Dialectical Behavior Therapy for Suicide Risk in Psychosis

Overseen By Wendy Potts

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Maryland, Baltimore

Disqualifiers: Intellectual disability, Traumatic brain injury, Deafness

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 3 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: Unknown

Duration: 16 weeks

68 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how Dialectical Behavior Therapy (DBT) Skills Training can help individuals with psychotic disorders manage emotions more effectively, thereby reducing suicide risk. The researchers aim to find effective support methods for those with psychosis, a condition involving delusions or hallucinations, who face a high suicide risk. Participants will either receive DBT skills training or continue their usual treatment to compare outcomes. This trial may suit adults diagnosed with psychosis who are receiving outpatient mental health care and feel at risk for suicide. As an unphased trial, it offers a unique opportunity to contribute to understanding and improving mental health care for those at high risk.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What prior data suggests that Dialectical Behavior Therapy Skills Training is safe for people with psychotic disorders?

Research shows that Dialectical Behavior Therapy (DBT) Skills Training is generally safe and well-tolerated. One study found that DBT reduced suicide attempts in teenagers, with 90.3% of those receiving DBT having fewer attempts compared to those who did not. Another study found that DBT can lower anxiety, depression, and stress, while also reducing suicidal thoughts and behaviors.

These studies have not reported any significant harm or serious side effects from DBT. Overall, DBT Skills Training appears to be a safe option for people facing emotional challenges and suicidal thoughts, offering positive results with few negative effects. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about Dialectical Behavior Therapy (DBT) Skills Training for suicide risk in psychosis because it offers a fresh approach compared to traditional treatments like medication and standard psychotherapy. DBT focuses on teaching practical skills for emotion regulation, distress tolerance, and interpersonal effectiveness, which are particularly beneficial for individuals with psychosis who may struggle with intense emotions and impulsivity. This method is unique as it empowers patients with tools they can use in their everyday lives, potentially reducing the risk of suicidal behaviors by addressing the root emotional and cognitive challenges directly.

What evidence suggests that Dialectical Behavior Therapy might be an effective treatment for suicide risk in psychosis?

Research has shown that Dialectical Behavior Therapy (DBT) can help reduce suicidal behavior. A review of studies found that DBT lowered outcomes related to suicide, suggesting it might reduce suicide risk. Studies also report that DBT can lessen the frequency and severity of suicidal thoughts and attempts. In this trial, participants will receive either DBT Skills Training or Treatment As Usual. DBT helps people manage their emotions, which is crucial for those with psychotic disorders who may struggle with intense feelings. While researchers have tested DBT in various groups, its specific effects on people with psychotic disorders are still under investigation, but early results appear promising. ^{2 6 7 8 9}

Are You a Good Fit for This Trial?

This trial is for adults with a psychosis spectrum disorder confirmed by an interview, who are already receiving outpatient mental health services. They must be able to read at a 6th-grade level and have a heightened risk of suicide as indicated by specific questionnaire scores. People with intellectual disabilities, traumatic brain injury, or deafness cannot participate.

Inclusion Criteria

I have been actively participating in outpatient mental health services.

6+ grade equivalent reading level as assessed by the Wide Range Achievement Test 4 (WRAT-4)

Psychosis spectrum disorder as assessed by the Mini International Neuropsychiatric Interview (MINI) for Psychotic Disorder Studies

Exclusion Criteria

Chart diagnosis of intellectual disability (DSM5 317, 318), traumatic brain injury, or deafness.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive Dialectical Behavior Therapy - Skill Training or Treatment As Usual

16 weeks

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Dialectical Behavior Therapy Skills Training

Trial Overview The study tests Dialectical Behavior Therapy Skills Training aimed at managing emotional turmoil in people with psychotic disorders to reduce their suicide risk. It includes advanced data collection methods like Ecological Momentary Assessment for real-time tracking of emotions and behaviors.

How Is the Trial Designed?

