Evidence Base Update of Psychosocial Treatments for Self-Injurious Thoughts and Behaviors in Youth: 2018-2024

This evidence base update investigates the empirical support of psychosocial interventions for self-injurious thoughts and behaviors (SITBs) in youth, focusing on the period since the prior review.

Two major scientific databases (PsycInfo and PubMed) were systematically searched to identify randomized controlled trials (RCTs) published or in press between June 1, 2018 and May 31, 2024.

The search yielded 11 RCTs new to this update and 1 new SITB outcome to an RCT included in the prior review. Since the prior review, Dialectical Behavior Therapy for Adolescents (DBT-A) was reclassified as Level 1: Well-established intervention for reducing adolescent suicide attempts, and Family Therapy was reclassified as Level 2: Probably efficacious for reducing youth suicide ideation (SI). Cognitive behavioral therapy-individual + family was reclassified as Level 4: Experimental for reducing youth suicide attempts. Four new RCTs examining adjunctive skills or boosters for brief interventions were rated as Level 2: Probably Efficacious for reducing SI (adjunctive mindfulness skills + Psychodynamic therapy, adjunctive skills - emotion regulation) or Level 3: Possibly Efficacious for reducing SITBs (adjunctive safety planning interventions).

DBT-A remains the sole well-established intervention for reducing SITBs, with replication by multiple independent research teams. Half the RCTs identified in this review aimed to replicate or extend prior interventions. Several newly identified trials in this review were primarily adjunctive or brief, demonstrating greater efforts to enhance the availability of interventions for SITBs in youth. Further replication of these adjunctive treatments is needed to clarify their effectiveness and potential for widespread implementation.