In 2008, Norwegian researchers started a long-term study: 77 Norwegian adolescents participated in the first randomized controlled trial (RCT) of Dialectical Behaviour Therapy for Adolescents (DBT-A) globally. Half of them got standard treatment in child and youth psychiatry, while the other half received DBT-A treatment.
DBT is a common treatment for Borderline Personality Disorder (BPD). Some of the study participants had this diagnosis, others not. In 2008, many professionals were still reluctant to diagnose adolescents with BPD, partly due to fear of stigmatization.
However, all of the 77 youngsters fulfilled at least three of the diagnosis criteria; repeated self-harm was one of them.
A better effect than standard treatment
“This study was the first to demonstrate that DBT-A had a significantly better effect than standard treatment on deliberate self-harm, even after three years. Later, studies in Spain and the US have shown similar results,” Iselin Solerød Dibaj says, a PhD student at the National Centre for Suicide Research and Prevention, part of University of Oslo.
However, even though the treatment is effective for many patients, there are differences in how fast and how much people improve, she adds. In the recent study, Dibaj and colleagues performed secondary analyses on data from the former follow-up studies.
“We found that DBT-A not only was associated with faster reduction of deliberate self-harm, but also seems to have a positive effect on emotion regulation three years later,” Dibaj says.
Emotion regulation improved over time
In addition to receiving DBT-A, lower levels of depressive symptoms and longer history of deliberate self-harm were related to faster reduction of deliberate self-harm, according to the study.
Second, the results revealed a subgroup of patients with stable high levels of emotion dysregulation over a 3-year period, compared to another group reporting improved emotion regulation over time. Interestingly, DBT-A was associated with belonging to the latter group.
“There are many reasons for why adolescents self-harm, however the most commonly reported is attempt to regulate intense and unpleasant emotions. DBT-A is based on the assumption that these patients need help to learn strategies to regulate their emotions in a less harmful way,” Dibaj says.
In fact, the ability to effectively regulate one’s emotions is one of the most important things we learn while growing up, she explains.
“It forms the basis of our abilities to function in society, to form lasting, healthy relationships and is closely related to good mental health,” Dibaj says.
Treatment of self-harm might influence emotion regulation
Still, few studies actually report on how emotion regulation changes during treatment, so in this study the researchers wanted to explore this further, she explains.
“Our results so far suggest that effective treatment of deliberate self-harm in adolescence might influence development of emotion regulation in the longer term, as well as reduce burden of disease in an important developmental phase. However, emotion regulation is a complex process still under development during adolescence,” Dibaj says.
In her PhD, she is doing further follow-up studies on the study participants, who are now 25-30 years old. These results have yet to be published.
“Future studies with longer follow-up intervals can provide more insight into whether the effect we see remains stable into adulthood and is associated with long-term psychological health, functioning and quality of life,” Dibaj says.
Read about former studies from the project:
For 15 years, University of Oslo researchers have followed study participants who received DBT-A treatment in adolescence.
• The first study, from 2014, indicated that this treatment had better effect than standard treatment on deliberate self-harm, depressive symptoms and suicidal thoughts throughout the 19-week treatment period.
• One year after treatment, the effect on self-harm was still strongest in the DBT-A group. The effect on depressive symptoms and suicidal thoughts was now equal between both groups; the control group had caught up with the DBT-A patients on all outcomes except for deliberate self-harm.
• Three years after treatment, the results were similar to one year after. DBT-A remained superior in reduction of DSH, and there was otherwise no sign of symptom relapse in neither group.