Evidence-Based Reviews

Adapting dialectical behavior therapy to help suicidal adolescents

Current Psychiatry. 2011 March;10(3):18-34

References

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4. Katz LY, Kozyrskyi AL, Prior HJ, et al. Effect of regulatory warnings on antidepressant prescription rates, use of health services and outcomes among children, adolescents and young adults. CMAJ. 2008;178:1005-1011.

5. Brent DA, Kolko DJ, Wartella ME, et al. Adolescent psychiatric inpatients’ risk of suicide attempt at 6-month follow-up. J Am Acad Child Adolesc Psychiatry. 1993;32:95-105.

6. Pfeffer CR, Klerman GL, Hurt SW, et al. Suicidal children grow up: rates and psychosocial risk factors for suicide attempts during follow-up. J Am Acad Child Adolesc Psychiatry. 1993;32:106-113.

7. Granboulan V, Roudot-Thoraval F, Lemerle S, et al. Predictive factors of post-discharge follow-up care among adolescent suicide attempters. Acta Psychiatr Scand. 2001;104:31-36.

8. Miller A, Rathus JH, Linehan MM. Dialectical behavior therapy with suicidal adolescents. New York NY: The Guilford Press; 2007.

9. Lynch TR, Trost WT, Salsman N, et al. Dialectical behavior therapy for borderline personality disorder. In: Nolen-Hoeksema S, Cannon TD, Widiger T, eds. Annual review of clinical psychology. Vol 3. Palo Alto, CA: Annual Reviews; 2007:181-205.

10. Rathus JH, Miller AL. Dialectical behavior therapy adapted for suicidal adolescents. Suicide Life Threat Behav. 2002;32(2):146-157.

11. Woodberry KA, Popenoe EJ. Implementing dialectical behavior therapy with adolescents and their families in a community outpatient clinic. Cogn Behav Pract. 2008;15:277-286.

12. James AC, Taylor A, Winmill L, et al. A preliminary community study of dialectical behaviour therapy (DBT) with adolescent females demonstrating persistent, deliberate self-harm (DSH). Child Adolesc Ment Health. 2008;13:148-152.

13. Katz LY, Cox BJ, Gunasekara S, et al. Feasibility of dialectical behavior therapy for suicidal adolescents inpatients. J Am Acad Child Adolesc Psychiatry. 2004;45:276-282.

14. Sunseri PA. Preliminary outcomes on the use of dialectical behavior therapy to reduce hospitalization among adolescents in residential care. Resid Treat Child Youth. 2004;21:59-76.

15. Trupin EW, Stewart DG, Beach B, et al. Effectiveness of a dialectical behaviour therapy program for incarcerated female juvenile offenders. Child Adolesc Ment Health. 2002;7:121-127.

16. Linehan MM. Validation and psychotherapy. In: Bohart AC Greenberg LS, eds. Empathy reconsidered: new directions in psychotherapy. Washington, DC: American Psychological Association; 1997:353-392.

17. Linehan MM, Armstrong HE, Suarez A, et al. Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Arch Gen Psychiatry. 1991;48:1060-1064.

18. Trautman PD, Stewart N, Morishima A. Are adolescent suicide attempters noncompliant with outpatient care? J Am Acad Child Adolesc Psychiatry. 1993;32:89-94.

Consultation team meetings. The consultation team meets weekly to increase therapists’ capabilities and motivation.

Therapists who treat suicidal adolescents often have a high degree of burnout, which leads to ineffective treatment and/or quitting.⁸ The team provides support, engages in problem-solving, and helps therapists adhere to the treatment model to improve effectiveness. Clinicians interested in participating a consultation team may review http://behavioraltech.org/resources/crd.cfm for a directory of existing DBT programs. Those interested in starting a consultation team may explore training programs such as those offered at www.behavioraltech.org.

Related Resources

Clinical Point

Weekly consultation team meetings help clinicians adhere to the DBT treatment model and avoid burnout

Lynch TR, Trost WT, Salsman N, et al. Dialectical behavior therapy for borderline personality disorder. Annu Rev Clin Psychol. 2007; 3: 181-205.
Miller A, Rathus JH, Linehan MM. Dialectical behavior therapy with suicidal adolescents. New York, NY: The Guilford Press; 2007.
Rathus JH, Miller AL. Dialectical behavior therapy adapted for suicidal adolescents. Suicide Life Threat Behav. 2002; 32(2): 146-157.

Disclosure

The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.

DBT for nonsuicidal self-injury: A ‘middle path’ example

Many adolescents who receive dialectical behavior therapy (DBT) find that nonsuicidal self-injury (NSSI) leads to physiological, affective, and/or cognitive relief from suffering. Research indicates that persons who engage in NSSI have significant improvement in mood and reductions in dissociation after NSSI^a and significantly higher analgesic response to pain than healthy controls.^b The antithesis of this is that NSSI causes long-term suffering by, for example, alienating friends and family.^c

One resolves this dialectical tension—ie, the validity in 2 opposing truths—by seeking a synthesis that maintains the truth in both sides and looks for what is being left out from both. In this case the DBT therapist must accept that NSSI provides benefits and validate the adolescent’s attempts to ease his or her emotional suffering. The therapist and patient also must recognize the harm and exacerbation of suffering that results from NSSI. The therapist and adolescent work to create a “middle path” to replace the NSSI with more skillful means that provide short-term relief, don’t exacerbate long-term suffering, and help the adolescent reach goals.

References

a. Kemperman I, Russ M, Shearin E. Self-injurious behavior and mood regulation in borderline patients. J Pers Disord. 1997; 11: 146-157.

b. Bohus M, Limberger M, Ebner U, et al. Pain perception during self-reported distress and calmness in patients with borderline personality disorder and self-mutilating behavior. Psychiatry Res. 2000; 95: 251-260.

c. Klonsky E, Oltmanns T, Turkheimer E. Deliberate self-harm in a nonclinical population: prevalence and psychological correlates. Am J Psychiatry. 2003; 160: 1501-1508.