title: Dialectical Behavioral Therapy for Adolescents (DBT-A): a clinical Trial for Patients with suicidal and self-injurious Behavior and Borderline Symptoms with a one-year Follow-up.
abstract: BACKGROUND
  To date, there are no empirically validated treatments of good quality for adolescents showing suicidality and non-suicidal self-injurious behavior. Risk factors for suicide are impulsive and non-suicidal self-injurious behavior, depression, conduct disorders and child abuse. Behind this background, we tested the main hypothesis of our study; that Dialectical Behavioral Therapy for Adolescents is an effective treatment for these patients.
  
  
  METHODS
  Dialectical Behavioral Therapy (DBT) has been developed by Marsha Linehan - especially for the outpatient treatment of chronically non-suicidal patients diagnosed with borderline personality disorder. The modified version of DBT for Adolescents (DBT-A) from Rathus & Miller has been adapted for a 16-24 week outpatient treatment in the German-speaking area by our group. The efficacy of treatment was measured by a pre-/post- comparison and a one-year follow-up with the aid of standardized instruments (SCL-90-R, CBCL, YSR, ILC, CGI).
  
  
  RESULTS
  In the pilot study, 12 adolescents were treated. At the beginning of therapy, 83% of patients fulfilled five or more DSM-IV criteria for borderline personality disorder. From the beginning of therapy to one year after its end, the mean value of these diagnostic criteria decreased significantly from 5.8 to 2.75. 75% of patients were kept in therapy. For the behavioral domains according to the SCL-90-R and YSR, we have found effect sizes between 0.54 and 2.14.During treatment, non-suicidal self-injurious behavior reduced significantly. Before the start of therapy, 8 of 12 patients had attempted suicide at least once. There were neither suicidal attempts during treatment with DBT-A nor at the one-year follow-up.
  
  
  CONCLUSIONS
  The promising results suggest that the interventions were well accepted by the patients and their families, and were associated with improvement in multiple domains including suicidality, non-suicidal self-injurious behavior, emotion dysregulation and depression from the beginning of therapy to the one-year follow-up.
authors.affiliation: Division of Child and Adolescent Psychiatry and Psychotherapy, Department of Psychiatry and Psychosomatic Medicine, Albert Ludwig University Medical Center Freiburg, Hauptstr. 8, 79104 Freiburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Fleischhaker
authors.affiliation: Gemeinschaftspraxis Kinder- und Jugendpsychiatrie Dres. Renate Böhme und Mariele Ritter-Gekeler, Hauptstr. 49, 79379 Müllheim, Germany.
authors.forename: Renate
authors.initials: R
authors.lastname: Böhme
authors.affiliation: Division of Child and Adolescent Psychiatry and Psychotherapy, Department of Psychiatry and Psychosomatic Medicine, Albert Ludwig University Medical Center Freiburg, Hauptstr. 8, 79104 Freiburg, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Sixt
authors.affiliation: Division of Child and Adolescent Psychiatry and Psychotherapy, Department of Psychiatry and Psychosomatic Medicine, Albert Ludwig University Medical Center Freiburg, Hauptstr. 8, 79104 Freiburg, Germany.
authors.forename: Christiane
authors.initials: C
authors.lastname: Brück
authors.affiliation: Division of Child and Adolescent Psychiatry and Psychotherapy, Department of Psychiatry and Psychosomatic Medicine, Albert Ludwig University Medical Center Freiburg, Hauptstr. 8, 79104 Freiburg, Germany.
authors.forename: Csilla
authors.initials: C
authors.lastname: Schneider
authors.affiliation: Division of Child and Adolescent Psychiatry and Psychotherapy, Department of Psychiatry and Psychosomatic Medicine, Albert Ludwig University Medical Center Freiburg, Hauptstr. 8, 79104 Freiburg, Germany.
authors.forename: Eberhard
authors.initials: E
authors.lastname: Schulz