Long Term Efficacy of DBT-A in Adolescents With Repetitive Self-harming and Suicidal Behaviours
Condition: Intentional Self Harm
MeSH terms: Self-Injurious Behavior
Study type: Interventional

Summary: 
      The purpose of the study is to evaluate the long-term efficacy of dialectical behavior
      therapy (DBT) in treatment of adolescents with deliberate self harm compared to enhanced
      usual care (EUC). This study follows-up 77 patients in the ages of 12-18 yrs who have been
      included in an RCT of DBT-A vs EUC. The main inclusion criterion for this study was
      repetitive self-harm behaviour. The patients were randomly allocated to receive 16 weeks of
      outpatient DBT or EUC in child and adolescent psychiatric clinics in Oslo. Participants have
      been assessed so far on five different time-points: baseline (before starting treatment), 9
      weeks, 15 weeks, 19 weeks and 71 weeks after start of the treatment. In the current project
      patients will be assessed a 6th time 2 years after treatment completion.

      The main study hypotheses are:

        -  DBT will be significantly more efficacious in reducing the number of self-harm episodes
           with or without intent to die, as well as reducing the number of emergency room visits
           for self-harm or suicidal behaviour, compared to EUC.

        -  DBT will be significantly more efficacious in reducing the level of suicidal ideation
           and depressive symptoms compared to EUC.
    

Detailed description: 
      The study is a long-term follow-up of a randomized trial comparing DBT-A with enhanced usual
      care (EUC). Participants were randomly allocated to receive either treatment at 1 of the
      participating child and adolescent psychiatric outpatient clinics in a 1:1 ratio stratified
      according to gender, presence of major depression, and presence of suicide intent during the
      most serious episode of self-harm behavior within the 16 weeks before enrollment. Treatment
      allocation of participants after baseline assessments was based on a permuted block
      randomization procedure with an undisclosed and variable blocking factor, and daily
      management of the randomization procedures was performed by an external group. Patients
      received either DBT or EUC by therapists working at and funded by the 10 child and adolescent
      psychiatric outpatient clinics participating in the study. They were assessed during
      treatment (9 and 15 weeks), at treatment completion 19 weeks, and at 71 weeks. In this study
      they are assessed at 2 years after treatment completion.

      The assessment of outcomes include: number of self-reported self-harm episodes (suicide
      attempts and non-suicidal self-harm episodes combined, measured by Lifetime Parasucide
      Count); the severity of suicidal ideation as measured by the 15-item self-report Suicidal
      Ideation Questionnaire (SIQ-JR; and level of depressive symptoms as measured by the 13-item
      version of the self-report Short Mood and Feelings Questionnaire (SMFQ) and through the
      interviewer rated 10-item Montgomery-_Asberg Depression Rating Scale (MADRS). Other outcomes
      are hopelessness, measured by the 20-item self-report Beck Hopelessness Scale
      (BHS);borderline symptoms, assessed through the 23-itemself-report Borderline Symptom List
      (BSL); Borderline Personality Disorder as measured by SCID-II; and hospital admissions and
      emergency department visits because of self-harm.
    

Intervention name(s): Dialectical behavior therapy; Enhanced usual care
Intervention type(s): Behavioral; Behavioral
Intervention description(s): 16 weeks of Dialectical behavior therapy with one weekly session of individual therapy, one weekly session of multifamily skills training group, telephone coaching and ancillary family therapy and/or pharmacological treatment as needed.
The treatment has been developed by Marsha Linehan (Linehan, 1993a; 1993b)and adapted for adolescents by Alec Miller (Miller, Rathus & Linehan, 2007). Individual DBT therapists have been trained by drs Alec L Miller and Sarah K Reynolds and have a minimum of one year clinical practise as DBT therapists. The therapists are organised in two consultation teams supervised on a bimonthly basis throughout the entire study by drs Miller and Reynolds respectively.; 16 weeks of outpatient treatment in child and adolescent psychiatric clinics in Oslo, on average one weekly session of individual therapy and ancillary supportive. family and/or pharmacological treatment as needed.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment