Division of Child and Adolescent Psychiatry and Psychotherapy, Department of Psychiatry and Psychosomatic Medicine, Albert Ludwig University Medical Center Freiburg, Hauptstr. 8, 79104 Freiburg, Germany.
Gemeinschaftspraxis Kinder- und Jugendpsychiatrie Dres. Renate Böhme und Mariele Ritter-Gekeler, Hauptstr. 49, 79379 Müllheim, Germany.
Child Adolesc Psychiatry Ment Health. 2011 Jan 28;5(1):3. doi: 10.1186/1753-2000-5-3.
To date, there are no empirically validated treatments of good quality for adolescents showing suicidality and non-suicidal self-injurious behavior. Risk factors for suicide are impulsive and non-suicidal self-injurious behavior, depression, conduct disorders and child abuse. Behind this background, we tested the main hypothesis of our study; that Dialectical Behavioral Therapy for Adolescents is an effective treatment for these patients.
Dialectical Behavioral Therapy (DBT) has been developed by Marsha Linehan - especially for the outpatient treatment of chronically non-suicidal patients diagnosed with borderline personality disorder. The modified version of DBT for Adolescents (DBT-A) from Rathus & Miller has been adapted for a 16-24 week outpatient treatment in the German-speaking area by our group. The efficacy of treatment was measured by a pre-/post- comparison and a one-year follow-up with the aid of standardized instruments (SCL-90-R, CBCL, YSR, ILC, CGI).
In the pilot study, 12 adolescents were treated. At the beginning of therapy, 83% of patients fulfilled five or more DSM-IV criteria for borderline personality disorder. From the beginning of therapy to one year after its end, the mean value of these diagnostic criteria decreased significantly from 5.8 to 2.75. 75% of patients were kept in therapy. For the behavioral domains according to the SCL-90-R and YSR, we have found effect sizes between 0.54 and 2.14.During treatment, non-suicidal self-injurious behavior reduced significantly. Before the start of therapy, 8 of 12 patients had attempted suicide at least once. There were neither suicidal attempts during treatment with DBT-A nor at the one-year follow-up.
The promising results suggest that the interventions were well accepted by the patients and their families, and were associated with improvement in multiple domains including suicidality, non-suicidal self-injurious behavior, emotion dysregulation and depression from the beginning of therapy to the one-year follow-up.
迄今为止，对于表现出自杀倾向和非自杀性自伤行为的青少年，尚无经过实证验证的优质治疗方法。自杀的风险因素包括冲动行为和非自杀性自伤行为、抑郁、品行障碍和儿童虐待。在此背景下，我们检验了研究的主要假设；即辩证行为疗法对这些患者是一种有效的治疗方法。
辩证行为疗法（DBT）是由玛莎·莱恩汉（Marsha Linehan）专门为门诊治疗慢性非自杀性患者的边缘性人格障碍而开发的。我们的研究团队对拉瑟斯和米勒（Rathus & Miller）的青少年版辩证行为疗法（DBT-A）进行了修订，使其适用于德语区 16-24 周的门诊治疗。治疗效果通过使用标准化工具（SCL-90-R、CBCL、YSR、ILC、CGI）进行的治疗前后比较和一年随访来衡量。
在试点研究中，我们对 12 名青少年进行了治疗。在治疗开始时，83%的患者符合边缘性人格障碍的五项或更多 DSM-IV 标准。从治疗开始到结束后一年，这些诊断标准的平均值从 5.8 显著下降到 2.75。75%的患者坚持完成了治疗。根据 SCL-90-R 和 YSR 的行为域，我们发现效应量在 0.54 到 2.14 之间。在治疗过程中，非自杀性自伤行为显著减少。在接受 DBT-A 治疗前，12 名患者中有 8 人至少尝试过一次自杀。在 DBT-A 治疗期间和一年随访期间均无自杀企图。
有希望的结果表明，干预措施得到了患者及其家属的良好接受，并且与自杀、非自杀性自伤行为、情绪调节障碍和抑郁等多个领域的改善相关，从治疗开始到一年随访期间。
