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Dialectical Behavior Therapy for Suicidal and Self-Harming Adolescents with Trauma Symptoms

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Evidence-Based Approaches for the Treatment of Maltreated Children

Part of the book series: Child Maltreatment ((MALT,volume 3))

Abstract

Suicide is the third leading cause of death among teens. Suicide attempts and non-suicidal self-injury behaviors are also significant public health problems in this age group. Despite the severity of the problem, there are no treatments that have been proven effective at reducing suicidal behavior in adolescents. Dialectical Behavior Therapy (DBT) has shown effectiveness at reducing suicide attempts in multiple randomized trials with suicidal adults with Borderline Personality Disorder (BPD) and has been adapted for suicidal teens with promising results. There is a strong association between childhood trauma, suicidal behaviors, and BPD traits. Accordingly, DBT targets both PTSD and self-injurious behaviors. In this chapter, we describe DBT and how it targets PTSD symptoms, discuss the use of DBT with adolescents with PTSD symptoms, and provide a case example to illustrate this approach.

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References

  • American Psychiatric Association [APA]. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

    Google Scholar 

  • American Psychiatric Association [APA]. (2001). Practice guideline for the treatment of patients with borderline personality disorder. Washington, DC: APA.

    Google Scholar 

  • Brent, D. A., Johnson, B. A., Perper, J., Connolly, J., Bridge, J., Bartle, S., et al. (1994). Personality disorder, personality traits, impulsive violence, and completed suicide in adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 1080–1086.

    Article  PubMed  Google Scholar 

  • Briere, J., & Runtz, M. (1987). Post sexual abuse trauma: Data and implications for clinical practice. Journal of Interpersonal Violence, 2(4), 367–379.

    Article  Google Scholar 

  • Briere, J., & Zaidi, L. Y. (1989). Sexual abuse histories and sequelae in female psychiatric emergency room patients. American Journal of Psychiatry, 146(12), 1602–1606.

    PubMed  Google Scholar 

  • Calkins, S. D., & Hill, A. (2007). Caregiver influences on emerging emotion regulation: Biological and environmental transactions in early development. In J. J. Gross (Ed.), Handbook of emotion regulation (pp. 229–248). New York: Guilford Press.

    Google Scholar 

  • Centers for Disease Control and Prevention [CDC]. (2013). Web-Based Injury Statistics Query and Reporting System (WISQARS). Retrieved from http://www.cdc.gov/injury/wisqars/index.html

  • Cloitre, M., Cohen, L. R., & Koenen, K. C. (2006). Treating survivors of childhood abuse: Psychotherapy for the interrupted life. New York: Guilford Press.

    Google Scholar 

  • Cohen, J. A., Mannarino, A. P., Berliner, L., & Deblinger, E. (2000). Trauma-focused cognitive behavioral therapy for children and adolescents: An empirical update. Journal of Interpersonal Violence, 15(11), 1202–1223.

    Article  Google Scholar 

  • Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2006). Treating trauma and traumatic grief in children and adolescents. New York: Guilford Press.

    Google Scholar 

  • Crowell, S. E., Beauchaine, T. P., & Linehan, M. M. (2009). A biosocial developmental model of borderline personality: Elaborating and extending Linehan’s theory. Psychological Bulletin, 135(3), 495–510.

    Article  PubMed Central  PubMed  Google Scholar 

  • DeRosa, R., & Pelcovitz, D. (2008). Group treatment for chronically traumatized adolescents: Igniting SPARCS of change. In D. Brom, R. Pat-Horenczyk, & J. D. Ford (Eds.), Treating traumatized children: Risk, resilience, and recovery (pp. 225–239). London: Routledge.

    Google Scholar 

  • Eaton, D.K., Kann, L., Kinchen, S., Shanklin, S., Ross, J., Hawkins, J., et al. (2010, June 4). Youth Risk Behavior Surveillance—United States, 2009. Morbidity and Mortality Weekly Report (MMWR). Retrieved from http://www.cdc.gov/MMWR/preview/mmwrhtml/ss5905a1.htm

  • First, M. B., Gibbon, M., Spitzer, R. L., Williams, J. B. W., & Benjamin, L. S. (1997). Structured clinical interview for DSM-IV for Axis II personality disorders (SCID-II) interview and questionnaire. Washington, DC: American Psychiatric Press.

    Google Scholar 

  • Foa, E. B., Keane, T. M., Friedman, M. J., & Cohen, J. A. (2009). Effective treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies (2nd ed.). New York: Guilford Press.

    Google Scholar 

  • Foa, E. B., & Rothbaum, B. (1998). Treating the trauma of rape: Cognitive-behavioral therapy for PTSD. New York: Guilford Press.

    Google Scholar 

  • Ford, J. D., & Cloitre, M. (2009). Best practices in psychotherapy for children and adolescents. In C. A. Courtois & J. D. Ford (Eds.), Treating complex traumatic stress disorders: An evidence-based guide (pp. 59–81). New York: Guilford Press.

