DBT Parenting Intervention for Youth with Self-Harm

• In Event: Integration of Dialectical Behavior Therapy and Parent Training: Results From Three New Dual-Generation Treatment Studies

Abstract

At present, DBT is the only treatment showing reduction in adolescent self-harm (SH, including both suicide attempts and non-suicidal self-injury) that has been replicated across two independent randomized controlled trials (RCTs; Mehlum et al., 2014; McCauley et al., 2018). Data supporting DBT as an effective treatment for reducing SH in youth is a significant step forward in the field of adolescent suicide prevention. However, in the one RCT that reported remission rates, only 36.5% of the sample were free of SH at the end of treatment and 50.2% were free of SH at 12-month follow-up (McCauley et al., 2018). Increasing the dose of parent intervention may be one strategy for increasing remission rates in DBT with adolescents. Family functioning is a critical focus of suicide prevention in youth. Parents also play a central role in youth safety, by restricting access to lethal means in the home, closely monitoring the teen to reduce opportunities for SH, and obtaining emergency services when needed. Establishing a positive parent/teen relationship is the foundation that enables parents to perform these vital safety functions and increases the likelihood that the adolescent ask the parent for help when they are suicidal.
This presentation will describe and report results of a newly-developed, DBT-based parenting intervention for parents of youth at high risk for suicide. The parenting intervention is 8-10 sessions long and is conducted with the parent(s) individually, to allow for in-depth skills teaching and application. The intervention focuses on the Walking the Middle Path module developed specifically for DBT with adolescents (Rathus & Miller, 2014) and includes skills for increasing positive interactions with the teen (e.g., being non-judgmental, validation, conflict resolution by finding a “middle path”) and using contingency management skills to address problem behaviors. Similar to other behavioral parent training models, the intervention has two primary goals: 1) improve the parent/teen relationship and increase parental validation and use of a non-judgmental stance toward the teen and 2) increase use of effective, behavioral parenting skills.
In this presentation, we will provide an overview of the parenting intervention components and report the results of a small open pilot trial of the intervention with the parents of N = 10 teens with recent SH. Results supported the feasibility and acceptability of the intervention and showed improvements in parent depressive symptoms, emotion dysregulation, overall psychiatric distress and interpersonal sensitivity (providing preliminary evidence of engagement of the treatment “target;” Berk et al., in press). Results supported further testing of the intervention, both as a stand-alone intervention for parents and as an adjunct to standard DBT-A, with a larger sample, in an RCT. Accordingly, we will also describe a follow-up pilot RCT of our DBT parenting intervention that we are currently conducting with youth in an intensive outpatient (IOP) DBT program. The potential to reduce youth suicide risk indirectly through parents is a promising development that may reduce treatment burden, help youth unwilling or unable to participate in treatment and be used adjunctively to increase the effectiveness of the youth’s treatment.

Author

• Michele Berk, Stanford University
  Presenting Author