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      Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis

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          Abstract

          Background

          Given the widespread nature and clinical consequences of self-harm and suicidal ideation among adolescents, establishing the efficacy of developmentally appropriate treatments that reduce both self-harm and suicidal ideation in the context of broader adolescent psychopathology is critical.

          Methods

          We conducted a systematic review and meta-analysis of the Dialectical Behaviour Therapy for Adolescents (DBT-A) literature on treating self-injury in adolescents (12–19 years). We searched for eligible trials and treatment evaluations published prior to July 2020 in MEDLINE/PubMed, Scopus, Google Scholar, EMBASE, and the Cochrane Library databases for clinical trials. Twenty-one studies were identified [five randomized-controlled trials (RCTs), three controlled clinical trials (CCTs), and 13 pre-post evaluations]. We extracted data for predefined primary (self-harm, suicidal ideation) and secondary outcomes (borderline personality symptoms; BPD) and calculated treatment effects for RCTs/CCTs and pre-post evaluations. This meta-analysis was pre-registered with OSF: osf.io/v83e7.

          Results

          Overall, the studies comprised 1673 adolescents. Compared to control groups, DBT-A showed small to moderate effects for reducing self-harm ( g = −0.44; 95% CI −0.81 to −0.07) and suicidal ideation ( g = −0.31, 95% CI −0.52 to −0.09). Pre-post evaluations suggested large effects for all outcomes (self-harm: g = −0.98, 95% CI −1.15 to −0.81; suicidal ideation: g = −1.16, 95% CI −1.51 to −0.80; BPD symptoms: g = −0.97, 95% CI −1.31 to −0.63).

          Conclusions

          DBT-A appears to be a valuable treatment in reducing both adolescent self-harm and suicidal ideation. However, evidence that DBT-A reduces BPD symptoms was only found in pre-post evaluations.

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          Most cited references62

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          Measuring inconsistency in meta-analyses.

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            Conducting Meta-Analyses inRwith themetaforPackage

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              Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs

              Effect sizes are the most important outcome of empirical studies. Most articles on effect sizes highlight their importance to communicate the practical significance of results. For scientists themselves, effect sizes are most useful because they facilitate cumulative science. Effect sizes can be used to determine the sample size for follow-up studies, or examining effects across studies. This article aims to provide a practical primer on how to calculate and report effect sizes for t-tests and ANOVA's such that effect sizes can be used in a-priori power analyses and meta-analyses. Whereas many articles about effect sizes focus on between-subjects designs and address within-subjects designs only briefly, I provide a detailed overview of the similarities and differences between within- and between-subjects designs. I suggest that some research questions in experimental psychology examine inherently intra-individual effects, which makes effect sizes that incorporate the correlation between measures the best summary of the results. Finally, a supplementary spreadsheet is provided to make it as easy as possible for researchers to incorporate effect size calculations into their workflow.
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                Author and article information

                Journal
                Psychol Med
                Psychol Med
                PSM
                Psychological Medicine
                Cambridge University Press (Cambridge, UK )
                0033-2917
                1469-8978
                May 2021
                20 April 2021
                : 51
                : 7
                : 1057-1067
                Affiliations
                [1 ]Department of Child and Adolescent Psychiatry, Medical University of Vienna , Vienna, Austria
                [2 ]Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna , Vienna, Austria
                [3 ]Outpatient Unit for Research, Teaching and Practice, Faculty of Psychology, University of Vienna , Vienna, Austria
                [4 ]School of Psychology, Te Herenga Waka – Victoria University of Wellington , Wellington, New Zealand
                [5 ]Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University , Mannheim, Germany
                [6 ]Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm , Ulm, Germany
                Author notes
                Author for correspondence: Oswald D. Kothgassner, E-mail: oswald.kothgassner@ 123456meduniwien.ac.at
                Author information
                https://orcid.org/0000-0002-3243-0238
                https://orcid.org/0000-0001-8994-964X
                https://orcid.org/0000-0002-9367-7445
                https://orcid.org/0000-0003-0089-5505
                https://orcid.org/0000-0003-0141-0821
                https://orcid.org/0000-0003-4333-1494
                Article
                S0033291721001355
                10.1017/S0033291721001355
                8188531
                33875025
                b9a1a3c0-5135-4f50-9f76-32052617ffe8
                © The Author(s) 2021

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 23 October 2020
                : 22 March 2021
                : 26 March 2021
                Page count
                Figures: 3, Tables: 2, References: 62, Pages: 11
                Categories
                Review Article

                Clinical Psychology & Psychiatry
                adolescence,borderline personality disorder,dbt-a,self-harm,self-injury,suicidal ideation

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