Dialectical Behavior Therapy (DBT) Applied to College Students: A Randomized Clinical Trial

Journal of Consulting and Clinical Psychology (Impact Factor: 4.85). 06/2012; 80(6). DOI: 10.1037/a0029096
Source: PubMed


College counseling centers (CCCs) are increasingly being called upon to treat highly distressed students with complex clinical presentations. This study compared the effectiveness of Dialectical Behavior Therapy (DBT) for suicidal college students with an optimized control condition and analyzed baseline global functioning as a moderator.

The intent-to-treat (ITT) sample included 63 college students between the ages of 18 and 25 years who were suicidal at baseline, reported at least 1 lifetime nonsuicidal self-injurious (NSSI) act or suicide attempt, and met 3 or more borderline personality disorder (BPD) diagnostic criteria. Participants were randomly assigned to DBT (n = 31) or an optimized treatment-as-usual (O-TAU) control condition (n = 32). Treatment was provided by trainees, supervised by experts in both treatments. Both treatments lasted 7-12 months and included both individual and group components. Assessments were conducted at pretreatment, 3 months, 6 months, 9 months, 12 months, and 18 months (follow-up).

Mixed effects analyses (ITT sample) revealed that DBT, compared with the control condition, showed significantly greater decreases in suicidality, depression, number of NSSI events (if participant had self-injured), BPD criteria, and psychotropic medication use and significantly greater improvements in social adjustment. Most of these treatment effects were observed at follow-up. No treatment differences were found for treatment dropout. Moderation analyses showed that DBT was particularly effective for suicidal students who were lower functioning at pretreatment.

DBT is an effective treatment for suicidal, multiproblem college students. Future research should examine the implementation of DBT in CCCs in a stepped care approach.

Download full-text


Available from: Jacqueline Pistorello, May 08, 2014
35 Reads
  • Source
    • "For each episode of each behavior, the L-SASI assesses participants' intent to die (none, clear, or ambivalent), type of medical attention received (if applicable), and level of lethality. No psychometric studies pertaining to the L-SASI have been performed; however, the items comprising the L-SASI are drawn from the Suicide Attempt Self-Injury Interview (SASII; Linehan et al., 2006), which has been found to demonstrate high inter-rater reliability and adequate validity (e.g., Pistorello et al., 2012). Based on the responses to this interview, three suicide-related outcome variables (i.e., lifetime number of suicide attempts with clear intent to die, lifetime number of suicide attempts with clear or ambivalent intent to die, and suicide potential) were calculated and examined as outcome variables in primary analyses. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Several theories posit a direct role of impulsivity in suicidal behavior. The interpersonal-psychological theory of suicidal behavior (IPTS) argues that the relationship between impulsivity and suicidal behavior is explained by the painful and/or provocative experiences (PPEs) often encountered by impulsive individuals. It thus seems plausible that nonsuicidal self-injury (NSSI), itself associated with impulsivity, might account for the relationship between impulsivity and suicidal behavior. We examined data from 93 adult inpatients (54.8% male) seeking treatment for substance use disorders. Patients completed a structured interview assessing prior suicidal behavior and a series of self-report questionnaires examining impulsivity, NSSI, and psychopathology. Four impulsivity dimensions (negative urgency, positive urgency, lack of premeditation, lack of perseverance) were associated with lifetime number of suicide attempts and/or suicide potential. Furthermore, results supported our hypotheses, as all but one relation was better accounted for by NSSI and, in the one exception, the direct effect was non-significant. Findings are consistent with the IPTS and suggest suicidal behavior may not be a direct manifestation of impulsivity, but facilitated through exposure to PPEs capable of altering an individual's relationship to pain and fear of death.
    08/2014; 218(1-2). DOI:10.1016/j.psychres.2014.03.031
  • Source
    • "Only suicidal behavior with clear intent to die was utilized as an outcome variable in this study (in order to avoid any spurious results when examining the role of NSSI in explaining the relationship between distress intolerance and suicidal behavior). No psychometric studies pertaining to the L-SASI have been performed; however, the items comprising the L-SASI are drawn from the Suicide Attempt Self-Injury Interview (SASII) [27], which has been found to demonstrate high inter-rater reliability and adequate validity (e.g., Pistorello et al. [28]). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Although some theorists conceptualize the relationship between emotion dysregulation and suicidal behavior as direct, recent research suggests that this relationship may be indirect and mediated by repeated experiences with certain behaviors (e.g., non-suicidal self-injury; NSSI) common among individuals with heightened emotion dysregulation. To date, however, this research has been limited in both scope (e.g., examining few components of emotion dysregulation) and generalizability (e.g., over-emphasis on undergraduate samples). This study sought to extend the research in this area by examining the mediating role of NSSI in the association between one relevant aspect of emotion dysregulation (i.e., low distress tolerance [DT]) and suicidal behavior with a clear intent to die among an at-risk sample of substance use disorder (SUD) patients in residential treatment. SUD patients (N=93) completed a structured interview assessing past suicidal behavior and questionnaires assessing DT and NSSI. Consistent with hypotheses, results revealed a significant indirect association between low DT and lifetime suicide attempts through NSSI frequency. These results suggest that exposure to painful and provocative events through experience with NSSI may be one pathway through which certain facets of emotion dysregulation increase the risk for suicidal behaviors (consistent with theories that individuals low in DT may be unable and/or unwilling to engage in suicidal behavior unless they have experienced sufficient levels of painful and/or provocative events capable of changing their relationship with and experience of pain and fear of death).
    Comprehensive psychiatry 05/2013; 54(7). DOI:10.1016/j.comppsych.2013.04.005 · 2.25 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In this study we investigated 3 domains of emotional functioning-emotion dysregulation, distress tolerance, and experiential avoidance-in young adult outpatients with borderline personality disorder (BPD) symptoms. Participants were 40 young adult outpatients at a university counseling center who reported current suicidal ideation and met diagnostic criteria for BPD or experienced subthreshold BPD symptoms (i.e., met diagnostic criteria for 3 or 4 symptoms). Participants completed 3 self-report measures of emotional functioning-experiential avoidance (Acceptance and Action Questionnaire-2; Bond et al., 2011; Hayes et al., 2004), emotion dysregulation (Difficulties in Emotion Regulation Scale; Gratz & Roemer, 2004), and distress tolerance (Distress Tolerance Scale; Simons & Gaher, 2005)-and a behavioral measure of distress tolerance (Paced Auditory Serial Addition Task-Computerized; Lejuez, Kahler, & Brown, 2003), in addition to self-report measures of depression and BPD symptom severity. Partial correlations demonstrated that both emotion dysregulation and experiential avoidance were significantly associated with BPD symptom severity after accounting for depression. However, neither the self-report nor behavioral measure of distress tolerance were related to BPD symptom severity. A regression analysis with emotion dysregulation and experiential avoidance as independent variables revealed that only experiential avoidance was significantly associated with BPD symptom severity after controlling for depression symptoms. The current findings suggest that experiential avoidance may be a central process in BPD symptom severity. Future research directions are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved).
    Personality Disorders: Theory, Research, and Treatment 07/2011; 3(4). DOI:10.1037/a0023703 · 3.54 Impact Factor
Show more