CARES: Collaborative Adolescent Research on Emotions and Suicide: An RCT of DBT for Adolescents

At a glance

Funded by: NIMH 2011-2016
Principal Investigator(s): Marsha Linehan
Research Team:
Participating Agencies: Seattle Children’s Hospital Harbor UCLA
Research Setting: University of Washington Behavioral Research and Therapy Clinics University of California Los Angeles


The objective of this clinical trial was to evaluate the efficacy of dialectical behavior therapy (DBT) compared with individual and group supportive therapy (IGST) for reducing suicide attempts, nonsuicidal self-injury, and overall self-harm among high-risk youths.


  • Significant advantages were found for DBT on all primary outcomes after treatment: 
  • suicide attempts: 90% of youth receiving DBT vs 79% of youth receiving IGST made no suicide attempts
  • nonsuicidal self-injury: 5y% of youth receiving DBT vs 40% of youth receiving IGST made no non-suicidal self-injuries
  • Self-harm: 54% of youth receiving DBT vs 37% of youth receiving IGST did not harm themselves 
  • Rates of self-harm decreased through 1-year follow-up 
  • The advantage of DBT decreased, with no statistically significant between-group differences, from 6 to 12 months 
  • Treatment completion rates were higher for DBT (75.6%) than for IGST (55.2%), but pattern-mixture models indicated that this difference did not informatively affect outcomes


  • Adrian, M., McCauley, E., Berk, M. S., Asarnow, J. R., Korslund, K., Avina, C., Gallop, R., & 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, and Allied Disciplines, 60(10), 1123–1132.
  • Berk, M., Adrian, M., McCauley, E., Asarnow, J., Avina, C., & Linehan, M. (2014). Conducting research on adolescent suicide attempters: Dilemmas and decisions. The Behavior Therapist, 37(3), 65–69.
  • McCauley, E., Berk, M. S., Asarnow, J. R., Adrian, M., Cohen, J., Korslund, K., Avina, C., Hughes, J., Harned, M., Gallop, R., & 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.