Emily Cooney, Kirsten Davis, Pania Thompson, Julie
Wharewera-Mika & Joanna Stewart

• Self-harm remains a significant problem for adolescents in our country. Despite several trials focussing on treatment for selfharm, we don’t really know what works for suicidal young people.
• Dialectical Behaviour Therapy (DBT) seems effective for adults with chronic suicidality and severe emotional instability (Linehan et al, 1991, 1993, 2006, McMain et al.,
2009, Verheul et al., 2003)
• Field trials evaluating adaptations of DBT for use with adolescents suggest that DBT shows promise for young people (Goldstein et al., 2007, Katz et al., 2004, Rathus &
Miller, 2002).

?
Is comprehensive DBT acceptable to adolescents, families and clinicians in New Zealand?
?
Is random assignment acceptable to suicidal adolescents, their families and treatment services in New Zealand?
?
Are our assessments and screens feasible and acceptable?
?
Will emotionally vulnerable adolescents tolerate the screening and assessment measures?
?
What participant retention rate can we expect?

Young people (and their families) seen at two government-funded community mental health outpatient services who
– were aged between 13 and 18 years*
– had self-injured or attempted suicide in the previous 3 months
– didn’t meet criteria for a psychotic disorder or life-threatening Anorexia Nervosa
– didn’t have an intellectual disability
– could speak and read English

• Self-harm
• Suicidal ideation and reasons for living
• Substance use
• Emotion Regulation
• Therapist burnout

• Multifamily skills groups
• Individual therapy
• 24/7 phone consultation
• Consultation team for therapists
• Family sessions and parent sessions as needed

• Depended on what the team, therapist and family thought would be helpful
• Range of therapy approaches, with cognitive-behavioural therapy being the most common treatment
• Provided by clinical psychologists, social workers, occupational therapists, and alcohol & drug counsellors

If needed, participants in both conditions could access:
• Medication
• Respite care
• Hospital

15 (30%) declined
50 young people and families had an orientation meeting
Screening assessment
4 discontinued during the assessments
29 completed the pre-treatment assessment
2 not eligible
TAU = 15 DBT = 14
29

Ethnicities of participants
Other
European
3%
NZ Māori
3%
South African
7%
NZ European
77%
UK
10%

Pre-treatment characteristics of DBT and TAU participants
Treatment condition
Dialectical Behaviour
Therapy (N=14)
Gender - female - n (%) 10 (71%)
Age - mean (SD) 16.2 (.98)
# self-harm acts in past 3 months – median (SD)
7.5 (17.6)
At school - n (%) 9 (64%)
At work - n (%)
Structured activity - n
(%)
1 (7%)
10 (71%)
Treatment as Usual
(N=15)
12 (80%)
15.7 (1.1)
4 (10.1)
10 (67%)
3 (20%)
11 (73%)
Site - North - n (%) 11 (79%) 14 (93%)

Kia tupato! While nosing through these results, we can’t draw many conclusions about how the treatments compare
• Variable assessment times
• Small n
• Differences between groups before they began treatment

• 1/14 DBT participants dropped out (4/15
TAU participants ‘dropped out’)
• The mean percent of sessions missed was
9% of individual sessions, and 12% of group sessions for adolescents in DBT
(the mean percent of individual sessions missed was 29% for TAU participants).

Means and standard deviations of sessions attended and not attended across the 6 months following pre-treatment assessment
Treatment condition
Individual sessions attended
Individual sessions not attended
Group sessions attended
Group sessions not attended
DBT
Mean SD
22.6
1.9
20.3
2.6
6.4
1.8
5.3
3.1
TAU
Mean SD
6.5
3
0
0
4.1
3.8
0
0
Family sessions attended
Med reviews attended
Parent sessions attended
8
2.4
3.9
3.1
2.2
4.1
3.1
1.6
0.5
3.3
2.9
0.7

Treatment condition
Dialectical Behaviour Therapy
Treatment as Usual
60%
40%
20%
0%
9/14 9/15
1
3/14 0/15
2
Assessment period
2/14 1/15
3

• Found DBT valuable and worthwhile
• Parents wanted their own support
• Treatment ending seemed arbitrary and was too abrupt

• Adherence ratings comparable to “goldstandard” DBT outcome trials
• Therapist burnout scores were within the
‘average’ range before and after treatment
• Team support and adherence feedback were critical

• Randomisation is acceptable to families and clinicians. Dual roles of research staff complicate this
• Consider risk factors for self-harm when deciding how to randomise
• Treatment ending has to be managed very carefully
• Contagion is potentially a greater concern than with adults
• Consider recruiting outside of services

• This study was funded by the New Zealand Ministry of
Health
• We are very grateful to the following people for their help and support:
• staff from Auckland DHB
• Dr. Sue Crengle
• Dr. Sarah Fortune
• the families who took part in this research
• Dr. Melanie Harned
• Dr. Simon Hatcher
• Dr. Kathryn Korslund
• Dr. Marsha Linehan
• Dr. Sally Merry
• Dr. Alec Miller
• Dr. Jill Rathus
• the research therapists
(Mike Batcheler, Helen
Clack and Ben Te Maro)
• Sharon Rickard
• Amy Rosso
• Dr. Paul Vroegrop
• staff from Waitemata
DHB