Dialectical Behavior Therapy (DBT) for Adolescents With Bipolar Disorder
Condition: Dialectical Behavior Therapy + Pharmacotherapy; Standard of Care Psychotherapy + Pharmacotherapy
MeSH terms: Bipolar Disorder
Study type: Interventional

Summary: 
      Of all psychiatric diagnoses, bipolar disorder imparts the greatest risk for completed
      suicide in adolescence, and is further associated with poor psychosocial functioning,
      substance abuse and legal difficulties, and exorbitant healthcare costs exceeding those for
      other adolescent psychiatric conditions. Treatment guidelines indicate optimal management of
      pediatric bipolar disorder includes a combination of medication and psychotherapy. Yet,
      little is known about effective psychotherapy approaches for this population, and none
      expressly target suicidality. An efficacious, cost-effective psychosocial intervention for
      adolescents with bipolar disorder has great potential to decrease the substantial morbidity,
      mortality and costs associated with adolescent bipolar disorder.
    

Detailed description: 
      Of all psychiatric diagnoses, bipolar disorder (BP) imparts the greatest risk for completed
      suicide in adolescence, and is associated with other negative outcomes including poor
      psychosocial functioning and substance abuse. Furthermore, healthcare costs for adolescents
      with BP exceed those for other adolescent psychiatric conditions. Treatment guidelines
      indicate optimal management of pediatric BP includes a combination of pharmacotherapy and
      psychotherapy. Yet, little is known about effective psychotherapy approaches for this
      population, and none expressly target suicidality. An efficacious, cost-effective
      psychotherapy for adolescents with BP has great potential to decrease the substantial
      morbidity, mortality and costs associated with this illness. Dialectical Behavior Therapy
      (DBT) is a skills-based psychotherapy originally developed for adults with borderline
      personality disorder. DBT holds promise for adolescents with BP given shared treatment
      targets including suicidality and psychosocial functioning. Our group's preliminary data on
      DBT for adolescents with BP provide strong support for the feasibility and acceptability of
      the treatment model, and indicate DBT is associated with improvement in targeted treatment
      domains including suicidality, emotional dysregulation, and depression, and these
      improvements are greater among adolescents receiving DBT as compared with standard of care
      (SOC) psychotherapy delivered at our Child and Adolescent Bipolar Services (CABS) specialty
      clinic. The proposed study aims to evaluate in a randomized controlled trial the efficacy of
      DBT + pharmacotherapy as compared with CABS SOC psychotherapy + pharmacotherapy over 2 year
      followup among adolescents (age 12-18) with BP (n=100). Primary outcome domains include
      suicidal events and mood symptoms. Our team includes an expert in health services cost
      effectiveness, enabling us to examine the cost effectiveness of DBT. Our exploratory aim is
      to elucidate moderators and mediators of DBT treatment response in this population.
      Identification of patient factors that predict response to DBT, as well as mechanisms by
      which DBT benefits patients, will directly inform the planful dissemination of the treatment
      (if shown to be effective) for those most likely to benefit. Furthermore, a supplement is
      enabling examination of neural mechanisms underlying DBT treatment response as assessed via
      fMRI at pre- and mid-treatment. These aims are in direct accord with the NIMH Strategic Plan
      to prioritize research on improved treatments for mental illness while also generating
      information regarding underlying mechanisms of disorder; facilitate widespread use of
      evidencebased interventions by demonstrating cost effectiveness; and systematically study
      elements of personalized intervention. Furthermore, this project aligns with the mission of
      the National Action Alliance for Suicide Prevention Research Prioritization Task Force: to
      prioritize gaps in the research that will reduce the rate of suicide and suicide attempts, to
      target particularly high-risk groups, and to move toward uptake of evidence-based
      interventions for suicidality.
    

Intervention name(s): Dialectical Behavior Therapy; Standard of Care Psychotherapy; Pharmacotherapy
Intervention type(s): Behavioral; Behavioral; Other
Intervention description(s): Dialectical Behavior Therapy; Standard of Care Psychotherapy; Standard of Care Pharmacotherapy
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Bipolar disorder; Adolescent suicidal behavior; Psychotherapy