Long term effectiveness of dialectical behavior therapy versus enhanced usual care for adolescents with self-harming and suicidal behavior
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BACKGROUND: Knowledge is lacking on the long-term outcomes of treatment for adolescents with repetitive suicidal and self-harming behavior. Furthermore, the pathways through which treatment effects may operate are poorly understood. Our aims were to investigate enduring treatment effects of dialectical behavior therapy adapted for adolescents (DBT-A) compared to enhanced usual care (EUC) through a prospective 3-year follow-up and to analyze possible mediators of treatment effects. METHODS: Interview and self-report data covering the follow-up interval were collected from 92% of the adolescents who participated in the original randomized trial. TRIAL REGISTRATION NUMBER: NCT01593202 (www.ClinicalTrials.gov). RESULTS: At the 3-year follow-up DBT-A remained superior to EUC in reducing the frequency of self-harm, whereas for suicidal ideation, hopelessness and depressive and borderline symptoms and global level of functioning there were no inter-group differences, with no sign of symptom relapse in either of the participant groups. A substantial proportion (70.8%) of the effect of DBT-A on self-harm frequency over the long-term was mediated through a reduction in participants' experience of hopelessness during the trial treatment phase. Receiving more than 3 months follow-up treatment after completion of the trial treatment was associated with further enhanced outcomes in patients who had received DBT-A. CONCLUSIONS: There were on average no between-group differences at the 3-year follow-up in clinical outcomes such as suicidal ideation, hopelessness, depressive and borderline symptoms. The significantly and consistently larger long-term reduction in self-harm behavior for adolescents having received DBT-A compared with enhanced usual care, however, suggests that DBT-A may be a favorable treatment alternative for adolescents with repetitive self-harming behavior.
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DBT-A is an evidence-based treatment for adolescents with emotion dysregulation, especially concerning the reduction of self-harm.
“According to international standards, Dialectical Behavior Therapy for Adolescents (DBT®-A) is an evidence-based treatment for these patients, especially concerning the reduction of self-harm (8–11).”
From Radical Acceptance of Reality: Putting DBT®-A Skill Groups Online During the COVID-19 Pandemic: A Qualitative Study (2022) · cites this paper as [11]
Other studies have found that changes in depression, hopelessness and quality of life measures were sustained at follow-up.
“Other studies have found that changes in depression (e.g. Lynch et al., 2003; Neacsiu et al., 2014; Mehlum et al., 2019), hopelessness (e.g. Mehlum et al., 2019) and quality of life (Carter et al., 2010) measures were sustained at follow-up.”
From Feasibility, Acceptability and Preliminary Efficacy of Dialectical Behavior Therapy for Autistic Adults without Intellectual Disability: A Mixed Methods Study (2022) · cites this paper as Mehlum et al., 2019
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- Authors
- Mehlum, L., Ramleth, R., Tørmoen, A. J., Haga, E., Diep, L. M., Stanley, B. H., Miller, A. L., Larsson, B., Sund, A. M., & Grøholt, B.
- Affiliations
- University of Oslo (NO)
- National Centre for Suicide Research and Prevention Institute of Clinical Medicine University of Oslo Oslo Norway
- Albert Einstein College of Medicine (US)
- Norwegian University of Science and Technology (NO)
- Corresponding author
- Mehlum, Lars
- Venue
- Journal of Child Psychology and Psychiatry
- Publisher
- Wiley
- Published
- 2019-05-25
- Volume
- 60
- Issue
- 10
- Pages
- 1112-1122
- ISSN
- 0021-9630 (ISSN-L)
- 1469-7610
- OpenAlex
- W2946487380
- Cited by
- 144
- References
- 35
- Citations by year
- 2026: 19 · 2025: 20 · 2024: 25 · 2023: 21 · 2022: 22 · 2021: 16 · 2020: 16 · 2019: 5
- FWCI
- 17.23
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- Locations
- Journal of Child Psychology and Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
- Funders
- Norges Forskningsråd (213734)
- Universitetet i Oslo (2006/2/0092)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Keywords
- dialectical behavior therapy, adolescents, self-harm, suicidal behavior, suicidal ideation, hopelessness, long-term treatment outcomes, follow-up treatment, depressive symptoms, borderline symptoms, level of functioning
- MeSH terms
- Dialectical Behavior Therapy, Suicide Prevention, Adolescent, Adolescent Behavior, Female, Follow-Up Studies, Humans, Male, Psychotherapeutic Processes, Self-Injurious Behavior, Outcome Assessment, Health Care, Suicidal Ideation
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