Adolescent Characteristics that Predict Success of Mindfulness Therapy to Reduce Self-Harm and Suicidality

Adolescent Characteristics that Predict Success of Mindfulness Therapy to Reduce Self-Harm and Suicidality

 

By John M. de Castro, Ph.D.

 

The pain of depression is quite unimaginable to those who have not suffered it,  and it kills in many instances because its anguish can no longer be borne.
The prevention of many suicides will continue to be hindered until there is a general awareness of the nature of this pain.” – William Styron

 

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. (Suicide Awareness Voices of Education). It is much more prevalent with males who account for 79% of suicides. 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.

 

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. It is important to identify the characteristics of adolescents who are most likely to benefit from DBT for the reduction of suicide.

 

In today’s Research News article “Predictors and moderators of recurring self‐harm in adolescents participating in a comparative treatment trial of psychological interventions.” (See summary below or view the full text of the study at: https://onlinelibrary.wiley.com/doi/full/10.1111/jcpp.13099), Adrian and colleagues recruited adolescents with previous lifetime suicide attempt, repetitive self‐harm in the past 12 weeks, borderline personality disorder (BPD) characteristics, and clinically significant suicidal ideation. They were randomly assigned to receive 6-months of either Dialectical Behavior Therapy (DBT) or individual/group supportive therapy. They were measured before and after treatment and at the midpoint of treatment for suicide attempts, non-suicidal self-injuries, self-harm, prior self-harm severity, externalizing symptoms, other psychiatric disorders, substance abuse, PTSD symptoms, borderline personality disorder (BPD) symptoms, adolescent-parent conflict, and emotional dysregulation. In addition, their parents were measured for emotional distress and adolescent-parent conflict.

 

They found that non-white adolescents had a greater response to treatment than white adolescents in the reduction in suicide ideation. The adolescent’s pre-treatment history also affected the response to treatment with adolescents with greater levels of family conflict, more extensive self‐harm histories, and more externalizing problems having a greater reduction in self-harm. They also found that Dialectical Behavior Therapy (DBT) was more effective for adolescents who were high in emotional dysregulation and whose parents had greater psychopathology and emotional dysregulation.

 

These results are interesting and suggest that certain adolescents are more responsive to treatment than others. Non-white (particularly Latino) youths, adolescents with greater levels of family conflict, more extensive self‐harm histories, more externalizing problems, higher in emotional dysregulation and whose parents had greater psychopathology and emotional dysregulation had more positive changes produced by therapy. These factors may be used to triage which youths would be most likely to benefit from different therapies and thus may potentiate therapeutic benefits.

 

Suicide is a major problem for adolescents and self-harm, self-injury, suicide ideation, and suicide attempts are all indicators of potential lethal outcomes. So, treatment is extremely important. Dialectical Behavior Therapy (DBT) appears to be effective but it is particularly effective for certain youths. Knowing this can help target and refine therapy to improve therapeutic effectiveness in reducing suicides in adolescents.

 

So, reduce suicidality in certain adolescents with mindfulness.

 

“Being curious about your suicidal thoughts is another part of mindful observation. If you have the thought, “I should kill myself,” how does it affect the thought’s meaning to then tell yourself, “Hmm, I wonder why I just had the thought that I should kill myself?” – Stacey Freedenthal

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Molly Adrian, Elizabeth McCauley, Michele S. Berk, Joan R. Asarnow, Kathryn Korslund, Claudia Avina, Robert Gallop, Marsha M. Linehan. Predictors and moderators of recurring self‐harm in adolescents participating in a comparative treatment trial of psychological interventions. Journal of Child Psychology and Psychiatry, 30 July 2019, 60(10), 1123-1132, https://doi.org/10.1111/jcpp.13099

 

Key points

  • Adolescent prior self‐harm, externalizing problems, and reported family conflict were significant predictors of change in self‐harm, NSSI, and suicidal ideation, where adolescents with higher family conflict and less severe self‐harm history produced on average more reduction in SH from baseline to post‐treatment.
  • DBT produced better rate of improvement compared to IGST for adolescents who were emotionally dysregulation and whose parents had higher baseline emotion dysregulation and psychopathology.
  • Clinicians could consider either IGST or DBT for adolescents with self‐harm histories whose parents are well regulated and do not have impairing psychopathology. Adolescents with emotional dysregulation and parents with psychopathology and emotion dysregulation may benefit more from DBT than IGST.

