Dialectical behavior therapy for adolescents (DBT‐A): Outcomes among sexual minorities at high risk for suicide

Poon, Jennifer A.; Galione, Janine N.; Grocott, Lauren R.; Horowitz, Karyn; Kudinova, Anastacia Y.; Kim, Kerri L.

doi:10.1111/sltb.12828

Cited by 16 publications

(20 citation statements)

References 74 publications

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“…In primary analyses, sexual minority participants did not differ from heterosexual participants in average levels or rates of change in suicide attempts, NSSI, global functioning, or hospitalization during DBT. This finding is consistent with past studies of DBT or DBT-based treatments (Beard et al, 2017; Poon et al, 2022). With regard to therapy more broadly, this finding is similar to a past study showing no differences in rates of change in anxiety and depression between sexual minority and heterosexual clients in college counseling centers (Lefevor et al, 2017) but differed from a past study finding worse outcomes on depression, anxiety, and functional impairment for lesbian and bisexual clients compared to heterosexual clients (Rimes et al, 2019).…”

Section: Discussionsupporting

confidence: 93%

“…Theoretical work suggests that the principles and structure of DBT may be well-suited to minoritized populations given its emphasis on the impact of invalidating environments on mental health and its core dialectic between acceptance and change (Chang & Cohen, 2022; Cohen et al, 2021; Pantalone et al, 2019; Pierson et al, 2021; Skerven et al, 2019; Sloan et al, 2017). Several studies have found that sexual minority people improved comparably to heterosexual people in various psychological and functional outcomes when participating in DBT for adolescents (Poon et al, 2022) and a cognitive behavioral therapy and DBT skills-based partial hospital program (Beard et al, 2017). However, bisexual people may have worse outcomes on suicidal and self-injurious thoughts compared to other sexual identity groups (Beard et al, 2017).…”

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confidence: 99%

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Sexual identity and race/ethnicity as predictors of treatment outcome and retention in dialectical behavior therapy.

Chang¹,

Halvorson²,

Lehavot³

et al. 2023

Journal of Consulting and Clinical Psychology

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Objective: There is inconclusive evidence regarding sexual identity and race/ethnicity differences in outcomes in evidence-based psychological treatments. Although dialectical behavior therapy (DBT) is well-studied, little is known about the extent to which its efficacy generalizes to sexual minority and racial/ethnic minority people. This study examined sexual identity, race/ethnicity, and their interaction as predictors of treatment outcome and retention in DBT. Method: Data were from five clinical trials conducted in research and community settings with a variety of adult populations (N = 269) engaged in standard DBT, augmented DBT, or DBT components. Longitudinal mixed-effects models evaluated sexual identity and racial/ethnic differences in clinical outcomes (suicide attempts, nonsuicidal self-injury [NSSI], global functioning, psychiatric hospitalizations) and retention. Results: Sexual identity, race/ethnicity, and their interaction did not predict the average severity or the rate of change in any clinical outcome over time. Sexual minority identity was associated with decreased risk of treatment dropout (OR = .44, p < .001). However, this effect was moderated by race/ethnicity, such that non-Hispanic White sexual minority participants had the lowest rates of dropout. Exploratory analyses suggested potential differences related to NSSI for certain sexual and racial/ethnic minority subgroups. Conclusions: Findings suggest no significant differences in DBT treatment outcomes when comparing between sexual minority and heterosexual individuals and between non-Hispanic White and racial/ethnic minority individuals. Sexual minority identity interacted with race/ethnicity to predict dropout, such that non-Hispanic sexual minority people were more likely to complete DBT compared to sexual minority people of color and heterosexual individuals. Further research is needed to clarify potential subgroup and intersectional differences.

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Section: Discussionsupporting

confidence: 93%

mentioning

confidence: 99%

Sexual identity and race/ethnicity as predictors of treatment outcome and retention in dialectical behavior therapy.

Chang¹,

Halvorson²,

Lehavot³

et al. 2023

Journal of Consulting and Clinical Psychology

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“…Despite disproportionately high levels of depression, self-harm, and suicidal thoughts and behaviors in LGBTQIA+ youth relative to the general youth population, there remains a lack of suicide-specific mental health treatment and research addressing this disparity [ 7 ]. Preliminary research indicates that LGBTQIA+ youth who participate in adapted treatments demonstrate considerable clinical improvement after treatment [ 8 ] and that LGBTQIA+ youth describe the treatment as helpful in addressing their life stresses [ 9 ]. Given the disparities and the importance of intervening in serious mental health issues in adolescence and young adulthood, there is a critical need for more research on the efficacy of general and population-specific programming for LGBTQIA+ youth [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…This substance use intervention found that the tailored intervention led to greater reductions in substance use [ 24 ]. In 2 studies that adapted programming for LGBTQIA+ youth, youth had significantly reduced posttraumatic stress disorder symptoms [ 25 ], depression, and borderline symptoms after treatment [ 8 ]. Research on adults has similarly documented clinical improvement following adapted interventions [ 26 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and Other Minoritized Gender and Sexual Identities–Adapted Telehealth Intensive Outpatient Program for Youth and Young Adults: Subgroup Analysis of Acuity and Improvement Following Treatment

