Feasibility and preliminary efficacy of dialectical behaviour therapy skills groups for veterans with suicidal ideation: pilot
Open accessAbstract
BACKGROUND: Veterans are at high risk for suicide; emotion dysregulation may confer additional risk. Dialectical behaviour therapy (DBT) is a well-supported intervention for suicide attempt reduction in individuals with emotion dysregulation, but is complex and multi-component. The skills group component of DBT (DBT-SG) has been associated with reduced suicidal ideation and emotion dysregulation. DBT-SG for Veterans at risk for suicide has not been studied. AIMS: This study sought to evaluate the feasibility and acceptability of DBT-SG in Veterans and to gather preliminary evidence for its efficacy in reducing suicidal ideation and emotion dysregulation and increasing coping skills. METHOD: Veterans with suicidal ideation and emotion dysregulation (N = 17) enrolled in an uncontrolled pilot study of a 26-week DBT-SG as an adjunct to mental health care-as-usual. RESULTS: Veterans attended an average 66% of DBT-SG sessions. Both Veterans and their primary mental health providers believed DBT-SG promoted Veterans' use of coping skills to reduce suicide risk, and they were satisfied with the treatment. Paired sample t-tests comparing baseline scores with later scores indicated suicidal ideation and emotion dysregulation decreased at post-treatment (d = 1.88, 2.75, respectively) and stayed reduced at 3-month follow-up (d = 2.08, 2.59, respectively). Likewise, skillful coping increased at post-treatment (d = 0.85) and was maintained at follow-up (d = 0.91). CONCLUSIONS: An uncontrolled pilot study indicated DBT-SG was feasible, acceptable, and demonstrated potential efficacy in reducing suicidal ideation and emotion dysregulation among Veterans. A randomized controlled study of DBT-SG with Veterans at risk for suicide is warranted.
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Decker et al. (2019) found that DBT-SG for Veterans with suicidal ideation improved suicidal risk, SI, and sustained improvement at a 3-month follow-up.
“For example, Decker et al. (2019) investigated the application of DBT-SG for Veterans with suicidal ideation and found improvements in suicidal risk, SI, and a sustained improvement at a 3-month follow-up.”
From Can dialectical behavior therapy skills group treat social anxiety disorder? A brief integrative review (2024) · cites this paper as Decker et al., 2019
The Results (Preliminary efficacy; page not provided) report reduced suicidal ideation after DBT-SG, maintained at the 3-month follow-up. They do not establish a separate reduction in suicide risk: the Abstract (Results; page not provided) reports that participants and providers believed the group promoted coping skills to reduce risk. Because this was an uncontrolled pilot, the claim also states the treatment effect more firmly than the paper does. (LLM, conf=0.86)
Experimental — accuracy not yet measuredDBT-SG effectively reduces suicidal behaviors and sustains that improvement over time while addressing comorbid disorders and symptoms.
“DBT-SG effectively reduced suicidal behaviors and sustained that improvement over time while addressing comorbid disorders and symptoms (Sambrook et al., 2007; Soler et al., 2009; Long et al., 2011; Decker et al., 2019).”
From Can dialectical behavior therapy skills group treat social anxiety disorder? A brief integrative review (2024) · cites this paper as Decker et al., 2019
The Results (Preliminary efficacy; page unavailable) report that suicidal ideation and emotion dysregulation decreased after DBT-SG and remained lower at three-month follow-up in veterans with varied diagnoses. They do not show a reduction in suicidal behaviors or improvement in the comorbid disorders themselves. The Conclusions describe potential efficacy from an uncontrolled pilot, so the claim of established effectiveness is stronger than the paper supports. (LLM, conf=0.88)
Experimental — accuracy not yet measuredDBT-SG is effective in addressing comorbid disorders, which may indirectly reduce suicidal behaviors and sustain improvement over time.
“In addition to the potential direct effect of DBG-SG on SI, extant research highlights the effectiveness of DBT-SG in addressing comorbid disorders, which may indirectly reduce suicidal behaviors and sustain improvement over time (Sambrook et al., 2007; Soler et al., 2009; Long et al., 2011; Decker et al., 2019).”
From Can dialectical behavior therapy skills group treat social anxiety disorder? A brief integrative review (2024) · cites this paper as Decker et al., 2019
The Introduction reports prior DBT-SG findings of faster improvement in anxiety and depression, and the Discussion reports that reductions in suicidal ideation and emotion dysregulation in this pilot were maintained at three-month follow-up. But the pilot did not establish that treating comorbid disorders indirectly reduces suicidal behavior; the Discussion explicitly says further study is needed to determine whether reduced emotion dysregulation mediates reduced suicidality. (LLM, conf=0.85)
Experimental — accuracy not yet measuredIn the uncontrolled pilot study, both Veterans and their therapists believed that the DBT skills group promoted Veterans' use of coping skills, and suicidal ideation and emotion dysregulation decreased posttreatment.
“In this study, both Veterans and their therapists believed that the DBT skills group promoted Veterans' use of coping skills, and suicidal ideation and emotion dysregulation decreased posttreatment. 14”
From Dialectical behaviour therapy skills training: A feasibility study with active duty military. (2022) · cites this paper as [14]
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Yaşam Boyu Bakış Açısından Diyalektik Davranış Terapisi
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Dialectical behavior therapy research and program evaluation in the Department of Veterans Affairs
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Dialectical behaviour therapy skills training: A feasibility study with active duty military.
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MethodInfluentialNSSI Among Military Service Members and Veterans
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Evaluation of DBT Skills: Construction and Validation of the DBT-H Scale
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- Authors
- Decker, S. E., Adams, L., Watkins, L. E., Sippel, L. M., Presnall-Shvorin, J., Sofuoglu, M., & Martino, S.
- Affiliations
- Yale University (US)
- VA Connecticut Healthcare System (US)
- Corresponding author
- Decker, Suzanne E.
- ORCID
- Venue
- Behavioural and Cognitive Psychotherapy
- Publisher
- Cambridge University Press (CUP)
- Published
- 2019-03-21
- Volume
- 47
- Issue
- 5
- Pages
- 616-621
- ISSN
- 1352-4658 (ISSN-L)
- 1469-1833
- PMC
- PMC6936751
- OpenAlex
- W2923806064
- Cited by
- 19
- References
- 5
- Citations by year
- 2026: 2 · 2024: 4 · 2023: 5 · 2022: 3 · 2021: 2 · 2020: 3
- FWCI
- 2.33
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Behavioural and Cognitive Psychotherapy (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (VA999999, UL1TR001863)
- National Center for Advancing Translational Sciences
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- dialectical behavior therapy, suicidal ideation, veterans, emotional dysregulation, suicide risk, coping strategies, treatment feasibility, acceptability, adjunctive psychotherapy
- MeSH terms
- Dialectical Behavior Therapy, Adaptation, Psychological, Adolescent, Adult, Aged, Emotions, Feasibility Studies, Female, Humans, Male, Middle Aged, Pilot Projects, Suicide, Attempted, Veterans, Treatment Outcome, Young Adult, Suicidal Ideation
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