    Google Scholar 

  • Ford, J. D., & Russo, E. (2006). Trauma-focused, present-centered, emotional self-regulation approach to integrated treatment for posttraumatic stress and addiction: Trauma Adaptive Recovery Group Education and Therapy (TARGET). American Journal of Psychotherapy, 60(4), 335–355.

    PubMed  Google Scholar 

  • Goldsmith, S. K., Pellmar, T. C., Kleinman, A. M., & Bunney, W. E. (2002). Reducing suicide: A national imperative. Washington, DC: National Academies Press.

    Google Scholar 

  • Goldstein, T. R., Axelson, D. A., Birmaher, B., & Brent, D. A. (2007). Dialectical behavior therapy for adolescents with bipolar disorder: A 1-years open trial. Journal of the American Academy of Child and Adolescent Psychiatry, 46(7), 820–830.

    Article  PubMed Central  PubMed  Google Scholar 

  • Gould, M. S., Greenberg, T., Velting, D. M., & Shaffer, D. (2003). Youth suicide risk and preventive interventions: A review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 386–405.

    Article  PubMed  Google Scholar 

  • Harned, M. S., Chapman, A. L., Dexter-Mazza, E. T., Murray, A., Comtois, K. A., & Linehan, M. M. (2008). Treating co-occurring Axis I disorders in recurrently suicidal women with borderline personality disorder: A 2-year randomized trial of dialectical behavior therapy versus community treatment by experts. Journal of Consulting and Clinical Psychology, 76(6), 1068–1075.

    Article  PubMed  Google Scholar 

  • Harned, M. S., Korslund, K. E., Foa, E. B., & Linehan, M. M. (2012). Treating PTSD in suicidal and self-injuring women with borderline personality disorder: Development and preliminary evaluation of a dialectical behavior therapy prolonged exposure protocol. Behaviour Research and Therapy, 50(6), 381–386.

    Article  PubMed Central  PubMed  Google Scholar 

  • Harned, M. S., & Linehan, M. M. (2008). Integrating dialectical behavior therapy and prolonged exposure to treat co-occurring borderline personality disorder and PTSD: Two case studies. Cognitive and Behavioral Practice, 15(3), 263–276.

    Article  Google Scholar 

  • Harris, E. C., & Barraclough, B. (1997). Suicide as an outcome for mental disorders: A meta-analysis. British Journal of Psychiatry, 170, 205–228.

    Article  PubMed  Google Scholar 

  • Huey, S. R., Henggeler, S. W., Rowland, M. D., Halliday-Boykins, C. A., Cunningham, P. B., Pickrel, S. G., et al. (2004). Multisystemic therapy effects on attempted suicide by youths presenting psychiatric emergencies. Journal of the American Academy of Child and Adolescent Psychiatry, 43(2), 183–190.

    Article  PubMed  Google Scholar 

  • Katz, L. Y., Cox, B. J., Gunasekara, S., & Miller, A. L. (2004). Feasibility of dialectical behavior therapy for suicidal adolescent inpatients. Journal of the American Academy of Child and Adolescent Psychiatry, 43(3), 276–282.

    Article  PubMed  Google Scholar 

  • Lanktree, C., Briere, J., & Zaidi, L. (1991). Incidence and impact of sexual abuse in a child outpatient sample: The role of direct inquiry. Child Abuse & Neglect, 15(4), 447–453.

    Article  Google Scholar 

  • Lewinsohn, P. M., Rohde, P., & Seeley, J. R. (1993). Psychosocial characteristics of adolescents with a history of suicide attempt. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 60–68.

    Article  PubMed  Google Scholar 

  • Lewinsohn, P. M., Rohde, P., & Seely, J. R. (1994). Psychosocial risk factors for future adolescent suicide attempts. Journal of Consulting and Clinical Psychology, 62, 297–305.

    Article  PubMed  Google Scholar 

  • Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guildford Press.

    Google Scholar 

  • Linehan, M. M., Armstrong, H. E., Suarez, A., & Allmon, D. (1991). Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48(12), 1060–1064.

    Article  PubMed  Google Scholar 

  • Linehan, M. M., Comtois, K., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard, H. L., et al. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63(7), 757–766.

    Article  PubMed  Google Scholar 

  • Linehan, M. M., Heard, H. L., & Armstrong, H. E. (1993). Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patients. Archives of General Psychiatry, 50(12), 971–974.

    Article  PubMed  Google Scholar 

  • Miller, A. L., Muehlenkamp, J. J., & Jacobson, C. M. (2008). Fact or fiction: Diagnosing borderline personality disorder in adolescents. Clinical Psychology Review, 28, 969–981.

    Article  PubMed  Google Scholar 

  • Miller, A. L., Rathus, J. H., & Linehan, M. M. (2007). Dialectical behavior therapy with suicidal adolescents. New York: Guilford Press.

    Google Scholar 

  • Najavits, L. M. (2006). Seeking safety: Therapy for posttraumatic stress disorder and substance use disorder. In V. M. Follette & J. I. Ruzek (Eds.), Cognitive-behavioral therapies for trauma (2nd ed., pp. 228–257). New York: Guilford Press.

