Feasibility of comparing DBT with treatment as usual for suicidal & self-injuring adolescents
•Download as PPT, PDF•
2 likes•945 views
By randomly assigning 29 adolescents, who in the previous three months had a suicide attempt or history of self-injury, either uncontrolled treatment or six months of dialectical behaviour therapy (DBT) this research assessed whether DBT was acceptable to New Zealand adolescents, families and clinicians. Presented by Dr. Emily Cooney, Dr. Kirsten Davis, Ms. Pania Thompson, Ms. Julie Wharewera-Mika (all from Kari Centre, ADHB) and Ms. Joanna Stewart (University of Auckland). View this presentation from the 2010 SPINZ World Suicide Prevention Day Forum on YouTube: http://www.youtube.com/watch?v=Ep5TdPGLIJQ
Recommended
More Related Content
What's hot
What's hot (15)
Viewers also liked
Viewers also liked (17)
Similar to Feasibility of comparing DBT with treatment as usual for suicidal & self-injuring adolescents
Similar to Feasibility of comparing DBT with treatment as usual for suicidal & self-injuring adolescents (20)
More from MHF Suicide Prevention
More from MHF Suicide Prevention (20)
Recently uploaded
Recently uploaded (20)
Feasibility of comparing DBT with treatment as usual for suicidal & self-injuring adolescents
- 1. Feasibility of researching Dialectical Behaviour Therapy for suicidal and self-injuring adolescents Emily Cooney, Kirsten Davis, Pania Thompson, Julie Wharewera-Mika & Joanna Stewart
- 2. Why do this study? • Self-harm remains a significant problem for adolescents in our country. Despite several trials focussing on treatment for self-harm, we don’t really know what works for suicidal young people. • Dialectical Behaviour Therapy (DBT) seems effective for adults with chronic suicidality and severe emotional instability (Linehan et al, 1991, 1993, 2006, McMain et al., 2009, Verheul et al., 2003) • Field trials evaluating adaptations of DBT for use with adolescents suggest that DBT shows promise for young people (Goldstein et al., 2007, Katz et al., 2004, Rathus & Miller, 2002).
- 3. But before we can do a big study…. …..we have some big questions
- 4. Feasibility questions ? Is comprehensive DBT acceptable to adolescents, families and clinicians in New Zealand? ? Is random assignment acceptable to suicidal adolescents, their families and treatment services in New Zealand? ? Are our assessments and screens feasible and acceptable? ? Will emotionally vulnerable adolescents tolerate the screening and assessment measures? ? What participant retention rate can we expect?
- 5. Participants Young people (and their families) seen at two government-funded community mental health outpatient services who – were aged between 13 and 18 years* – had self-injured or attempted suicide in the previous 3 months – didn’t meet criteria for a psychotic disorder or life-threatening Anorexia Nervosa – didn’t have an intellectual disability – could speak and read English
- 6. We measured • Self-harm • Suicidal ideation and reasons for living • Substance use • Emotion Regulation • Therapist burnout
- 7. DBT • Multifamily skills groups • Individual therapy • 24/7 phone consultation • Consultation team for therapists • Family sessions and parent sessions as needed
- 8. TAU • Depended on what the team, therapist and family thought would be helpful • Range of therapy approaches, with cognitive-behavioural therapy being the most common treatment • Provided by clinical psychologists, social workers, occupational therapists, and alcohol & drug counsellors
- 9. If needed, participants in both conditions could access: • Medication • Respite care • Hospital
- 10. 50 young people and families had 15 (30%) an orientation meeting declined Screening assessment 2 not eligible 4 discontinued during the 29 completed the pre-treatment assessments assessment TAU = 15 DBT = 14 29
- 11. Ethnicities of participants Other European 3% NZ Māori 3% South African 7% NZ European 77% UK 10%
- 12. Pre-treatment characteristics of DBT and TAU participants Treatment Dialectical Behaviour Treatment as Usual condition Therapy (N=14) (N=15) Gender - female - n (%) 10 (71%) 12 (80%) Age - mean (SD) 16.2 (.98) 15.7 (1.1) # self-harm acts in past 3 months – median (SD) 7.5 (17.6) 4 (10.1) At school - n (%) 9 (64%) 10 (67%) At work - n (%) 1 (7%) 3 (20%) Structured activity - n (%) 10 (71%) 11 (73%) Site - North - n (%) 11 (79%) 14 (93%)
- 13. Kia tupato! While nosing through these results, we can’t draw many conclusions about how the treatments compare • Variable assessment times • Small n • Differences between groups before they began treatment
- 14. Treatment engagement • 1/14 DBT participants dropped out (4/15 TAU participants ‘dropped out’) • The mean percent of sessions missed was 9% of individual sessions, and 12% of group sessions for adolescents in DBT (the mean percent of individual sessions missed was 29% for TAU participants).