Group I: Dialectical Behavior Therapy - Skill Training Experimental Treatment 1 Intervention

Group II: Treatment As Usual Active Control 1 Intervention

Dialectical Behavior Therapy Skills Training is already approved in United States, European Union, Canada for the following indications:

Approved in United States as DBT Skills Training for:

• Borderline Personality Disorder
• Emotion Dysregulation
• Suicidal Ideation

Approved in European Union as Dialectical Behavior Therapy for:

• Borderline Personality Disorder
• Emotion Dysregulation
• Post-Traumatic Stress Disorder

Approved in Canada as DBT Skills Training for:

• Borderline Personality Disorder
• Emotion Dysregulation
• Eating Disorders

Who Is Running the Clinical Trial?

University of Maryland, Baltimore

Lead Sponsor

Trials

729

Recruited

540,000+

Published Research Related to This Trial

Dialectical behavior therapy (DBT) is an effective treatment for individuals with borderline personality disorder, specifically targeting life-threatening behaviors like suicide attempts and self-injury.

DBT incorporates various strategies for risk management and safety planning, such as diary cards and phone coaching, to help clients commit to reducing harmful behaviors throughout their treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Risk management in dialectical behavior therapy: Treating life-threatening behaviors as problems to be solved. Alba, MC., Bailey, KT., Coniglio, KA., et al.[2022]

In a study of 118 individuals with borderline personality disorder (BPD), comorbidities such as Eating Disorders (ED) and Cocaine Use Disorder (CUD) were significant predictors of early dropout from dialectical behavior therapy skills training (DBT-ST).

Trait impulsiveness also showed a tendency to influence dropout rates, suggesting that addressing these comorbid conditions may improve retention in DBT-ST for patients with BPD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Factors predicting early dropout from dialectical behaviour therapy in individuals with borderline personality disorder. Carmona I Farrés, C., Pascual, JC., Elices, M., et al.[2019]

A pilot study involving 17 Veterans showed that Dialectical Behavior Therapy Skills Group (DBT-SG) was feasible and acceptable, with participants attending an average of 66% of sessions and reporting satisfaction with the treatment.

Results indicated significant reductions in suicidal ideation and emotion dysregulation after the 26-week program, with improvements maintained at a 3-month follow-up, suggesting that DBT-SG may effectively enhance coping skills and reduce suicide risk in Veterans.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Feasibility and preliminary efficacy of dialectical behaviour therapy skills groups for Veterans with suicidal ideation: pilot. Decker, SE., Adams, L., Watkins, LE., et al.[2022]

A study involving 84 out-patients with borderline personality disorder (BPD) found that 20 weeks of brief dialectical behavior therapy (DBT) skills training significantly reduced suicidal and self-injurious behaviors compared to a waitlist group.

Participants receiving DBT also showed notable improvements in anger management, distress tolerance, and emotion regulation, suggesting that this brief intervention can effectively support high-risk behaviors in BPD patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A randomized trial of brief dialectical behaviour therapy skills training in suicidal patients suffering from borderline disorder. McMain, SF., Guimond, T., Barnhart, R., et al.[2022]

A comprehensive Dialectical Behavior Therapy (DBT) program was developed for patients with recent psychiatric hospitalization and significant emotion dysregulation, including a notable 58% of participants having a history of psychosis.

Preliminary evaluation showed that patients improved on most measures of suicidality, emotion regulation, and depression, with no hospitalizations or suicide attempts during treatment, indicating the program's potential efficacy and safety.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Description of a Dialectical Behavior Therapy program in a Veterans Affairs Health Care System. Phalen, P., Grossmann, J., Bruder, T., et al.[2022]

Dialectical Behavior Therapy (DBT) has been shown to significantly reduce self-directed violence, including suicide attempts and non-suicidal self-injury, based on a meta-analysis of 18 controlled trials.

DBT also decreased the frequency of psychiatric crisis services accessed by patients, indicating its effectiveness in managing acute suicidality, although it did not significantly impact suicidal ideation itself.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Dialectical Behavior Therapy Is Effective for the Treatment of Suicidal Behavior: A Meta-Analysis. DeCou, CR., Comtois, KA., Landes, SJ.[2019]

A clinical curriculum for teaching Dialectical Behavior Therapy (DBT) to psychiatry residents was developed, with 87% of participants incorporating DBT into their practice after training, indicating its effectiveness in preparing them to treat borderline personality disorder (BPD) and self-harm behaviors.

