Dialectical behavior therapy for justice-involved veterans: randomized clinical trial protocol comparing treatment approaches for veterans with criminal-legal involvement

Criminal-legal involvement is a commonly overlooked risk factor for suicide, preceding up to 30% of suicide deaths in the United States (U.S.). Interventions to reduce risk for suicide and/or criminal-legal involvement, however, rarely address these outcomes concurrently. This paper describes a recently developed intervention, Dialectical Behavior Therapy for Justice-Involved Veterans (DBT-J), that was specifically designed to address concurrent risk of criminal-legal involvement and suicide among at-risk U.S. military Veterans. A protocol for a multisite randomized clinical trial to evaluate the efficacy of this intervention is also outlined (clinicaltrials.gov ID: NCT05974553, registered July 26, 2023). Development and evaluation of this intervention highlight necessary considerations around culture and clinical needs of the presenting population, suicide risk assessment and management strategies, and treatment engagement. Each of these considerations can be readily applied to development, evaluation, and implementation of programs for similarly at-risk populations.