A stakeholder study of Comprehensive School-Based Dialectical Behaviour Therapy for self-harm

Introduction

Self-harm is a growing concern among children and young people, and schools play an important role in supporting children and young people who engage in this behaviour. However, currently there is no established evidence-base of targeted approaches for adolescent self-harm that can be implemented in schools. Dialectical Behaviour Therapy for Adolescents (DBT-A) is an evidence-based treatment approach that has been shown to be effective in reducing adolescent self-harm in clinical settings. DBT-A has since been adapted for use in schools for ages 11+.  This study reports on a pilot that used the adapted comprehensive school-based DBT (CSB-DBT) intervention with self-harming secondary age students (ages 11-16). The aim of this study was to explore the initial views of stakeholders on potential feasibility and acceptability.

Methods

Semi-structured interviews were carried out with students, school staff and CSB-DBT therapists at one school in the South of England.  Interviews took place in person at the school. Analysis was conducted using an adapted form of thematic analysis.

Results

7 students, 14 school staff and 3 CSB-DBT therapists participated in interviews.  We found that providing CSB-DBT in a secondary school setting is feasible and acceptable. Students found the structured and group-based aspect of the therapy useful and reported using the skills taught in CSB-DBT to manage emotionally charged situations.  Having therapists readily available on the school campus helped students embed the skills they were learning in their lives and provided reassurance to staff that students were receiving the support they needed.

Discussion

These findings suggest that school based CSB-DBT may be a promising approach for supporting young people who engage in self-harm. However, before the efficacy of CSB-DBT can be established, further research is needed that robustly compares outcomes before and after treatment in students that have been randomly allocated to treatment or no treatment.