Muristek
Care Management or Online Dialectical Behavior Therapy Skills Training vs Usual Care and Self-harm Among Adults With Suicidal Ideation
To the Editor A recent study found that care management did not alter the risk of serious self-harm compared with treatment as usual for suicidal and self-harm ideation. Moreover, the DBT used in this study was associated with a significant increase in risk of self-harm. These findings appear to contradict evidence supporting caring interventions as suicide risk reduction and the accepted efficacy of DBT in reducing suicidality. As suggested in the related Editorial, the study findings may have been affected by the mode of implementation. Dialectical behavior therapy is a comprehensive treatment that includes individual therapy and group skills training. Even when skills training is used as a stand-alone intervention, effective implementation has included a high level of clinician engagement as well as the interpersonal context of the group training. This study demonstrates that separating DBT skills from meaningful interpersonal contact, whether through therapy or skills groups, may be detrimental, not merely ineffective.
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