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J Am Acad Child Adolesc Psychiatry. 2014 Oct;53(10):1082-91. doi: 10.1016/j.jaac.2014.07.003. Epub 2014 Jul 22.

Dialectical behavior therapy for adolescents with repeated suicidal and self-harming behavior: a randomized trial.

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National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway. Electronic address:
National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway.
Norwegian University of Science and Technology, Trondheim, Norway.
Columbia University, New York City, and the University of Oslo, Norway.
Montefiore Medical Center and Albert Einstein College of Medicine, New York City.
Norwegian University of Science and Technology and St Olav's University Hospital, Trondheim, Norway.



We examined whether a shortened form of dialectical behavior therapy, dialectical behavior therapy for adolescents (DBT-A) is more effective than enhanced usual care (EUC) to reduce self-harm in adolescents.


This was a randomized study of 77 adolescents with recent and repetitive self-harm treated at community child and adolescent psychiatric outpatient clinics who were randomly allocated to either DBT-A or EUC. Assessments of self-harm, suicidal ideation, depression, hopelessness, and symptoms of borderline personality disorder were made at baseline and after 9, 15, and 19 weeks (end of trial period), and frequency of hospitalizations and emergency department visits over the trial period were recorded.


Treatment retention was generally good in both treatment conditions, and the use of emergency services was low. DBT-A was superior to EUC in reducing self-harm, suicidal ideation, and depressive symptoms. Effect sizes were large for treatment outcomes in patients who received DBT-A, whereas effect sizes were small for outcomes in patients receiving EUC. Total number of treatment contacts was found to be a partial mediator of the association between treatment and changes in the severity of suicidal ideation, whereas no mediation effects were found on the other outcomes or for total treatment time.


DBT-A may be an effective intervention to reduce self-harm, suicidal ideation, and depression in adolescents with repetitive self-harming behavior. Clinical trial registration information-Treatment for Adolescents With Deliberate Self Harm;; NCT00675129.


attempted suicide; psychotherapy; randomized trial; self-harm

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