2 - (SYM 8) Understanding Treatment Response to Dialectical Behavior Therapy for Suicidal and Self-harming Adolescents: Remission, Recovery and Trajectories of Response

Despite the urgent need to reduce suicide rates among adolescents, there are few evidence-based treatment approaches and additional research on understanding the nuances of treatment response is needed. Few studies have described rates of remission, recovery, relapse, and recurrence of suicide attempts (SA), non-suicidal self-injury (NSSI) and self-harm (SH, defined as SA and NSSI combined) in response to suicide-focused treatments.  In addition, few studies have described patterns or trajectories of treatment response for suicide-related outcomes over time. This knowledge is critical for preventing youth suicide and suicidal behavior by informing how to match adolescents to optimal treatment approaches, decide when to switch or augment treatments, and provide accurate estimates of prognosis.  This presentation will describe recent findings on rates of remission, recovery, relapse, and recurrence rates for SA and NSSI in the Collaborative Adolescent Research on Emotions and Suicide (CARES) Study, as well as on trajectories of treatment response for suicidal ideation (SI) and SH in this sample. The CARES Study was a large, multisite RCT testing the effectiveness of DBT with a sample of adolescents with suicide attempts, repetitive self-harm, and elevated suicidal ideation (SI). Participants received 6-months of either dialectical behavior therapy (DBT) or individual and group supportive therapy (IGST). In this presentation, we will discuss results showing higher rates of remission and recovery and lower rates of relapse and recurrence for both SA and NSSI for DBT versus IGST. In addition, we will discuss the high remission and recovery rates observed for SA for DBT, as well as the lower rates observed for remission and recovery of NSSI than for SA across conditions. We will also describe findings on trajectories of treatment response over time for SI and SH, with results showing a substantial percentage of youth, including those with high levels of baseline SI and SH, with trajectories of improvement; as well as a subset of youth with high suicide risk that do not appear to respond to treatment and may worsen while in treatment. We will discuss the clinical implications of all results presented and directions for future research.