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

Trial Summary

What is the purpose of this trial?

This trial aims to help people with psychotic disorders manage their emotions better, as they are at high risk of suicide. By improving emotional control, the treatment hopes to reduce suicidal thoughts and behaviors in this group.

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 data supports the effectiveness of the treatment Dialectical Behavior Therapy Skills Training for suicide risk in psychosis?

Research shows that Dialectical Behavior Therapy (DBT) can help reduce suicide attempts and improve emotional regulation in patients with psychosis, as seen in a VA Health Care System program where patients showed improvements in suicidality and emotion regulation. Additionally, DBT has been effective in reducing self-harm behaviors in borderline personality disorder, suggesting its potential benefits for other mental health conditions. ^{1 2 3 4 5}

Is Dialectical Behavior Therapy (DBT) safe for humans?

Dialectical Behavior Therapy (DBT) has been shown to be safe for humans, as it is an evidence-based treatment that helps reduce self-harm behaviors and suicidal actions, particularly in individuals with borderline personality disorder. It includes safety planning measures and risk management strategies to ensure the well-being of participants during treatment. ^{1 5 6 7 8}

How is Dialectical Behavior Therapy Skills Training different from other treatments for suicide risk in psychosis?

Dialectical Behavior Therapy Skills Training is unique because it focuses on teaching practical skills to manage emotions and reduce suicidal thoughts, specifically tailored for individuals with psychosis, which is not commonly addressed by other treatments. It combines elements of cognitive-behavioral therapy with mindfulness and emotional regulation techniques, making it a comprehensive approach for those with complex mental health needs. ^{1 4 5 7 9}

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

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]

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 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]

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]

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]

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]

References

1. United States pubmed.ncbi.nlm.nih.gov

Teaching Dialectical Behavior Therapy to Psychiatry Residents: The Columbia Psychiatry Residency DBT Curriculum. [2022]

2. England pubmed.ncbi.nlm.nih.gov

Dialectical behavior therapy group skills training in a community mental health setting: a pilot study. [2021]

3. United States pubmed.ncbi.nlm.nih.gov

Predictors of Adoption and Reach Following Dialectical Behavior Therapy Intensive Training™. [2020]

4. England pubmed.ncbi.nlm.nih.gov

Description of a Dialectical Behavior Therapy program in a Veterans Affairs Health Care System. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

A randomized trial of brief dialectical behaviour therapy skills training in suicidal patients suffering from borderline disorder. [2022]

6. England pubmed.ncbi.nlm.nih.gov

Dialectical Behavior Therapy Is Effective for the Treatment of Suicidal Behavior: A Meta-Analysis. [2019]

7. United States pubmed.ncbi.nlm.nih.gov

Risk management in dialectical behavior therapy: Treating life-threatening behaviors as problems to be solved. [2022]

8. Spain pubmed.ncbi.nlm.nih.gov

Factors predicting early dropout from dialectical behaviour therapy in individuals with borderline personality disorder. [2019]

9. United States pubmed.ncbi.nlm.nih.gov

Feasibility and preliminary efficacy of dialectical behaviour therapy skills groups for Veterans with suicidal ideation: pilot. [2022]