Effectiveness of dialectical behavior therapy (DBT) in reducing suicidal behaviors and improving emotion regulation among adolescents: A systematic review
DOI: https://doi.org/10.33024/minh.v9i2.2931
Adolescents Dialectical Behavior Therapy Emotional Regulation Self-harm Suicide Systematic Review
Abstract
Background: Suicidal behavior and non-suicidal self-injury (NSSI) among adolescents are increasing globally, and the WHO ranks suicide as the third leading cause of death among adolescents. In Indonesia, the 2022 I-NAMH Survey shows that 14.4% of adolescents have suicidal thoughts and 4.7% have attempted suicide. This situation highlights the importance of interventions that can improve emotional regulation and reduce self-harming behavior. Dialectical Behavior Therapy for Adolescents (DBT-A) has shown potential, but its effectiveness among adolescents remains inconsistent.
Purpose: To evaluate the effectiveness of DBT-A in reducing suicidal behaviors and NSSI and improving emotional regulation in adolescents.
Method: A literature search was conducted via PubMed and ScienceDirect for publications from 2011 to 2025. Inclusion criteria included quantitative studies with DBT interventions in adolescents aged 12–19 years, with outcomes of suicidal ideation, self-harm, or emotional regulation. Of the 585 articles identified, 10 studies met the criteria and were assessed for quality using the Joanna Briggs Institute (JBI) instrument.
Results: DBT-A consistently reduces self-harm behavior, NSSI, and suicidal ideation. Most studies report significant improvements in emotional regulation, with the highest effectiveness seen in multi-component programs involving families. Studies with shorter durations or limited components show less stable results.
Conclusion: DBT is effective in reducing self-harm and suicidal ideation and improving emotional regulation. Structured implementation of DBT involving families, including cultural adaptation and the use of digital platforms, has the potential to expand access to services. Further research is needed to test the long-term effectiveness and application of DBT in more diverse adolescent populations.
Downloads
References
Adrian, M., McCauley, E., Berk, M. S., Asarnow, J. R., Korslund, K., Avina, C., & Linehan, M. M. (2019). Predictors and moderators of recurring self‐harm in adolescents participating in a comparative treatment trial of psychological interventions. Journal of child psychology and psychiatry, 60(10), 1123-1132.
Asarnow, J. R., Berk, M. S., Bedics, J., Adrian, M., Gallop, R., Cohen, J., & McCauley, E. (2021). Dialectical behavior therapy for suicidal self-harming youth: Emotion regulation, mechanisms, and mediators. Journal of the American Academy of Child & Adolescent Psychiatry, 60(9), 1105-1115.
Center for Reproductive Health, University of Queensland, & Johns Hopkins Bloomberg School of Public Health. (2022). Indonesia – National Adolescent Mental Health Survey (I-NAMHS) Report. Center for Reproductive Health, Faculty of Medicine, Public Health, and Nursing. Universitas Gadjah Mada. Retrieved from: https://publichealth.jhu.edu/sites/default/files/2025-05/I-NAMHS-Report-English.pdf
Fischer, S., & Peterson, C. (2015). Dialectical behavior therapy for adolescent binge eating, purging, suicidal behavior, and non-suicidal self-injury: a pilot study. Psychotherapy, 52(1), 78.
Fleischhaker, C., Böhme, R., Sixt, B., Brück, C., Schneider, C., & Schulz, E. (2011). Dialectical behavioral therapy for adolescents (DBT-A): A clinical trial for patients with suicidal and self-injurious behavior and borderline symptoms with a one-year follow-up. Child and adolescent psychiatry and mental health, 5(1), 1-10.
Ghosh, R. (2024). Effect of Mindfulness and Emotion Regulation Skills of Dialectical Behaviour Therapy on Executive Functions in Patients With Bipolar Affective Disorder, Current Episode Manic (Master's thesis, Central Institute of Psychiatry (India)).
Goldstein, T. R., Merranko, J., Rode, N., Sylvester, R., Hotkowski, N., Fersch-Podrat, R., & Birmaher, B. (2024). Dialectical behavior therapy for adolescents with bipolar disorder: a randomized clinical trial. JAMA psychiatry, 81(1).
Joanna Briggs Institute. (2020). Critical Appraisal Tools. JBI’s critical appraisal tools assist in assessing the trustworthiness, relevance and results of published papers. Retrieved from: https://jbi.global/critical-appraisal-tools
Kashani, P. A., Naderi, F., Zadeh, S. S., Hafezi, F., & EftekharSaadi, Z. (2020). Comparison of the effect of dialectical behavior therapy and emotion regulation on distress tolerance and suicide ideation in symptoms of attention deficit/hyperactivity disorder in adolescents. Psychological Achievements, 27(2), 69-88.
Kothgassner, O. D., Goreis, A., Robinson, K., Huscsava, M. M., Schmahl, C., & Plener, P. L. (2021). Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis. Psychological medicine, 51(7), 1057-1067.
Linehan, M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford press.
McCauley, E., Berk, M. S., Asarnow, J. R., Adrian, M., Cohen, J., Korslund, K., & Linehan, M. M. (2018). Efficacy of dialectical behavior therapy for adolescents at high risk for suicide: A randomized clinical trial. JAMA psychiatry, 75(8), 777-785.
Mehlum, L., Tørmoen, A. J., Ramberg, M., Haga, E., Diep, L. M., Laberg, S., & Grøholt, B. (2014). Dialectical behavior therapy for adolescents with repeated suicidal and self-harming behavior: a randomized trial. Journal of the American Academy of child & adolescent psychiatry, 53(10), 1082-1091.
Mehlum, L., Ramberg, M., Tørmoen, A. J., Haga, E., Diep, L. M., Stanley, B. H., & Grøholt, B. (2016). Dialectical behavior therapy compared with enhanced usual care for adolescents with repeated suicidal and self-harming behavior: outcomes over a one-year follow-up. Journal of the American Academy of Child & Adolescent Psychiatry, 55(4), 295-300.
Mehlum, L., Ramleth, R. K., Tørmoen, A. J., Haga, E., Diep, L. M., Stanley, B. H., & Grøholt, B. (2019). Long term effectiveness of dialectical behavior therapy versus enhanced usual care for adolescents with self‐harming and suicidal behavior. Journal of Child Psychology and Psychiatry, 60(10), 1112-1122.
Miller, A. L., Carnesale, M. T., & Courtney, E. A. (2014). Dialectical behavior therapy. Handbook of borderline personality disorder in children and adolescents, 385-401.
Millner, A. J., Lee, M. D., Hoyt, K., Buckholtz, J. W., Auerbach, R. P., & Nock, M. K. (2020). Are suicide attempters more impulsive than suicide ideators?. General hospital psychiatry, 63, 103-110.
Ministry of Health of the Republic of Indonesia. (2019). Laporan Nasional Riskesdas 2018. Badan Penelitian dan Pengembangan Kesehatan. Retrieved from: https://repository.kemkes.go.id/book/1323.
Syversen, A. M., Schønning, V., Fjellheim, G. S., Elgen, I., & Wergeland, G. J. (2024). Evaluation of dialectical behavior therapy for adolescents in routine clinical practice: a pre-post study. BMC psychiatry, 24(1), 447.
World Health Organization. (2021). Suicide worldwide in 2019: global health estimates. Retrieved from: https://iris.who.int/server/api/core/bitstreams/3bd4ac79-4347-420e-b675-948d36ab3d90/content.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Pratiwi Tangkawarow
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
