Effective treatment offers hope to lower the rate of teen suicides

Recent reports of the rising rates of teen suicide across the nation confirm what mental health providers know – there is an urgent need to identify treatment methods that can help to reverse those frightening trends. Psychologist Michele Berk, PhD, is now co-leading a clinical program in Palo Alto, in collaboration with the Children’s Health Council, centered on the Dialectical Behavior Therapy (DBT) method. DBT is a specialized intervention for individuals with suicidal and/or self-harming behaviors. DBT includes individual therapy, group skills training with multiple families working together, and having therapist support available 24/7 by phone to the teens and parents.

Stanford Medicine Children’s Health experts like Berk see hope in expanding access to what they refer to as a continuum of care for mental health services. Experts believe that a child’s best mental health outcome depends not on one provider but on a cohesive system of care with many touch points, resources and compassionate representatives throughout the community.

“A critical component of the continuum of care is intensive outpatient care for patients as well as their families,” said Berk who has extensive background in research and clinical expertise in treating patients who experience suicidal thoughts or behaviors or engage in self-harming behaviors.

Berk says that what makes DBT different and more effective than other methods is the multi-component treatment package that focuses primarily on skills for changing behaviors, as well as provides contact with the therapist outside of therapy sessions and works on what is called a commitment to change, including a focus on acceptance as well as change.

The new program in Palo Alto, called RISE, offers DBT in an intensive outpatient therapy (IOP) format to teens ages 14 to 18 who are struggling with suicidal thoughts, suicidal behaviors and/or self-harm, as well as severe mental health challenges.

The Stanford Medicine Children’s Health announcement on August 20 describes that treatment covers the often overlooked but essential “middle ground” between weekly outpatient therapy and hospitalization and provides support for patients who are transitioning between the two. The program also offers a critical step-down option for teens who have been discharged and are returning home from psychiatric inpatient or residential stays.

Berk recently co-authored a study in JAMA Psychiatry that examined how to reduce suicide attempts in at-risk teens. The treatment tested, dialectical behavior therapy, was found to decrease self-harm and suicide attempts in young people.

As Berk noted in an interview for Stanford Medicine’s Scope Blog in May 2018, the randomized trial gave researchers scientific evidence that the treatment is effective in the adolescent population.

[Prior to the study] There was no definitive evidence on whether DBT was effective for teens. I was fortunate to be able to collaborate with Marsha Linehan, PhD, who developed DBT, and others, comparing DBT to another commonly used approach, supportive therapy.

Significantly more patients in the DBT group than in the supportive therapy comparison group told us they had not attempted suicide or engaged in self-harm at the end of the six month treatment. Both therapies helped participants improve over time, with no difference between treatments a year after the study began, but the kids who got DBT improved more quickly.

Through RISE, Berk will also lead research of the effectiveness of DBT provided in the IOP format in comparison to the standard outpatient format.

“DBT has proven to be an effective treatment for adolescents with suicidal feelings or self-harming behaviors,” said Berk. “Now we’ll try to understand which elements of the treatment have the most impact on positive outcomes. Learning what the most essential aspects of the treatment are would allow for more patients to get effective treatment, as well as more therapists to provide it.

Individuals in crisis can receive help from the Santa Clara County Suicide & Crisis Hotline at (855) 278-4204. Help is also available from anywhere in the United States via Crisis Text Line (text HOME to 741741) or the National Suicide Prevention Lifeline at 988. All three services are free, confidential and available 24 hours a day, seven days a week.

View/download the Stanford Medicine Children’s Health Mental Health Community Resource Guide

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