Self‐harm and self‐regulation in urban ethnic minority youth: a pilot application of dialectical behavior therapy for adolescents

Abstract

BackgroundDifficulties in coping with stress and regulating emotions are transdiagnostic risk factors for self‐harming behavior. Due to sociocultural stressors, ethnic minority adolescents may be at greater risk for self‐regulation difficulties and self‐harm. Dialectical behavior therapy for adolescents (DBT‐A) frames adaptive skill acquisition as a mechanism of change, but few studies have investigated its impact on ethnic minority adolescents’ self‐regulation (i.e. coping, emotion regulation). Therefore, this pilot study examined relations between self‐regulation and self‐harm among ethnic minority adolescents and investigated changes in their self‐regulation upon completing DBT‐A.MethodsA clinically referred sample of 101 ethnic minority adolescents (Mage = 14.77; female = 69.3%) completed questionnaires about a history of self‐harm, coping (DBT Ways of Coping Checklist), and emotion regulation (Difficulties in Emotion Regulation Scale). Of the initial sample, 51 adolescents (Mage = 14.73; female = 80.4%) entered a 20‐week DBT‐A program due to self‐harm and/or Borderline Personality features.ResultsIn a pretreatment sample, the frequency of dysfunctional coping, but not of adaptive coping, differentiated self‐injurers from non‐self‐injurers. Full information maximum likelihood estimation was used to address high attrition (60.8%) from DBT‐A. Those who completed DBT‐A (n = 20) reported significantly improved emotion regulation. Adaptive coping at pretreatment predicted increased DBT skills use at post‐treatment.ConclusionsThis non‐randomized pilot study highlights dysfunctional coping and emotion dysregulation as risk factors for self‐harm and suggests that 20‐week DBT‐A may help improve emotion regulation. Future research should employ a randomized design to further examine the effect of DBT‐A on these transdiagnostic processes of psychopathology.Key Practitioner Message Due to cultural and environmental stressors, ethnic minority adolescents may be at greater risk for developing self‐regulatory difficulties – transdiagnostic mechanisms known to underly self‐harming behaviors; however, we know little about whether empirically supported treatments for self‐harm will improve youth’s coping and emotion regulation. In a clinically referred, pretreatment sample of ethnic minority youth, levels of BPD symptomatology, emotion dysregulation, and dysfunctional coping, but not of adaptive coping, differentiated teens who self‐harmed from those who did not. Self‐harming ethnic minority youth who participated in an uncontrolled, pilot trial of dialectical behavior therapy for adolescents (DBT‐A) at an urban mental health clinic reported improved emotion regulation at post‐treatment. Baseline emotion regulation skills were not predictive of treatment‐related changes, suggesting that other factors, such as DBT‐A, may have played a decisive role in improving teens’ emotion regulation. In contrast, adaptive coping skills at pretreatment were linked to increased DBT skills use at post‐treatment, indicating that patients’ baseline coping skills may play a predictive role in psychotherapy outcomes. Future research should employ a randomized control trial to examine the effect of DBT‐A on vulnerable ethnic minority youth’s development of self‐regulation. It should also investigate the hypothesized mediating role of self‐regulation in effecting lasting clinical gains.

The inclusion of ethnoracial, sexual, and gender minority groups in randomized controlled trials of dialectical behavior therapy: A systematic review of the literature.

“…This indicates a need for future studies that overrecruit and/or focus exclusively on ethnoracial, sexual, and gender minority groups. To date, these types of studies have been conducted using non-RCT designs, such as pre–post studies of DBT with American Indian/Alaska Native adolescents (Beckstead et al, 2015), ethnic minority youth (Berk et al, 2020; Yeo et al, 2020), and sexual minority veterans (Cohen et al, 2021). Future research utilizing RCT designs and/or larger samples of ethnoracial, sexual, and gender minority participants is needed to expand DBT’s evidence base for individuals from these groups.…”

Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis

“…Preliminary research provides tentative support for these mechanisms of change. In a non-randomized pilot of DBT-A among a small sample of ethnic minority adolescents, adaptive coping at pretreatment predicted subsequent increased use of DBT skills at post-treatment (Yeo et al, 2020 ). Secondary analysis of McCauley et al ( 2018 ) revealed that adolescents who reported higher emotion dysregulation at baseline, and whose parents reported greater psychopathology and emotion dysregulation demonstrated greater reduction in self-harm following 6-months of DBT-A treatment (Adrian et al, 2019 ).…”

The Co-occurrence of Self-Harm and Aggression: A Cognitive-Emotional Model of Dual-Harm

“…The absence of any of these components would indicate emotional dysregulation (Gratz and Roemer, 2004). The above definition has been shown to be clinically useful, with research demonstrating a relationship between the emotional regulation components and harmful behaviours (Gratz, 2007;Peh et al, 2017;Velotti et al, 2020;Yeo et al, 2020).…”