Reduce the Risk of Suicide in Adolescents with Mindfulness
By John M. de Castro, Ph.D.
“results support DBT as the first well-established, empirically supported treatment for decreasing repeated suicide attempts and self-harm in youths.” — Christina Vogt
Around 43,000 people take their own lives each year in the US. Someone dies from suicide every 12.3 minutes. Worldwide over 800,000 people die by suicide every year. The problem is far worse than these statistics suggest as it has been estimated that for every completed suicide there were 12 unsuccessful attempts. In other words, about a half a million people in the U.S. attempt suicide each year. Yet compared with other life-threatening conditions there has been scant research on how to identify potential suicide attempters, intervene, and reduce suicidality.
Adolescence can be a difficult time, fraught with challenges. During this time the child transitions to young adulthood; including the development of intellectual, psychological, physical, and social abilities and characteristics. There are so many changes occurring during this time that the adolescent can feel overwhelmed and unable to cope with all that is required. This can produce despair leading to suicide. Indeed, suicide is the second leading cause of death in adolescents.
Mindfulness training for children and adolescents has been shown to have very positive effects. These include academic, cognitive, psychological, and social domains. Mindfulness training has been shown to improve emotion regulation and to benefit the psychological and emotional health of adolescents. Importantly, mindfulness training with children and adolescents appears to improve the self-concept, improve attentional ability and reduce stress. This suggests that mindfulness practices may be effective in reducing the risk of suicide in adolescents. Indeed, mindfulness training has been shown to reduce suicidality.
Dialectical Behavior Therapy (DBT) is a mindfulness-based therapy targeted at changing the problem behaviors including self-injury and suicide. Behavior change is accomplished through focusing on changing the thoughts and emotions that precede problem behaviors, as well as by solving the problems faced by individuals that contribute to problematic thoughts, feelings and behaviors. In DBT five core skills are practiced; mindfulness, distress tolerance, emotion regulation, the middle path, and interpersonal effectiveness. Hence it makes sense to review the published research studies examining the effectiveness of DBT for the reduction of the risk of suicide in adolescents.
In today’s Research News article “Recent advances in understanding and managing self-harm in adolescents.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6816451/), Clarke and colleagues review and summarize the published research studies on the use of various therapeutic techniques including Dialectical Behavior Therapy (DBT) for the reduction of the risk of suicide in adolescents. They report that the published research supports the ability of mindfulness-based interventions, especially DBT for the reduction of self-injurious behaviors in adolescents with a high risk of suicide. It appears that the most important components for the effectiveness of DBT are “family involvement, emotion regulation skills, communication skills, and problem-solving skills.” As a result, they deem DBT as “the first and only “well-established” treatment for suicidal and [self-injurious] adolescents.”
So, reduce the risk of suicide in adolescents with mindfulness.
“One RCT of DBT with adolescents has been conducted in Norway demonstrating greater reductions in self-harm behaviors than enhanced usual care at 19 week and one year follow-up.” Michele Berk
CMCS – Center for Mindfulness and Contemplative Studies
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Clarke, S., Allerhand, L. A., & Berk, M. S. (2019). Recent advances in understanding and managing self-harm in adolescents. F1000Research, 8, F1000 Faculty Rev-1794. doi:10.12688/f1000research.19868.1
Adolescent suicide is a serious public health problem, and non-suicidal self-injury (NSSI) is both highly comorbid with suicidality among adolescents and a significant predictor of suicide attempts (SAs) in adolescents. We will clarify extant definitions related to suicidality and NSSI and the important similarities and differences between these constructs. We will also review several significant risk factors for suicidality, evidence-based and evidence-informed safety management strategies, and evidence-based treatment for adolescent self-harming behaviors. Currently, dialectical behavior therapy (DBT) for adolescents is the first and only treatment meeting the threshold of a well-established treatment for self-harming adolescents at high risk for suicide. Areas in need of future study include processes underlying the association between NSSI and SAs, clarification of warning signs and risk factors that are both sensitive and specific enough to accurately predict who is at imminent risk for suicide, and further efforts to sustain the effects of DBT post-treatment. DBT is a time- and labor-intensive treatment that requires extensive training for therapists and a significant time commitment for families (generally 6 months). It will therefore be helpful to assess whether other less-intensive treatment options can be established as evidence-based treatment for suicidal adolescents.