Enhanced Dialectical Behavior Therapy for Adolescents: Impacts of Individualized Skills Coaching on Constructs of Suicidality

Background Suicide is a leading cause of death and significant concerns for adolescents and young adults. Dialectical Behavior Therapy for Adolescents (DBT-A) is an evidence-based intervention that effectively reduces life-threatening behaviors. Limited research examines the impact of adding individualized skills coaching sessions (ISCS) to the DBT-A model, a novel intervention referred to in this paper as “Enhanced DBT-A.” This study evaluates the effectiveness of Enhanced DBT-A in reducing suicidality over 1 year of treatment in an outpatient and intensive outpatient setting.Objective Determine the effectiveness of ISCS in reducing suicidal ideation (SI) and behavior among adolescents in comprehensive DBT (as evidenced by standardized measures including the PHQ-A, C-SSRS, and BRFL-A).Methods Participants (n = 47, Mage = 17.8 years), who were predominantly white (85.1%) and female (78.7%), engaged in Enhanced DBT-A services, including individual therapy, group skills training, phone coaching, and ISCS. Participants completed assessment batteries at intake, 6 months, and 1 year, and the outcome measures assessed participants’ severity and intensity of SI, reasons for living, and depressive symptoms.Results Mixed-effects analyses revealed significant improvements in SI and some improvements in reasons for living, and depressive symptoms across the first year of treatment, with the most substantial gains occurring within the first 6 months. Importantly, participation in more ISCS was associated with greater reductions in SI, as measured by the C-SSRS.Conclusion These results suggest that Enhanced DBT-A may provide added benefits beyond standard DBT-A by offering participants additional, individualized opportunities to engage in skill acquisition, rehearsal, and application.Trial Registration: ClinicalTrials.gov Identifier: NCT07256496; Compass Behavioral Health Protocol Record: Pro00078098.