    Google Scholar 

  • Nelson-Gray, R. O., Keane, S. P., Hurst, R. M., Mitchell, J. T., Warburton, J. B., Chok, J. T., et al. (2006). A modified DBT skills training program for oppositional defiant adolescents: Promising preliminary findings. Behaviour Research and Therapy, 44(12), 1811–1820.

    Article  PubMed  Google Scholar 

  • Powers, M. B., Halpern, J. M., Ferenschak, M. P., Gillihan, S. J., & Foa, E. B. (2010). A meta-analytic review of prolonged exposure for posttraumatic stress disorder. Clinical Psychology Review, 30, 635–641.

    Article  PubMed  Google Scholar 

  • Rathus, J. H., & Miller, A. L. (2002). Dialectical behavior therapy adapted for suicidal adolescents. Suicide and Life-Threatening Behavior, 32(2), 146–157.

    Article  PubMed  Google Scholar 

  • Resick, P. A., Bovin, M. J., Calloway, A. L., Dick, A. M., King, M. W., Mitchell, K. S., et al. (2012). A critical evaluation of the complex PTSD literature: Implications for DSM-5. Journal of Traumatic Stress, 25, 241–251.

    Article  PubMed  Google Scholar 

  • Riggs, S., Alario, A. J., & McHorney, C. (1990). Health risk behaviors and attempted suicide in adolescents who report prior maltreatment. Journal of Pediatrics, 116(5), 815–821.

    Article  PubMed  Google Scholar 

  • Saunders, B. E., Villeponteaux, L. A., Lipovsky, J. A., & Kilpatrick, D. G. (1992). Child sexual assault as a risk factor for mental disorders among women: A community survey. Journal of Interpersonal Violence, 7(2), 189–204.

    Article  Google Scholar 

  • Shaffer, D., Gould, M. S., Fisher, P., & Trautman, P. (1996). Psychiatric diagnosis in child and adolescent suicide. Archives of General Psychiatry, 53(4), 339–348.

    Article  PubMed  Google Scholar 

  • Silverman, A. B., Reinherz, H. Z., & Giaconia, R. M. (1996). The long-term sequelae of child and adolescent abuse: A longitudinal community study. Child Abuse & Neglect, 20(8), 709–723.

    Article  Google Scholar 

  • Soloff, P. H., Lynch, K. G., & Kelly, T. M. (2002). Childhood abuse as a risk factor for suicidal behavior in borderline personality disorder. Journal of Personality Disorders, 16, 201–214.

    Article  PubMed  Google Scholar 

  • Soloff, P. H., Lynch, K. G., Kelly, T. M., Malone, K. M., & Mann, J. J. (2000). Characteristics of suicide attempts of patients with major depressive episode and borderline personality disorder: A comparative study. American Journal of Psychiatry, 157, 601–608.

    Article  PubMed  Google Scholar 

  • Wood, A., Trainor, G., Rothwell, J., Moore, A., & Harrington, R. (2001). Randomized trial of group therapy for repeated deliberate self-harm in adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 40(11), 1246–1253.

    Article  PubMed  Google Scholar 

  • Woodberry, K. A., & Popenoe, E. J. (2008). Implementing dialectical behavior therapy with adolescents and their families in a community outpatient clinic. Cognitive and Behavioral Practice, 15(3), 277–286.

    Article  Google Scholar 

  • Zanarini, M. C., Williams, A. A., Lewis, R. E., Reich, R. B., Vera, S. C., Marino, M. F., et al. (1997). Reported pathological childhood experiences associated with the development of borderline personality disorder. American Journal of Psychiatry, 154, 1101–1106.

    PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Harbor-UCLA Medical Center, Torrance, CA, USA

    Michele S. Berk Ph.D., Janine Shelby Ph.D., Claudia Avina Ph.D. & Keegan R. Tangeman Psy.D.

  2. Los Angeles Biomedical Research Institute, Torrance, CA, USA

    Michele S. Berk Ph.D., Claudia Avina Ph.D. & Keegan R. Tangeman Psy.D.

  3. David Geffen School of Medicine, University of California, Los Angeles, CA, USA

    Michele S. Berk Ph.D. & Janine Shelby Ph.D.

Authors
  1. Michele S. Berk Ph.D.
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  2. Janine Shelby Ph.D.
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  3. Claudia Avina Ph.D.
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  4. Keegan R. Tangeman Psy.D.
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Corresponding author

Correspondence to Michele S. Berk Ph.D. .

Editor information

Editors and Affiliations

  1. Department of Pediatrics, CAARE Center, Sacramento, California, USA

    Susan Timmer

  2. Department of Pediatrics, CAARE Center, Sacramento, California, USA

    Anthony Urquiza

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Berk, M.S., Shelby, J., Avina, C., Tangeman, K.R. (2014). Dialectical Behavior Therapy for Suicidal and Self-Harming Adolescents with Trauma Symptoms. In: Timmer, S., Urquiza, A. (eds) Evidence-Based Approaches for the Treatment of Maltreated Children. Child Maltreatment, vol 3. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-7404-9_12

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