Dialectical Behaviour Therapy for young people with self-harm behaviour

INTERVENTION: The experimental intervention was 6 months of Dialectical Behavior Therapy (DBT). DBT is a cognitive–behavioral treatment originally developed for suicidal adults who meet criteria for Borderline Personality Disorder. DBT targets, in hierarchical order, life‐threatening behaviors (e.g., suicide attempts and NSSI), behaviors that interfere with treatment delivery (e.g., noncompliance), and severe quality of life interfering behaviors (e.g. depression, not attending school, substance use). Adapted for adolescents in the current study, DBT consisted of (a) weekly individual psychotherapy (of approximately 1 hour); (b) weekly multi‐family skills training (2 hours across a 26 week schedule) attended by adolescents and parents; (c) phone consultation (as needed); (d) family sessions (occurring 1‐2 times/month) and (e) weekly therapist consultation team meetings. DBT included the 24‐hour rule (a rule which states that patients may not have unscheduled contact with their individual therapist for 24 hours following self‐harm), however parents could access the DBT team for phone coaching in such instances. The treatment protocol used an early draft of the 2nd edition of the skills manual, with minor adaptations for adolescents. Individual DBT psychotherapy sessions with adolescents involved a blend of validation and behavior therapy. Sessions usually began with a review of their diary card (a self‐monitoring form completed daily which recorded ratings or urges and actions related to therapy targets described above), the collaborative assessment of instances of target behaviors, and problem‐solving alternative responses to stressful events, as well as a focus on other problems in the adolescents' life, and the application of DBT skills to these problems. Sessions typically included practicing the application of skills via role play and/or imaginal rehearsal. For both conditions, treatment included risk assessment and management, and access to crisis services, me CONDITION: Injuries and Accidents ‐ Other injuries and accidents Mental Health ‐ Depression Mental Health ‐ Suicide Suicidal and self‐injurious behaviour; ; Suicidal and self‐injurious behaviour SECONDARY OUTCOME: Hospitalisation rates gathered from review of patients' medical records. Following verification of consent from each participant, a member of the research team (who was not blind to condition) reviewed their electronic medical record and counted the number of ED visits and days spent in hospital from their record for each patient for each time period, [Time 1 ‐ at enrollment just prior to treatment randomisation ; Time 2 ‐ 3 months following enrollment (mid‐intervention) ; Time 3 ‐ 6 months following enrollment (post‐intervention) ; Time 4 ‐ 9 months following enrollment (3 months after intervention completion) ; Time 5 ‐ 12 months following enrollment (6 months after intervention completion) ; Time 6 ‐ 15 months following enrollment (9 months after intervention completion) ; Time 7 ‐ 18 months following enrollment (12 months after intervention completion)] INCLUSION CRITERIA: Adolescents aged 13‐19 years with a history of at least one suicide attempt or self‐injury in the 3 months prior to the pretreatment assessment, and who are proficient in spoken English. Adolescents aged 19 years provided they are still living at home, can attend group accompanied by an adult who is an ongoing presence in their lives, and are attending some form of secondary education. PRIMARY OUTCOME: .The acceptability of the experimental intervention, as measured by treatment retention rate (number of participants completing DBT, from the total number of participants assigned to DBT), and whether patients would tolerate the research assessments, as measured by the study retention rate (percent of people completing assessments for each time period, number of people continuing to take part at the conclusion of the study)[At the conclusion of data collection] The effect size of DBT as measured by responses on the Suicide Attempt Self‐Injury Interview (SASII):; Proportion of participants who have injured themselves or attempted suicide (i.e. self‐harmed) for each assessment period and condition ; Median frequency of episodes of self‐injurious behaviour and/or suicide attempts for each assessment period and for each condition[These were the scheduled timepoints of the assessments: ; Time 1 ‐ at enrollment just prior to treatment randomisation; Time 2 ‐ 3 months following enrollment (mid‐intervention); Time 3 ‐ 6 months following enrollment (post‐intervention); Time 4 ‐ 9 months following enrollment (3 months after intervention completion); Time 5 ‐ 12 months following enrollment (6 months after intervention completion); Time 6 ‐ 15 months following enrollment (9 months after intervention completion); Time 7 ‐ 18 months following enrollment (12 months after intervention completion)] Whether patients and clinicians will accept randomization (as measured by (1) the recruitment rate i.e. number of people consenting to take part out of the total number invited to participate in the research, (2) successful attainment of ethics approval, and (3) agreement from the host site to host the research study); [Prior to randomisation]