Covariation of symptomatic and mechanistic change during dialectical behavior therapy for suicidal self-harming youth

The effectiveness of psychotherapy for suicidal youth remains a public health priority. Dialectical behavior therapy (DBT; Linehan, 1993) has been recognized as a well-established treatment for suicidal youth (Witt et al., 2021). Although promising, little work has explored mechanisms of change in DBT for suicidal youth (Asarnow et al., 2021). This study aimed to examine covariation in rates of change between symptoms and theorized mechanistic variables during a randomized controlled trial of DBT for suicidal youth.

The present study was a secondary data analysis of a randomized controlled trial of DBT for 173 suicidal youth (ages 12-18; McCauley et al., 2018). Multilevel modeling was used to examine the association between person-level rates of change for self-harm (suicide attempts and nonsuicidal self-injury), suicidal ideation, DBT skills, emotion dysregulation, and reasons for living.

Both treatment groups showed statistically significant covariation between reductions in self-harm and suicidal ideation. Rates of change in self-harm and suicidal ideation decreased with improvement in emotion regulation for both treatments. An increase in endorsed reasons for living significantly covaried with reductions in self-harm and suicidal ideation within the DBT condition only.

Study results support the potential value of efforts to reduce suicidal ideation and self-harm through improving emotion regulation and demonstrate common and unique mechanisms of change across treatments for youths at elevated suicide/self-harm risk. (PsycInfo Database Record (c) 2026 APA, all rights reserved).