Description: Perhaps you have heard about the alarming increases that are being observed in rates of self-harming behavior and suicidal thoughts and actions among teenagers. These stats are often discussed in relation to the question of whether they might be linked to recent generational jumps in use of social media and the attendant shifts in the nature and extent of social contact (that I have previously posted about). Research into those questions is ongoing but a more important research question is to ask, “for those teens, what helps, what works?” One of the fundamental ethical commitments of clinical psychology and psychiatry is to only use treatment approached tools and techniques that have been shown to be effective not at the individual level but in well designed and large research projects. To have a look not just at the `what works` question but at how psychological researchers take up such questions have a rad through the article linked below. As you go though the article pay particular attention to the research/practice links and discussions.
Source: ‘The Best Tool We Have’ for Self-Harming and Suicidal Teens, Matt Richtel, The New York Times.
Date: August 27, 2022
Clearly the simple answer to the question of what works is Dialectical Behavior Therapy as demonstrated by the several large well designed, peer reviewed studies noted in the article (see links to some of that work below if you would like a closer look). The bigger picture answer, however, is more complicated and involves consideration of the cost of such treatment and of the number of levels it involves (Individual, group, and parent therapy/instruction and related supports). What is available will vary by jurisdiction (province or state). Many jurisdictions provide insurance coverage if the therapy is provided by medical professionals (Psychiatrists) or by others such as Psychologists or social workers in hospitals or other funded health settings. There are a few sample links below but you will need to research your local resources to know what is available in your area.
Questions for Discussion:
- Why are issues of self-harm or suicide particularly challenging when they involve teenagers?
- What are some of the developmental issues that contribute to a full answer to the previous question?
- What works by way of treatment and how do we know?
References (Read Further):
University of Washington (2022) Dialectical Behavior Therapy. Link
Brown, G. K., Ten Have, T., Henriques, G. R., Xie, S. X., Hollander, J. E., & Beck, A. T. (2005). Cognitive therapy for the prevention of suicide attempts: a randomized controlled trial. Jama, 294(5), 563-570. Link
Iyengar, U., Snowden, N., Asarnow, J. R., Moran, P., Tranah, T., & Ougrin, D. (2018). A further look at therapeutic interventions for suicide attempts and self-harm in adolescents: an updated systematic review of randomized controlled trials. Frontiers in psychiatry, 9, 583. Link
Berk, M. S., Starace, N. K., Black, V. P., & Avina, C. (2020). Implementation of dialectical behavior therapy with suicidal and self-harming adolescents in a community clinic. Archives of suicide research, 24(1), 64-81. Link
Tebbett-Mock, A. A., McGee, M., & Saito, E. (2021). Efficacy and sustainability of dialectical behaviour therapy for inpatient adolescents: a follow-up study. General Psychiatry, 34(4). Link
University Health Network (2022) A guide to finding dialectical behaviour therapy (Ontario). Link
eMentalHealth.ca (2022) Dialectical Behaviour Therapy (DBT) Link