辩证行为疗法治疗有自杀自残行为的青少年：情绪调节、机制和中介因素。

Dialectical Behavior Therapy for Suicidal Self-Harming Youth: Emotion Regulation, Mechanisms, and Mediators.

机构信息

University of California, Los Angeles.

Stanford University, California.

出版信息

J Am Acad Child Adolesc Psychiatry. 2021 Sep;60(9):1105-1115.e4. doi: 10.1016/j.jaac.2021.01.016. Epub 2021 Feb 1.

DOI:10.1016/j.jaac.2021.01.016

PMID:33539915

Abstract

OBJECTIVE

This study evaluated mechanisms, mediation, and secondary/exploratory outcomes in our randomized controlled trial evaluating dialectical behavior therapy (DBT) compared to individual and group supportive therapy (IGST). We expand on previously reported results indicating a DBT advantage at posttreatment on planned suicide/self-harm outcomes, and greater self-harm remission (absence of self-harm, post hoc exploratory outcome) during active-treatment and follow-up periods.

METHOD

This was a multi-site randomized trial of 173 adolescents with prior suicide attempts, self-harm, and suicidal ideation. Randomization was to 6 months of DBT or IGST, with outcomes monitored through 12 months. Youth emotion regulation was the primary mechanistic outcome.

RESULTS

Compared to IGST, greater improvements in youth emotion regulation were found in DBT through the treatment-period [t(498) = 2.36, p = .019] and 12-month study period (t(498) = 2.93, p = .004). Their parents reported using more DBT skills: posttreatment t(497) = 4.12, p < .001); 12-month follow-up t(497) = 3.71, p < .001). Mediation analyses predicted to self-harm remission during the 6- to 12-month follow-up, the prespecified outcome and only suicidality/self-harm variable with a significant DBT effect at follow-up (DBT 49.3%; IGST 29.7%, p = .013). Improvements in youth emotion regulation during treatment mediated the association between DBT and self-harm remission during follow-up (months 6-12, estimate 1.71, CI 1.01-2.87, p = .045). Youths in DBT reported lower substance misuse, externalizing behavior, and total problems at posttreatment/6 months, and externalizing behavior throughout follow-up/12 months.

CONCLUSION

Results support the significance of emotion regulation as a treatment target for reducing self-harm, and indicate a DBT advantage on substance misuse, externalizing behavior, and self-harm-remission, with 49.3% of youths in DBT achieving self-harm remission during follow-up.

CLINICAL TRIAL REGISTRATION INFORMATION

Collaborative Adolescent Research on Emotions and Suicide; https://www.clinicaltrials.gov/; NCT01528020.

摘要

目的

本研究评估了我们的随机对照试验中的机制、中介和次要/探索性结果，该试验评估了辩证行为疗法（DBT）与个体和团体支持性治疗（IGST）相比的效果。我们扩展了先前报告的结果，表明在治疗后，DBT 在计划的自杀/自残结果上具有优势，并且在积极治疗和随访期间自我伤害缓解（无自我伤害，事后探索性结果）的可能性更大。

方法

这是一项多地点的随机试验，共有 173 名有自杀未遂、自残和自杀意念的青少年参与。随机分为 6 个月的 DBT 或 IGST，通过 12 个月的监测来评估结果。青少年情绪调节是主要的机制结果。

结果

与 IGST 相比，DBT 组在治疗期间[（498）= 2.36，p =.019]和 12 个月的研究期间[（498）= 2.93，p =.004]中，青少年情绪调节的改善更为显著。他们的父母报告说使用了更多的 DBT 技能：治疗后（497）= 4.12，p <.001）；12 个月随访时（497）= 3.71，p <.001）。中介分析预测了 6 至 12 个月随访期间的自我伤害缓解，这是预先指定的结果，也是随访时唯一具有 DBT 效果的自杀/自残变量（DBT 为 49.3%；IGST 为 29.7%，p =.013）。治疗期间青少年情绪调节的改善中介了 DBT 与随访期间自我伤害缓解之间的关联（6-12 个月，估计值为 1.71，CI 为 1.01-2.87，p =.045）。DBT 组的青少年在治疗后/6 个月时报告物质滥用、外化行为和总问题较少，且在整个随访/12 个月期间外化行为较少。