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Feasibility of comparing DBT with treatment as usual for suicidal & self-injuring adolescents
This document discusses the feasibility of researching dialectical behavior therapy (DBT) for suicidal and self-injuring adolescents in New Zealand, highlighting the need for effective treatments for self-harm. It raises important feasibility questions regarding the acceptability of DBT and random assignment among adolescents and their families, and presents initial engagement data from participants enrolled in the study. The findings suggest the potential for DBT to be a valuable treatment option, although the study is limited by small sample sizes and variable assessment times.
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Feasibility of comparing DBT with treatment as usual for suicidal & self-injuring adolescents
- 1. Feasibility of researching DialecticalBehaviour Therapy for suicidal and self-injuring adolescents Emily Cooney, Kirsten Davis, Pania Thompson, Julie Wharewera-Mika & Joanna Stewart
- 2. Why do thisstudy? • 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 wecan do a big study…. …..we have some big questions
- 4. Feasibility questions ? Iscomprehensive 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 (andtheir 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 onwhat 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, participantsin both conditions could access: • Medication • Respite care • Hospital
- 10. 50 young peopleand 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 ofDBT 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! Whilenosing 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 • 1/14DBT 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 standarddeviations 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 focusgroup with DBT participants • Found DBT valuable and worthwhile • Parents wanted their own support • Treatment ending seemed arbitrary and was too abrupt
- 19. DBT therapists • Adherenceratings 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 sofar • 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 studywas 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
- #2 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.
- #3 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.
- #4 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.
- #5 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.
- #6 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.
- #7 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.
- #8 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.
- #9 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.
- #10 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.
- #11 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.
- #12 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.
- #13 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.
- #14 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.
- #15 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.
- #16 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.
- #17 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.
- #18 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.
- #19 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.
- #20 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.
- #21 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.
- #22 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.