Dialectical Behaviour Therapy for the Treatment of Emotion Dysregulation and Trauma Symptoms in Self-Injurious and Suicidal Adolescent Females: A Pilot Programme within a Community-Based Child and Adolescent Mental Health Service
Background. The literature suggests a link between childhood trauma and maladaptive emotion regulation strategies, including nonsuicidal self-injury (NSSI) and suicidality. We assessed the impact of a pilot dialectical behaviour therapy (DBT) programme on reducing trauma-related symptoms and improving emotional regulation, suicidality, and NSSI in adolescents. Methods. Six adolescents attending a community mental health service received 26 weeks of DBT, together with a parent. Independent assessors collected measures on each participant at baseline, posttreatment, and three-month followup. We implemented further improvements over past research with the use of adolescent-specific outcome measures as well as independent assessment of treatment integrity, noted as problematic in previous studies, using videotapes. Results. Firstly, adolescents reported a decrease in trauma-based symptoms, suicidality, and NSSI following participation in the DBT programme that was maintained at the three-month followup. Secondly, adolescents also reported improved emotion regulation immediately following treatment, and this was maintained, albeit more moderately, three months later. Given the burgeoning demand on mental health services, it is notable that five of the six adolescents were discharged from the service following the DBT intervention. Conclusions. The results of this pilot programme suggest that DBT has the potential to improve the symptoms of this at-risk population. 1. Introduction A large percentage of adolescents present at community-based mental health clinics following acts of nonsuicidal self-injury, such as cutting or burning, due to significant difficulties with self-regulation of their emotions [1–4]. These adolescents often report using self-injury strategies to overcome emotional numbing [3], and many experience ongoing suicidal ideation, while some go on to make at least one and often more suicide attempts [3, 5, 6]. Given the nature of their presenting difficulties, many would argue that these adolescents have an “emerging borderline personality structure” [7–10]. These distressed adolescents, and the family systems in which they have been developed, have been shown to be remarkably difficult to treat [11], so that many will graduate from child and adolescent mental health settings to become long-term patients of adult mental health services, with multiple hospital admissions due to high levels of dysfunction, extreme management issues, and treatment resistance [3, 12]. The challenges to government-funded health services, both in the public and
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