Dialectical behavioural therapy uniquely effective in reducing suicide

The success of dialectical behavioural therapy (DBT) in the treatment of suicidal behaviour cannot reasonably be attributed solely to general factors associated with receiving expert psychotherapy, say US researchers.The researchers conducted a study to systematically examine DBT in order to identify the specific elements of treatment that are necessary and sufficient for an efficacious outcome among individuals with borderline personality disorder (BPD) when compared with community treatment by experts (CTBE).In order to rule out factors widely considered to be effective across a variety of disorders, CTBE was specifically designed to maximise internal validity by controlling for a number of factors, including treatment availability, therapist sex and expertise, allegiance to therapy and institutional prestige.The study included 101 women aged 18 to 45 years with BPD and current or past suicidal behaviour who were randomised to receive one year of treatment with DBT (n=52) or CTBE (n=49). Assessments were conducted at baseline prior to informing subjects of their treatment allocation, then every four months during treatment and one year of follow-up. No suicides were recorded in either group over the two-year study. Significantly fewer suicide attempts occurred in the DBT group than in the CTBE group (23.1% versus 46%, p=0.01; hazard ratio=2.66, p=0.005). The number of patients that needed to be treated with DBT during two years of treatment plus follow-up in order to prevent one person from attempting suicide was four (NNT=4.24).In addition, fewer subjects in the DBT group made non-ambivalent suicide attempts (ie, those with high intent and planning, 5.8% versus 13.3%, p=0.18, NNT=13.3).Subjects in the DBT group had a significantly lower medical risk, were significantly less likely to visit an emergency department or to be admitted to hospital for any psychiatric reason than those in the CTBE group.Both treatments were effective in reducing the number of non-suicidal injuries and in improving suicide ideation and reasons for living but the difference in rates of change was not significant. The risk of dropping out of therapy was three times higher in the CTBE group than in the DBT group."Results indicated that DBT was superior to CTBE in preventing suicide attempts with a hazard ratio suggesting that suicide attempts can be reduced by half with DBT compared with non-behavioural therapy by experts."The hazard ratio for non-ambivalent suicide attempts was almost identical to that for suicide attempts overall (2.2 versus 2.66), suggesting that DBT may be uniquely effective in treating suicidal individuals, the researchers conclude.They add that future studies are needed to clarify which elements of DBT are essential.Reference...