During her clinical training, Stanford psychologist Michele Berk, PhD, found her professional calling: providing mental health care for people struggling with suicidal feelings. “I liked being able to make a big difference by helping somebody who was at risk of harming themselves,” she said. “I realized it was a situation where a therapist could make a big, big impact.”
Berk recently co-authored a study in JAMA Psychiatry that examined how to reduce suicide attempts in at-risk teens. The treatment tested, dialectical behavior therapy, was found to decrease self-harm and suicide attempts in young people. I spoke with her recently to learn more.
The new study compared two treatments for teenagers who had a prior suicide attempt. Why was it important to conduct a randomized controlled trial?
There is real urgency to find treatments that work to lower suicide rates in adolescents.
There are several studies showing that dialectical behavior therapy reduces suicide attempts and self-harm in adults. By self-harm, we mean behaviors such as cutting where the person’s goal is not to die but rather to manage their emotions.
There was no definitive evidence on whether DBT was effective for teens. I was fortunate to be able to collaborate with Marsha Linehan, PhD, who developed DBT, and others, comparing DBT to another commonly used approach, supportive therapy.
What did you find?
Significantly more patients in the DBT group than in the supportive therapy comparison group told us they had not attempted suicide or engaged in self-harm at the end of the six month treatment. Both therapies helped participants improve over time, with no difference between treatments a year after the study began, but the kids who got DBT improved more quickly.
This makes DBT the only treatment for adolescents with replicated evidence that it decreases self-harm.
You had a study site in Los Angeles for this multi-center trial. What was significant about that site?
We included patients at Harbor-UCLA Medical Center, a county hospital, where we were able to enroll a large sample of ethnic minority patients from families with low socioeconomic status.
These patients often do not have access to state-of-the-art therapy. Their participation was also really important for science, because patients like these aren’t usually included in clinical trials. It’s useful to clinicians to see that this can work in a county mental health clinic, where patients are dealing with multiple life stressors as well as mental health issues.
What did the teenagers enrolled in the study have to say about DBT?
The kids really liked the different skills we taught about how to regulate emotions; they felt that was helpful. The treatment also has a focus on being non-judgmental and accepting things the way they are, radical acceptance, which they liked. And they liked that we helped their parents learn how to validate them more.
Our participants also liked taking part in multi-family group sessions. Knowing other teens and families are struggling with the same issues makes them feel that they’re not alone in dealing with these problems.
What are the next steps for this research?
We’ll try to understand which aspects of DBT account for the most change and improvement in our patients. DBT includes individual therapy, group therapy with multiple families working together, and making the therapist available 24/7 by phone to the teens and parents. It’s pretty labor-intensive for the therapist and the family. So an important next step is to see which of those ingredients are essential, and ask if we might be able to deliver a little less treatment with the same impact. That would allow more patients to get effective treatment for suicidal feelings or self-harm, and more therapists to provide it.
Also, we’re continuing to learn the best ways to help parents of these teens. Parents play such an important role in teenagers' lives, and it is often very difficult for them to know how to respond to self-harming or suicidal urges and behaviors. So we have a pilot study of a DBT-based parenting intervention to flesh out parenting skills that help moms and dads know how to respond to teen in crisis, how to keep them safe.
Individuals in crisis can receive help from the Santa Clara County Suicide & Crisis Hotline at (855) 278-4204. Help is also available from anywhere in the United States via Crisis Text Line (text HOME to 741741) or the National Suicide Prevention Lifeline at (800) 273-8255. All three services are free, confidential and available 24 hours a day, seven days a week.
Photo by Drew Hays