Berry¹,

Gliske²,

Schmidt³

et al. 2023

JMIR Form Res

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Background Lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other minoritized gender and sexual identities (LGBTQIA+) youth have disproportionately high levels of depression, self-harm, and suicidal thoughts and behaviors. In addition, LGBTQIA+ youth frequently report lower levels of satisfaction or comfort with their health care providers because of stigmatization, which may prevent continuation of care, yet there is a lack of mental health treatment and outcome research addressing these disparities. However, there is some indication that LGBTQIA+ individuals feel more comfortable with web-based formats, indicating that telehealth services may be beneficial for this population. Objective This program evaluation explored the effectiveness of a remote intensive outpatient program with a curriculum tailored specifically to LGBTQIA+ youth with high-acuity depression, anxiety, and suicidality. This study sought to understand baseline acuity differences between LGBTQIA+ and non-LGBTQIA+ youth and young adult patients and to determine if there were differences in clinically significant improvement by subtypes within the LGBTQIA+ population following participation in LGBTQIA+-specific programming. Methods Data were collected from intake and discharge outcome surveys measuring depression, suicidality, and nonsuicidal self-injury (NSSI) in 878 patients who attended at least six sessions of a remote intensive outpatient program for youth and young adults. Of these 878 clients, 551 (62.8%) were identified as having at least one LGBTQIA+ identity; they participated in an LGBTQIA+-adapted program of the general curriculum. Results LGBTQIA+ patients had more clinically severe intake for depression, NSSI, and suicidal ideation. Nonbinary clients had greater NSSI within the LGBTQIA+ sample at intake than their binary counterparts, and transgender clients had significantly higher depressive scores at intake than their nontransgender counterparts. LGBTQIA+ patients demonstrated improvements in all outcomes from intake to discharge. The Patient Health Questionnaire for Adolescents depression scores improved from 18.15 at intake to 10.83 at discharge, representing a 41.5% reduction in depressive symptoms. Overall, 50.5% (149/295) of the LGBTQIA+ youth who endorsed passive suicidal ideation at intake no longer reported it at discharge, 72.1% (160/222) who endorsed active suicidal ideation at intake no longer reported it at discharge, and 55.1% (109/198) of patients who met the criteria for clinical NSSI no longer met the criteria at discharge. In the subgroup analysis, transgender patients were still 2 times more likely to report clinical NSSI at discharge. Conclusions This program evaluation found substantial differences in rates of depression, NSSI, and suicidal ideation between LGBTQIA+ clients compared with their non-LGBTQIA+ counterparts. In addition, this evaluation showed a considerable decrease in symptoms when clients attended LGBTQIA+-affirming care. The findings provide support for the role of LGBTQIA+-specific programming to meet the elevated mental health needs of these youth and that more research is needed to understand barriers that may negatively affect transgender clients, specifically.

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“…Si bien el tratamiento de TDC se presenta de manera lineal y progresiva, las etapas del tratamiento con frecuencia se superponen y, a menudo, un paciente progresará en una etapa solo para retroceder nuevamente en otro momento (Koerner, 2012). Los estudios sobre los impactos de la TDC en población clínica se refieren principalmente a problemas de etapa 1 (Alba et al, 2022;Dunn et al, 2022;Hernández et al, 2022;Poon et al, 2022;Weinberg, 2022).…”

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Utilidad de la terapia dialéctica conductual abreviada para dificultades de regulación emocional en estudiantes mexicanos: Casos clínicos

Reyes-Ortega¹,

Téllez

Gil-Díaz

et al. 2023

RPPC

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La terapia dialéctica conductual (TDC) es un tratamiento con sustento empírico dirigido a personas con trastornos de salud mental complejos y considerados de difícil tratamiento; su meta final es que el paciente pueda construir una vida que valga la pena vivir. El objetivo del presente estudio fue evaluar la utilidad de la TDC para reducir la sintomatología del trastorno límite de personalidad, la depresión, la ansiedad y el estrés, y para aumentar la salud mental general y la atención plena en un grupo de estudiantes universitarios mexicanos. En una clínica universitaria de la Ciudad de México se identificaron a estudiantes que presentaron dificultades de regulación emocional y asistieron a una intervención basada en la TDC comprehensiva adaptada para una duración de seis meses. De los 19 pacientes enrolados en el programa, seis lo culminaron en su totalidad. Se encontraron mejoras en todas las variables. Los resultados sugieren que esta versión abreviada de la TDC podría ser efectiva para ayudar a estudiantes con dificultades de regulación emocional. Palabras clave: Terapia dialéctica conductual; regulación emocional; trastorno límite de personalidad; estrés.

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Dialectical behavior therapy for adolescents (DBT‐A): Outcomes among sexual minorities at high risk for suicide

Cited by 16 publications

References 74 publications

Sexual identity and race/ethnicity as predictors of treatment outcome and retention in dialectical behavior therapy.

Sexual identity and race/ethnicity as predictors of treatment outcome and retention in dialectical behavior therapy.

Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and Other Minoritized Gender and Sexual Identities–Adapted Telehealth Intensive Outpatient Program for Youth and Young Adults: Subgroup Analysis of Acuity and Improvement Following Treatment

Utilidad de la terapia dialéctica conductual abreviada para dificultades de regulación emocional en estudiantes mexicanos: Casos clínicos

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