Abstract

Background

In primary analyses, dialectical behavior therapy (DBT) was associated with greater reduction in self‐harm during treatment than individual/group supportive therapy (IGST). The objective of this paper was to examine predictors and moderators of treatment outcomes for suicidal adolescents who participated in a randomized controlled trial evaluating DBT and IGST.

Methods

Adolescents (N = 173) were included in the intent‐to‐treat sample and randomized to receive 6 months of DBT or IGST. Potential baseline predictors and moderators were identified within four categories: demographics, severity markers, parental psychopathology, and psychosocial variables. Primary outcomes were suicide attempts (SA) and nonsuicidal self‐injury evaluated at baseline, midtreatment (3 months), and end of treatment (6 months) via the Suicide Attempt and Self‐Injury Interview (Psychological Assessment, 18, 2006, 303). For each moderator or predictor, a generalized linear mixed model was conducted to examine main and interactive effects of treatment and the candidate variable on outcomes.

Results

Adolescents with higher family conflict, more extensive self‐harm histories, and more externalizing problems produced on average more reduction on SH frequency from baseline to post‐treatment. Adolescents meeting BPD diagnosis were more likely to have high SH frequency at post‐treatment. Analyses indicated significant moderation effects for emotion dysregulation on NSSI and SH. DBT was associated with better rates of improvement compared to IGST for adolescents with higher baseline emotion dysregulation and those whose parents reported greater psychopathology and emotion dysregulation. A significant moderation effect for ethnicity on SA over the treatment period was observed, where DBT produced better rate of improvement compared to IGST for Hispanic/Latino individuals.

Conclusions

These findings may help to inform salient treatment targets and guide treatment planning. Adolescents that have high levels of family conflict, externalizing problems, and increased level of severity markers demonstrated the most change in self‐harm behaviors over the course of treatment and benefitted from both treatment interventions. Those with higher levels of emotion dysregulation and parent psychopathology may benefit more from the DBT.

https://onlinelibrary.wiley.com/doi/full/10.1111/jcpp.13099

 

Mindfulness Training is Effective with Widely Diverse Populations

Mindfulness Training is Effective with Widely Diverse Populations

 

By John M. de Castro, Ph.D.

 

“In the last two decades, references to mindfulness-based treatments have proliferated. Its benefits are touted for many medical conditions and seem to be universally accepted as a technique to improve mental health across diverse populations.” – Sara Davin

 

Disadvantaged populations have a disproportionate share of mental health issues. Indeed, the lower the socioeconomic status of an individual the greater the likelihood of a mental disorder. It is estimated that major mental illnesses are almost 3 times more likely in the disadvantaged, including almost double the incidence of depression, triple the incidence of anxiety disorders, alcohol abuse, and eating disorders. These higher incidences of mental health issues occur, in part, due to mental health problems leading to unemployment and poverty, but also to the stresses of life in poverty.

 

Most psychotherapies were developed to treat disorders in affluent western populations and are not affordable or sensitive to the unique situations and education levels of the diverse populations. Hence, there is a great need for alternative treatments for diverse populations. One increasingly popular alternative is mindfulness practices. These include meditationtai chi, qigongyoga, guided imagery, prayer, etc. The research on the effectiveness of mindfulness practices with diverse populations is accumulating, so it makes sense to stop and summarize what has been learned.

