Intensive Dialectical Behavior Therapy for Self-Harm and Suicidal Behavior in Youth: A Pilot Study

The prevalence of self-harm and suicidal behavior among adolescents has increased dramatically over the past two decades-a fourfold rise that represents both a severe personal burden and a substantial public health challenge. Dialectical Behavior Therapy for Adolescents (DBT-A) is the gold-standard treatment; however, the standard 20-week format is resource-intensive and time-consuming, which limits accessibility. An intensive 4-week DBT (I-DBT) program has been developed that may improve access and reach a larger number of adolescents. The investigators now seek to evaluate its feasibility and preliminary outcomes. The investigators will assess the feasibility of I-DBT in two to three adolescent groups comprising a total of 8-12 participants and their caregivers in spring and autumn 2026, examining recruitment, feasibility, and outcome measures such as self-harm, suicide attempts, acute hospital admissions, depression, and quality of life, as well as treatment dropout. The investigators aim to use the feedback to make necessary adjustments before broader testing of the I-DBT intervention.

Introduction Burden of self-harm and suicidal behavior. Self-harming behavior (self-poisoning or self-injury regardless of the degree of suicidal intent) and attempted suicide among adolescents have increased fivefold over the last two decades. A meta-analysis including data on 12- to 18-year-olds from 41 countries reported a lifetime prevalence of 16.9 % for self-harming behavior, with higher rates among girls than boys. An increase from 4.1% to 16.2% in self-harm prevalence from 2002 to 2017/18 is also reported among Norwegian adolescents. Self-harm and suicidal behavior in adolescents result from a complex interplay between genetic, biological, psychiatric, psychological, social, and cultural factors. Self-harm often starts and peaks in early adolescence (i.e., 13-16 years). Earlier onset and higher frequency of self-harm increase the risk of a more severe trajectory, and a history of repetitive hospital-treated self-harm is one of the most prominent predictors of suicide. Psychiatric disorders, particularly mood disorders, stress-related disorders, and emergent traits consistent with borderline personality disorder (BPD), are associated with an increased risk for self-harm in adolescents. Adolescents with repetitive self-harm and suicidal behavior have substantial medical and mental health service use. It is estimated that this group of patients generates 24% of the total costs of psychiatric inpatient treatments across age groups. The personal, familial, and societal costs of self-harm and suicidal behavior are considerable. This underscores the importance of accessible, evidence-based treatments for adolescents presenting with self-harm and suicidal behavior, such as Dialectical Behavior Therapy (DBT). Dialectical behavior therapy (DBT) for self-harm and suicidal behavior. DBT was initially developed to treat women with Borderline Personality Disorder (BPD) and suicidal behavior and is widely recommended as the first-line treatment of BPD, self-harming behavior, suicidal behavior, and emotional dysregulation given its robust empirical support. DBT is manualized and based on the premise that some individuals are more sensitive to and experience emotions more intensely than others. To manage intense emotions, more emotionally sensitive persons tend to react in more extreme and impulsive manners (e.g., self-harm). A lack of awareness of emotional experiences interferes with the development of more effective coping strategies. DBT focuses on providing individuals with skills (e.g., mindfulness, distress tolerance, interpersonal effectiveness, emotion regulation) to develop an awareness and acceptance of distressing internal experiences and to use these skills to overcome pervasive emotion dysregulation. Examples of some of the distress tolerance skills are to use distraction, self-soothing, and guidelines for accepting reality; for interpersonal effectiveness to learn how to keep relationship and keeping self-respect; and for emotion regulati Покажи пълното описание...

Inclusion Criteria * Age 14-18 years * Current or previous self-harm within the past six months * Current suicidal behavior (suicidal ideation or at least one suicide attempt in the past six months) * Meets at least three criteria for Borderline Personality Disorder (BPD) according to DSM-5, or meets the criterion for self-destructive behavior in addition to at least two subthreshold criteria, assessed using the Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD) (29) * Sufficient Norwegian language proficiency to participate in group-based treatment * One parent or another close adult able to participate together with the adolescent Exclusion Criteria * Intellectual disability * Significant learning or language difficulties * Autism spectrum disorder * Anorexia nervosa * Psychotic disorder * Substance use disorder