How DBT Can Reduce Suicidal and Self-Harm Behavior in Youth

While some emotional issues and disorders can be treated with a variety of approaches and practices, certain mental health symptoms may benefit most from a highly specialized type of treatment. Specifically, when it comes to suicide risk and self-harm, dialectical behavior therapy (DBT) is a specialized treatment that should be considered when suicidal or self-harming behavior is present. In this post, I’ll review what DBT is and will highlight what can make this treatment uniquely effective.

What is DBT?

DBT is a type of psychotherapeutic treatment developed by Marsha Linehan. It was originally developed for the treatment of borderline personality disorder (BPD) but has shown effectiveness in helping to manage suicidal and self-harm behavior. The treatment has several components, including individual therapy, skill-based groups, and inter-session coaching (Linehan and Wilks, 2015). The treatment focuses on four types of skills in various areas: emotional regulation, distress tolerance, mindfulness, and interpersonal effectiveness.

The crucial conception of dialectics

Part of what makes DBT so unique is that its core addresses two seemingly conflicting concepts: acceptance and change. As applied to an individual’s mental and emotional struggles, the treatment acknowledges that coping more effectively in life requires a certain acceptance of distressing thoughts and feelings, while simultaneously acknowledging the need to change or modify one’s behavior and reactions. The patient making space for these two seemingly competing concepts is what helps to chip away at and rebuild the old, maladaptive coping framework of absolutist or all-or-nothing thinking. As an example, if Person A said or did X thing, the patient may historically have been prone to determine that it must mean Y, which typically is a negative and highly generalized explanation that leads the individual to feel worse.

In particular, suicidal thoughts and self-harm urges can be improved by DBT by reducing the intensity and impulsiveness that often comes with black-or-white thinking (e.g., "There's no point in living;" "I am a burden to those who love me").

Research on DBT’s effectiveness with suicidal ideation and self-harm

Research from McCauley et al. (2018) included youth ages 12 to 18 who were at risk for suicide, with participants in the study: having attempted suicide at least once; having had a history of self-injury; and having had difficulty with emotional control. Participants were randomly assigned to either a protocol of DBT or a comparison treatment, individual and group-supported therapy. Six months into the trial, suicide attempts and non-suicidal injury were significantly less likely for participants who had DBT than for the comparison treatment.

Why DBT skills may be especially effective

The four skills reviewed in DBT therapy by the therapist and applied by the patient address the intense emotionality and thinking that often correlates with suicidal thinking and behavior. At the root of the struggle for many patients who experience thoughts of suicide or self-harm is great difficulty tolerating their intense level of distress. When negative events take place and their environment feels out of control, they frequently experience panic. A rush of negative thoughts often leads to negative feelings, which then causes the individual to engage in behaviors that result in definite or potential harm. DBT encourages the patient to increase their ability to make sense of their distress and to engage in a host of techniques to reduce negative thoughts and feelings.

The psychoeducational component of mindfulness is integral to the treatment as well, helping the patient to become more aware of how the thoughts and feelings created by their brain is felt in their body. Mindfulness practices in DBT include transformative concepts for suicidal or self-harming patients, such as the "wise mind" concept. According to this concept, there are three types of mental states: the emotional mind (feelings), the rational mind (thinking), and the wise mind (a deeper understanding of what is actually true). What’s valuable about such practices is that the patient is given specific tools they can use on their own when they are confronted with thoughts of self-harm.

Finally, the component of interpersonal effectiveness provides a helpful, utilitarian way for the patient who struggles with emotional intensity to learn more adaptive coping skills so that they have more successful relationships with family members, friends, and others. Individuals who experience suicidal ideation or engage in self-harm behavior often get negatively triggered by the actions of others close to them, and DBT provides skills so that the struggling patient can learn to communicate their thoughts and feelings in a way that is productive and does not push others away or assign a level of responsibility to them that is greater than it should be.

Consider asking about dialectical behavior therapy when looking for a therapist

Therapy is most effective when the therapist’s skills are a good fit with the patient’s symptoms. If you or your child—teen or adult—is struggling with suicidal thoughts or self-harm behavior, talk openly with any prospective therapist about what skills they would use in treatment and consider asking specifically if they have received training in this particular treatment.

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If you or someone you love is contemplating suicide, seek help immediately. For help 24/7, contact the 988 Suicide & Crisis Lifeline by calling 988, or the Crisis Text Line by texting HOME to 741741. To find a therapist near you, see the Psychology Today Therapy Directory.