents who participated in Dialectical Behavior Therapy (DBT) and individual and group supportive therapy (IGST). Participants were randomly assigned to DBT or IGST. Measures utilized include the Child Behavior Checklist, Schedule for Affective Disorders and Schizophrenia for School-Aged Children, Drug Use Screening Inventory-Revised, UCLA PTSD Reaction Index for DSM-IV, Brief Symptom Inventory, Difficulties with Emotion Regulation Scale, and the Conflict Behavior Questionare-20. Results indicate that 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. Limitations include few male participants, limitations of assessing externalizing problems, possibility of bias of clinicians and families, and lack of generalizability to adolescents with mild symptomology.

Length of controlled postintervention follow-up: None.

Tebbett-Mock, A. A., Saito, E., McGee, M., Woloszyn, P., & Venuti, M. (2020). Efficacy of Dialectical Behavior Therapy versus treatment as usual for acute-care inpatient adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 59(1), 149–156. https://doi.org/10.1016/j.jaac.2019.01.020

Type of Study: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants: 425

Population:

• Age — 12–17 years
• Race/Ethnicity — Race: 41% White; Ethnicity: 74% Non-Hispanic/Latino
• Gender — 66% Female
• Status — Participants were adolescents hospitalized on acute-care inpatient unit within a private psychiatric hospital.

Location/Institution: Private psychiatric hospital in the Northeast United States

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate Dialectical Behavior Therapy (DBT) versus treatment as usual (TAU) for adolescents on an acute-care psychiatric inpatient unit. Measures utilized include a retrospective chart review for adolescents receiving inpatient DBT and for a historical control group (TAU) treated on the same unit before DBT was completed. Results indicate that patients who received DBT had significantly fewer constant observation (CO) hours for self-injury; incidents of suicide attempts and self-injury; restraints; and days hospitalized compared to patients who received TAU. Statistically significant differences were not found between DBT and TAU groups for number of CO hours for aggression, incidents of aggression toward patients or staff, seclusions, or readmissions. A cost analysis determined that $251,609 less was spent on staff time for CO hours with DBT compared to TAU. Limitations include the nonrandomized nature of the sample, as well as inability to examine other variables due to data being retrieved from an electronic medical record; there was no follow-up data, and it was not possible to capture potential re-admission of participants to other inpatient units at other hospitals; and, there were no assessments of staff-related variables, which could have impacted outcomes.

Length of controlled postintervention follow-up: None.

Tebbett-Mock, A. A., McGee, M., & Saito, E. (2021). Efficacy and sustainability of Dialectical Behaviour Therapy for inpatient adolescents: a follow-up study. General Psychiatry, 34(4) e100452. https://doi.org/10.1136/gpsych-2020-100452

Type of Study: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants: 425

Population:

• Age — 12–17 years
• Race/Ethnicity — Race: 41% White; Ethnicity: 74% Non-Hispanic/Latino
• Gender — 66% Female
• Status — Participants were adolescents hospitalized on acute-care inpatient unit within a private psychiatric hospital.

Location/Institution: Private psychiatric hospital in the Northeast United States

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Tebbett-Mock et al (2020). The purpose of the study is to report the follow-up of a previous study by Tebbett-Mock et al. (2020) and examine the efficacy and sustainability of an adolescent Dialectical Behavior Therapy (DBT) inpatient unit within a psychiatric hospital in the Northeast. Participants were from a retrospective chart review for adolescents receiving inpatient DBT (DBT Group 1, DBT Group 2) and a historical control group (TAU) Results indicate that patients in DBT Group 2 were comparable to DBT Group 1 for the number of constant observation hours for self-injury, restraints and days hospitalized. Patients in DBT Group 2 had a significantly greater number of incidents of suicide attempts compared with DBT Group 1 and of self-injury compared with patients in DBT Group 1. Limitations include the nonrandomized nature of the sample, as well as inability to examine other variables due to data being retrieved from an electronic medical record; there was no follow-up data, and it was not possible to capture potential re-admission of participants to other inpatient units at other hospitals; and there were no assessments of staff-related variables, which could have impacted outcomes.

Length of controlled postintervention follow-up: 1 year.

The following studies were not included in rating Dialectical Behavior Therapy (DBT) on the Scientific Rating Scale...

Burckhardt, R., Manicavasagar, V., Shaw, F., Fogarty, A., Batterham, P. J., Dobinson, K., & Karpin, I. (2018). Preventing mental health symptoms in adolescents using Dialectical Behaviour Therapy skills group: A feasibility study. International Journal of Adolescence and Youth, 23(1), 70–85. https://doi.org/10.1080/02673843.2017.1292927

The purpose of the study was to conduct a feasibility trial that evaluated a prevention program, Dialectical Behavior Therapy (DBT), that teaches cognitive reappraisal, acceptance, and problem-solving strategies to adolescent females. Participants (n=96) were randomly allocated to either DBT skills group or control condition. Measures utilized include Difficulties in Emotion Regulation Scale, Centre for Epidemiologic Studies—Depression Scale Eight Item Version, PROMIS-Anxiety Short Form, and PROMIS-Anger Short Form. Results indicate that there were no statistical differences between the conditions although effect sizes suggested a small advantage favoring the control condition. On the qualitative evaluation, however, most participants reported important benefits in relation to improved emotion regulation abilities. Limitations include lack of generalizability due to participants identifying as female; only a selected portion of DBT skills group material was used in this feasibility study; and a potential for bias due to a qualitative question emphasizing the benefits of the program. Note: This study was not used in the rating of Dialectical Behavior Therapy (DBT) in this topic area due to only part of the group material being used.