2_2 Treatment of Suicidal and Self_Injurous Adolescents with Emotional Dysregula

描述（由申请人提供）：我们研究的长期目标是开发和评估针对自杀风险高的青少年的有效治疗方法，以减少自杀和自残行为，改善青少年及其家庭的功能和生活质量。本研究的主要目的是通过将辩证行为治疗（DBT）与专门为最大化内部效度而选择的个人和团体支持治疗控制条件（I/GST）进行比较，来评估辩证行为治疗（DBT）对青少年的疗效。研究对象是170名13-17岁的青少年他们具有边缘性人格特征，因自杀风险高而接受治疗。结果目标包括减少自杀行为的频率和严重程度，特别是自杀企图，住院或急诊室治疗自杀，增加维持和遵守治疗，以及增强跨多个领域的功能。在成人中，DBT在降低符合边缘型人格障碍（BPD）标准的个体中自杀企图和非自杀性自残的发生率、频率和医疗风险方面具有经验跟踪记录。然而，尽管DBT被广泛应用于有自杀倾向的青少年，尤其是那些具有BPD特征的困难（如情绪调节和冲动控制能力差）的青少年，但目前还没有针对青少年进行DBT的随机试验。因此，虽然非随机试验表明有效，但没有随机试验，我们根本不知道DBT对青少年是否有效。鉴于问题的严重性和缺乏对高危青少年的替代治疗，解决这个问题很重要。本研究的第二个目的是分析青少年自杀和自伤行为减少的中介因素。DBT基于一个理论模型，即自杀行为是高压力事件和情绪失调以及应对负面情绪和生活事件的行为技能不足的综合结果。青少年自杀和故意自伤的风险因素包括最重要的家庭冲突，但也包括与同伴、老师、损失、法律或纪律问题（压力事件）以及高度负面情绪和情绪调节能力不足。我们将分析家庭冲突的减少、父母DBT行为技能的提高、情绪失调的减少和DBT行为技能的提高对自杀行为的潜在中介作用。还将收集关于成本效益的初步数据。

DESCRIPTION (provided by applicant): The long term aim of our research is to develop and evaluate effective treatments for adolescents at high risk for suicide that will reduce suicidal and self-injurious behaviors as well as improve functioning and the quality of life of teens and their families. The primary aim of the research proposed here is to evaluate the efficacy of dialectical behavior therapy (DBT) for adolescents by comparing it to a combined individual and group supportive therapy control condition (I/GST) chosen specifically to maximize internal validity. Subjects will be 170 teens 13-17 years old with borderline personality traits referred to treatment due to high risk for suicide. Outcome targets include reduced frequency and severity of suicidal behaviors, especially suicide attempts, inpatient or ER treatment for suicidality, increased maintenance in and compliance with treatment, and enhanced functioning across multiple domains. DBT has an empirical track record with adults of reducing the incidence, frequency and medical risk of suicide attempts and non-suicidal self-injuries among individuals meeting criteria for borderline personality disorder (BPD). However, although DBT is widely used with suicidal adolescents, particularly those with difficulties characteristic of BPD such as poor emotion regulation and impulse control, no randomized trial of DBT with adolescents has been conducted. Thus, although non- randomized trials suggest effectiveness, without a randomized trial we simply do not know whether DBT for adolescents is efficacious or not. Given the severity of the problem and the lack of alternative treatments for high risk adolescents, addressing this question is important. The second aim of this research is to analyze mediators of reduced suicidal and self-injurious behaviors in adolescents. DBT is based on a theoretical model that suicidal behavior is a combined outcome of high stressful events and emotion dysregulation together with inadequate behavioral skills for coping with negative emotions and life events. Risk factors for adolescent suicide and intentional self-injury include most importantly family conflict but also conflict with peers, teachers, losses, legal or disciplinary problems (stressful events) combined with high negative emotions and inadequate abilities in emotion regulation. We will analyze the potential mediating effects on suicidal behaviors of decreases in family conflict, increases in parent DBT behavioral skills, reductions in emotion dysregulation and increases in DBT behavioral skills. Preliminary data on cost-effectiveness will also be collected.