Introduction
Repeated deliberate self-harm (DSH) in adolescence is associated with increased risk of suicide attempts, psychopathology and emotion dysregulation in adulthood. Dialectical behavioural therapy (DBT-A) has previously been shown to be effective in reducing DSH, however less is known about 1) What predicts DSH reduction in treatment, and 2) Whether DSH remission in adolescence can predict later emotion dysregulation.
Methods
A randomized controlled trial comparing DBT-A with enhanced usual care in adolescents (N=77) with repeated DSH and borderline features, with follow-up assessments extending to 12.4 years post randomization. Two studies from this trial will be presented: The first study investigated baseline predictors of different trajectories of DSH reduction, that were first identified by Latent Class Analysis. The second study applied a causal inference mediation framework, to examine direct effect of DSH remission on adult emotion dysregulation, and whether this was mediated through reductions in dysfunctional coping strategies.
Results
Early DSH reduction during treatment was predicted by lower levels of baseline depressive symptoms, longer histories of DSH and receiving DBT-A. DSH remission one year after treatment predicted better emotion regulation in adulthood, and this effect was direct and not mediated through use of dysfunctional coping strategies.
Conclusions
Early remission of deliberate self-harm in psychotherapy with adolescents can have long-term consequences for emotion regulation capacity in adulthood.