Residents who underwent the year-long DBT clinical training showed significant improvements in their ability to apply DBT techniques, enhancing their confidence and willingness to treat patients with BPD, which suggests that structured training can effectively equip future psychiatrists with essential skills.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Teaching Dialectical Behavior Therapy to Psychiatry Residents: The Columbia Psychiatry Residency DBT Curriculum. Brodsky, BS., Cabaniss, DL., Arbuckle, M., et al.[2022]

The DBT Intensive Training™ program effectively led to the adoption of Dialectical Behavior Therapy (DBT) by 75% of community teams, with each team serving an average of 118 clients, indicating its practical applicability in real-world settings.

Factors such as prior DBT experience and team dynamics significantly influenced both the adoption of DBT modes and the number of clients reached, suggesting that training effectiveness can be enhanced by addressing team composition and clinician experience.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Predictors of Adoption and Reach Following Dialectical Behavior Therapy Intensive Training™. Navarro-Haro, MV., Harned, MS., Korslund, KE., et al.[2020]

A pilot study showed that a modified dialectical behavior therapy (DBT) protocol, involving six months of weekly group skills training, significantly reduced depression symptoms in individuals with severe and persistent mental illness.

Higher attendance in the DBT sessions was linked to greater improvements in depression symptoms, quality of life, and community functioning, indicating that consistent participation is important for treatment effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Dialectical behavior therapy group skills training in a community mental health setting: a pilot study. Blackford, JU., Love, R.[2021]

Citations

1. clinicaltrials.gov clinicaltrials.gov/study/NCT02932241

Computerized DBT Skills Training for Suicidal and Heavy ... This project will consist of a randomized controlled pilot trial, an initial "strong test" of efficacy of cDBT for the treatment of HED and suicidal behaviors, ...

2. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0005789418300492

Dialectical Behavior Therapy Is Effective for the Treatment ... DBT has been shown to reduce suicide-related outcomes in published studies. •. This meta-analysis found that DBT was effective for reducing suicidal behavior. •.

3. jamanetwork.com jamanetwork.com/journals/jama/fullarticle/2789028

Effect of Offering Care Management or Online Dialectical ... Offering care management did not significantly reduce the risk of self-harm, and offering brief online dialectical behavior therapy skills training increased ...

4. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/25806661/

Dialectical behavior therapy for high suicide risk in individuals ... Results: All treatment conditions resulted in similar improvements in the frequency and severity of suicide attempts, suicide ideation, use of crisis services ...

5. tandfonline.com tandfonline.com/doi/full/10.1080/17522439.2025.2570374?src=

Pilot of Dialectical Behavior Therapy (DBT) skills training ... Specifically, we present outcome data related to emotion (depressive symptoms as measured by the Patient Health Questionnaire-9 [PHQ-9; Beard et ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8848197/

Effect of Offering Care Management or Online Dialectical ... Offering care management did not significantly reduce the risk of self-harm, and offering brief online dialectical behavior therapy skills training increased ...

7. jamanetwork.com jamanetwork.com/journals/jamapsychiatry/fullarticle/2685324

Efficacy of Dialectical Behavior Therapy for Adolescents at ... Significant advantages were found for DBT on all primary outcomes after treatment: suicide attempts (65 [90.3%] of 72 receiving DBT vs 51 ...

8. bmcpsychiatry.biomedcentral.com bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-024-06243-8

Factors associated with the implementation of dialectical ... The main aim of this study was to evaluate the effect of DBT-IT on therapists' attitudes regarding treating suicide risk and its relationship with the ...

9. paloaltou.edu paloaltou.edu/resources/business-of-practice-blog/pros-and-cons-of-dbt

Pros and Cons of DBT | CONCEPT Professional Training It reduces anxiety, depression, trauma, and stress symptoms and decreases suicidal and self-harming thoughts and behaviors. - Increases consumers' self-worth ...