- 15. Means and standard deviations of sessions attended and not attended across the 6 months following pre-treatment assessment DBT TAU Treatment condition Mean SD Mean SD Individual sessions attended 22.6 6.4 6.5 4.1 Individual sessions not attended 1.9 1.8 3 3.8 Group sessions attended 20.3 5.3 0 0 Group sessions not attended 2.6 3.1 0 0 Family sessions attended 8 3.1 3.1 3.3 Med reviews attended 2.4 2.2 1.6 2.9 Parent sessions attended 3.9 4.1 0.5 0.7
- 16. Treatment condition Dialectical Behaviour Therapy Percent attempting suicide Treatment as Usual 60% 40% 20% 9/14 9/15 3/14 0/15 2/14 1/15 0% 1 2 3 Assessment period
- 18. Results of focus group with DBT participants • Found DBT valuable and worthwhile • Parents wanted their own support • Treatment ending seemed arbitrary and was too abrupt
- 19. DBT therapists • Adherence ratings comparable to “gold- standard” DBT outcome trials • Therapist burnout scores were within the ‘average’ range before and after treatment • Team support and adherence feedback were critical
- 20. Lessons learned so far • Randomisation is acceptable to families and clinicians. Dual roles of research staff complicate this • Consider risk factors for self-harm when deciding how to randomise • Treatment ending has to be managed very carefully • Contagion is potentially a greater concern than with adults • Consider recruiting outside of services
- 21. Acknowledgements • This study was funded by the New Zealand Ministry of Health • We are very grateful to the following people for their help and support: • staff from Auckland DHB • Dr. Sally Merry • Dr. Sue Crengle • Dr. Alec Miller • Dr. Sarah Fortune • Dr. Jill Rathus • the families who took • the research therapists part in this research (Mike Batcheler, Helen Clack and Ben Te Maro) • Dr. Melanie Harned • Sharon Rickard • Dr. Simon Hatcher • Amy Rosso • Dr. Kathryn Korslund • Dr. Paul Vroegrop • Dr. Marsha Linehan • staff from Waitemata DHB
Editor's Notes
- This report summarises the early findings from the treatment phase of a feasibility study conducted in Auckland, New Zealand. The data from the first three assessments across 6 months (from an ultimate total of seven planned assessments across 18 months) are reported. The study was designed to answer preliminary questions to inform the design and methodology of a larger multi-site randomised controlled trial evaluating the efficacy of Dialectical Behaviour Therapy (DBT) for adolescents and families.
- This report summarises the early findings from the treatment phase of a feasibility study conducted in Auckland, New Zealand. The data from the first three assessments across 6 months (from an ultimate total of seven planned assessments across 18 months) are reported. The study was designed to answer preliminary questions to inform the design and methodology of a larger multi-site randomised controlled trial evaluating the efficacy of Dialectical Behaviour Therapy (DBT) for adolescents and families.
- This report summarises the early findings from the treatment phase of a feasibility study conducted in Auckland, New Zealand. The data from the first three assessments across 6 months (from an ultimate total of seven planned assessments across 18 months) are reported. The study was designed to answer preliminary questions to inform the design and methodology of a larger multi-site randomised controlled trial evaluating the efficacy of Dialectical Behaviour Therapy (DBT) for adolescents and families.
- This report summarises the early findings from the treatment phase of a feasibility study conducted in Auckland, New Zealand. The data from the first three assessments across 6 months (from an ultimate total of seven planned assessments across 18 months) are reported. The study was designed to answer preliminary questions to inform the design and methodology of a larger multi-site randomised controlled trial evaluating the efficacy of Dialectical Behaviour Therapy (DBT) for adolescents and families.
- This report summarises the early findings from the treatment phase of a feasibility study conducted in Auckland, New Zealand. The data from the first three assessments across 6 months (from an ultimate total of seven planned assessments across 18 months) are reported. The study was designed to answer preliminary questions to inform the design and methodology of a larger multi-site randomised controlled trial evaluating the efficacy of Dialectical Behaviour Therapy (DBT) for adolescents and families.
- This report summarises the early findings from the treatment phase of a feasibility study conducted in Auckland, New Zealand. The data from the first three assessments across 6 months (from an ultimate total of seven planned assessments across 18 months) are reported. The study was designed to answer preliminary questions to inform the design and methodology of a larger multi-site randomised controlled trial evaluating the efficacy of Dialectical Behaviour Therapy (DBT) for adolescents and families.
- This report summarises the early findings from the treatment phase of a feasibility study conducted in Auckland, New Zealand. The data from the first three assessments across 6 months (from an ultimate total of seven planned assessments across 18 months) are reported. The study was designed to answer preliminary questions to inform the design and methodology of a larger multi-site randomised controlled trial evaluating the efficacy of Dialectical Behaviour Therapy (DBT) for adolescents and families.
- This report summarises the early findings from the treatment phase of a feasibility study conducted in Auckland, New Zealand. The data from the first three assessments across 6 months (from an ultimate total of seven planned assessments across 18 months) are reported. The study was designed to answer preliminary questions to inform the design and methodology of a larger multi-site randomised controlled trial evaluating the efficacy of Dialectical Behaviour Therapy (DBT) for adolescents and families.
