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Dialectical Behavior Therapy Can Help Teens at Risk of Suicide


Despite increased awareness and understanding of mental health issues, the tragedy of teen suicide and self-harm are growing problems in the U.S. Among teens and young adults age 10 to 24, suicide is the second-leading cause of death (after accidents), according to the Centers for Disease Control and Prevention. The rate of teen suicide has been on the rise for more than a decade.

New research finds that specific type of psychotherapy, dialectical behavior therapy (DBT), may help save lives and prevent self-harm among high-risk teens.

Writing in a companion commentary on the research, Paul Oliver Wilkinson, M.D., of Cambridge University in England, noted that self-harm is common in adolescents and is associated with future suicide attempts.

What is DBT?

Dialectical Behavior Therapy is a multicomponent treatment that targets reducing self-harm and suicide attempts. It is designed to help with extreme emotional instability that can lead to impulsive and self-destructive behaviors. DBT focuses on teaching skills to understand and manage emotions, to cope with distress and to develop coping strategies to deal with challenges, including relationships with friends and family. It has been adapted specifically for adolescents with extreme emotional instability. Dialectical refers to dealing with two things that may appear contradictory: accepting one’s feelings (drawn from mindfulness practice) and learning to use thinking to change feelings (drawn from cognitive behavior therapy).

DBT skills training includes such things as understanding the signs of out-of-control emotions, coping with difficult situations, interacting more effectively with others, recognizing urges that might be harmful and consciously controlling them and learning how to compromise and negotiate, according to Child Mind Institute.

teens.jpgDBT treatment typically consists of

  • weekly individual therapy sessions
  • a weekly group skills training session with parents
  • consultation between client and therapist outside of sessions as needed

DBT was initially developed to help treat people with symptoms of borderline personality disorder and are suicidal and is now used to help with a variety of mental health problems.

DBT to help prevent teen suicide

Researchers led by Elizabeth McCauley, Ph.D., with the University of Washington, Seattle, Wash., compared DBT with individual and group supportive therapy among a group of youth 12 to 18 who were at-risk for suicide (had attempted suicide at least once and had a history of self-harm).

After six months in the study, those receiving DBT were significantly less likely (about a third less) to engage in self-arm, including both suicide attempts and non-suicidal self-injury, than those receiving supportive therapy. After one year, rates of self-harm had decreased in both groups, although the rate was still lower in the DBT group.

Youth in the DBT group attended significantly more treatment sessions and were more likely to complete treatment than youth in the comparison group. McCauley and colleagues conclude that their results “support DBT as the first well-established, empirically supported treatment for decreasing repeated suicide attempts and self-harm in youths.”

The research was supported by the National Institute of Mental Health.


  • McCauley, E, et al. Efficacy of Dialectical Behavior Therapy for Adolescents at High Risk for Suicide. JAMA Psychiatry. Published online June 20, 2018.
  • Alexander L. Chapman, PhD Dialectical Behavior Therapy: Current Indications and Unique Elements. Psychiatry (Edgmont). 2006 Sep; 3(9): 62–68.
  • Wilkinson, MD, MrCPsych. Dialectical Behavior Therapy—A Highly Effective Treatment for Some Adolescents Who Self-harm. Invited Commentary. JAMA Psychiatry. Published online June 20, 2018.
  • Fact Sheet: Dialectical Behavior Therapy. Association for Cognitive and Behavioral Therapies.


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