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Child / Adolescent - Externalizing

Dialectical Behavior Therapy for Externalizing Problems Among Adolescents: A Meta-Analysis

(PS11-B42) Dialectical Behavior Therapy for Externalizing Problems Among Adolescents: A Meta-analysis

Sunday, November 20, 2022

9:00 AM – 10:00 AM EST

Location: Westside Ballroom, 5th Floor

Author(s)

Rafaella J. Jakubovic, M.A.

Graduate Student
Temple University
Philadelphia, Pennsylvania

Co-Author(s)

DD

Deborah Drabick, Ph.D.

Associate Professor
Temple University
Philadelphia, Pennsylvania

Externalizing problems (e.g., aggression, oppositional behavior) are among the most common reasons for referral to psychiatric clinics for youth (Connor et al., 2019). However, only a minority of youth with externalizing problems receive evidence-based treatment, with staggering economic and public health implications (McCart & Sheidow, 2016). One well-studied, evidence-based intervention that aims to reduce maladaptive behavior by building emotion regulation skills is Dialectical Behavior Therapy (DBT). DBT has been adapted for diagnostically diverse, high-risk populations, including adolescents. Although DBT has garnered encouraging empirical support among adolescents, most studies have focused on outcomes related to suicidality or self-injury. The present study sought to quantitatively synthesize existing evidence for the effectiveness of DBT-based interventions on externalizing behaviors among adolescents. We further investigated potential moderating roles of setting (inpatient vs. outpatient), country (US vs. abroad), participants’ age, intervention duration, number of sessions, number of skills groups, availability of phone/milieu coaching, use of multi-family skills groups, and outcome reporter. A search of academic databases (i.e., PsycINFO, PubMed) through February 2022 produced 125 unique results. Following screening for eligibility, the final sample included 17 studies reporting on 16 independent samples. Each study provided one or more relevant outcome variables, resulting in 25 data points. After accounting for nesting, results suggested that DBT interventions have a small-to-medium effect in reducing externalizing symptoms among adolescents (Hedge’s g = -.499, 95% CI [-.683, -.315], p < .001). The overall variance of the results was large (I²= 77.763), suggesting heterogeneity among studies in magnitude of prediction (i.e., 78% of the variance may be accounted for by covariates). We performed a “one study removed” analysis, revealing that exclusion of any one study did not result in significantly different estimates (Hedge’s g range: -.433 to -.538, all ps < .001). Orwin’s Fail-safe N was 20 (with a trivial effect size of Hedge’s g = -.10 and a threshold of p < .05), suggesting 20 data points with a mean Hedge’s g of .000 would need to be added for the effect to become trivial. Duval and Tweedie’s Trim and Fill approach using the random effects model imputed values to the right of mean effect size where studies lacked, decreasing the effect size to Hedge’s g = -.319, 95% CI [-.488, -.151], suggesting that publication bias is not a significant concern. In terms of moderators, greater intervention duration was associated with greater decrease in externalizing symptoms (slope = -.014, Z = -2.312, SE = .006, p = .021). Thus, results suggest that DBT-based interventions are a promising approach to reducing externalizing problems among adolescents, and that greater duration is associated with greater symptom relief. Although present analyses are limited by inclusion of studies lacking control group and randomization, they provide promising insight into the effectiveness of DBT for externalizing problems as it is currently being delivered across settings, comorbidities, and degrees of modification.