- This report summarises the early findings from the treatment phase of a feasibility study conducted in Auckland, New Zealand. The data from the first three assessments across 6 months (from an ultimate total of seven planned assessments across 18 months) are reported. The study was designed to answer preliminary questions to inform the design and methodology of a larger multi-site randomised controlled trial evaluating the efficacy of Dialectical Behaviour Therapy (DBT) for adolescents and families.
- This report summarises the early findings from the treatment phase of a feasibility study conducted in Auckland, New Zealand. The data from the first three assessments across 6 months (from an ultimate total of seven planned assessments across 18 months) are reported. The study was designed to answer preliminary questions to inform the design and methodology of a larger multi-site randomised controlled trial evaluating the efficacy of Dialectical Behaviour Therapy (DBT) for adolescents and families.
- This report summarises the early findings from the treatment phase of a feasibility study conducted in Auckland, New Zealand. The data from the first three assessments across 6 months (from an ultimate total of seven planned assessments across 18 months) are reported. The study was designed to answer preliminary questions to inform the design and methodology of a larger multi-site randomised controlled trial evaluating the efficacy of Dialectical Behaviour Therapy (DBT) for adolescents and families.
- This report summarises the early findings from the treatment phase of a feasibility study conducted in Auckland, New Zealand. The data from the first three assessments across 6 months (from an ultimate total of seven planned assessments across 18 months) are reported. The study was designed to answer preliminary questions to inform the design and methodology of a larger multi-site randomised controlled trial evaluating the efficacy of Dialectical Behaviour Therapy (DBT) for adolescents and families.
- This report summarises the early findings from the treatment phase of a feasibility study conducted in Auckland, New Zealand. The data from the first three assessments across 6 months (from an ultimate total of seven planned assessments across 18 months) are reported. The study was designed to answer preliminary questions to inform the design and methodology of a larger multi-site randomised controlled trial evaluating the efficacy of Dialectical Behaviour Therapy (DBT) for adolescents and families.
- This report summarises the early findings from the treatment phase of a feasibility study conducted in Auckland, New Zealand. The data from the first three assessments across 6 months (from an ultimate total of seven planned assessments across 18 months) are reported. The study was designed to answer preliminary questions to inform the design and methodology of a larger multi-site randomised controlled trial evaluating the efficacy of Dialectical Behaviour Therapy (DBT) for adolescents and families.
- This report summarises the early findings from the treatment phase of a feasibility study conducted in Auckland, New Zealand. The data from the first three assessments across 6 months (from an ultimate total of seven planned assessments across 18 months) are reported. The study was designed to answer preliminary questions to inform the design and methodology of a larger multi-site randomised controlled trial evaluating the efficacy of Dialectical Behaviour Therapy (DBT) for adolescents and families.
- This report summarises the early findings from the treatment phase of a feasibility study conducted in Auckland, New Zealand. The data from the first three assessments across 6 months (from an ultimate total of seven planned assessments across 18 months) are reported. The study was designed to answer preliminary questions to inform the design and methodology of a larger multi-site randomised controlled trial evaluating the efficacy of Dialectical Behaviour Therapy (DBT) for adolescents and families.
- This report summarises the early findings from the treatment phase of a feasibility study conducted in Auckland, New Zealand. The data from the first three assessments across 6 months (from an ultimate total of seven planned assessments across 18 months) are reported. The study was designed to answer preliminary questions to inform the design and methodology of a larger multi-site randomised controlled trial evaluating the efficacy of Dialectical Behaviour Therapy (DBT) for adolescents and families.
- This report summarises the early findings from the treatment phase of a feasibility study conducted in Auckland, New Zealand. The data from the first three assessments across 6 months (from an ultimate total of seven planned assessments across 18 months) are reported. The study was designed to answer preliminary questions to inform the design and methodology of a larger multi-site randomised controlled trial evaluating the efficacy of Dialectical Behaviour Therapy (DBT) for adolescents and families.
- This report summarises the early findings from the treatment phase of a feasibility study conducted in Auckland, New Zealand. The data from the first three assessments across 6 months (from an ultimate total of seven planned assessments across 18 months) are reported. The study was designed to answer preliminary questions to inform the design and methodology of a larger multi-site randomised controlled trial evaluating the efficacy of Dialectical Behaviour Therapy (DBT) for adolescents and families.
- This report summarises the early findings from the treatment phase of a feasibility study conducted in Auckland, New Zealand. The data from the first three assessments across 6 months (from an ultimate total of seven planned assessments across 18 months) are reported. The study was designed to answer preliminary questions to inform the design and methodology of a larger multi-site randomised controlled trial evaluating the efficacy of Dialectical Behaviour Therapy (DBT) for adolescents and families.
- This report summarises the early findings from the treatment phase of a feasibility study conducted in Auckland, New Zealand. The data from the first three assessments across 6 months (from an ultimate total of seven planned assessments across 18 months) are reported. The study was designed to answer preliminary questions to inform the design and methodology of a larger multi-site randomised controlled trial evaluating the efficacy of Dialectical Behaviour Therapy (DBT) for adolescents and families.