 

In today’s Research News article “Addressing Diversity In Mindfulness Research On Health: A Narrative Review Using The Addressing Framework.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6746558/),Chin and colleagues review and summarize the published research studies on the effectiveness of mindfulness practice for various populations.

 

They report that the published studies found that mindfulness practice was beneficial regardless of age, being effective in children, adolescents, adults, and the elderly, regardless of ethnicity, including black, Hispanic, native American, and Asian populations, and regardless of sexual orientation, including lesbian, gay, bisexual, and transgender participants. Mindfulness training was also found to improve the well-being of patients with acquired disabilities including Alzheimer’s disease, diabetic peripheral neuropathy, traumatic brain injury, and multiple sclerosis. Mindfulness appears to be effective regardless of socioeconomic status, being beneficial in both affluent and poor participants and regardless of nationality, being beneficial for European Americans, Taiwanese, South Africans, British and Swedes. Finally, there’s only a small number of studies that compare the effectiveness of mindfulness practice for males versus females. In general, mindfulness practice appears to be beneficial for both genders, but possibly more beneficial for women than men.

 

These findings are quite striking and suggest that mindfulness training is beneficial for a wide variety of people with a wide variety of conditions. It is no wonder that mindfulness practice appears to be spreading rapidly, with meditation practice increasing from 4% to 14% of the US population over the last 5 years.

 

Hus, mindfulness training is effective with widely diverse populations.

 

“The application of mindfulness to diversity and inclusion is about opening and appreciating rather than rejecting difference.” – Joshua Ehrlich

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Chin, G., Anyanso, V., & Greeson, J. (2019). Addressing Diversity In Mindfulness Research On Health: A Narrative Review Using The Addressing Framework. Cooper Rowan medical journal, 1(1), 2.

 

INTRODUCTION

Over the past 5 years, the number of Americans practicing meditation has more than tripled, rising from 4% of adults in 2010 to 14% in 2017.1 This rise is likely related to the increasing focus on preventive and integrative approaches to healthcare in the United States, such as meditation, which is often used to reduce stress, anxiety, depression, and pain in conjunction with improving health and well-being.2 While many different meditative practices exist, mindfulness meditation emphasizes nonjudgmental awareness of the present moment. Although substantial research supports mindfulness-related improvements in patient-reported mental and physical health,3 the replication crisis in social science and medicine, alongside numerous methodological concerns about extant mindfulness studies,4 invites questions regarding the generalizability of research on the reported health-promoting effects of mindfulness meditation and mindfulness as an innate, dispositional quality (trait mindfulness). Moreover, as much of mindfulness research over-samples middle-to-upper class, Caucasian, women,5 the extent to which results generalize to a broader, more diverse population is unclear. One possible reason for this overrepresentation could be that this population has the time and/or finances to participate in mindfulness-based interventions (MBIs) from which researchers draw samples.

In 2001, Dr. Pamela Hays published Addressing Cultural Complexities in Practice,6 introducing the ADDRESSING framework as a guide to help clinicians better identify and understand the relevant cultural identities of their clients. According to Dr. Hays, the facets of identity include: Age, Developmental and acquired Disabilities, Religion, Ethnicity, Socioeconomic status, Sexual orientation, Indigenous heritage, National origin, and Gender. This framework allows room for intersectionality between identity facets and does not inherently exclude non-minority individuals. As such, the ADDRESSING framework, with its attention to multiple aspects of identity, provides an effective structure for organizing research published on different populations and identifying 1) which populations are represented and underrepresented in various categories and 2) what is known about underrepresented groups in research. The main purpose of this review, therefore, was to use the ADDRESSING framework to highlight mindfulness research conducted on historically underrepresented groups as both a method to summarize what has been done and to point out gaps for future research.

Overall, mindfulness can reduce stress and improve mental health in diverse populations. Given the unique stressors and mental health disparities individuals in diverse groups experience, mindfulness-related changes in mental health likely support improvements in health-related behavior, QoL and well-being.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6746558/