Secondary effects of dialectical behaviour therapy on social functioning, quality of life, and autism traits in autistic adults with suicidality.
Anne Huntjens, Lmc Wies van den Bosch, Bram Sizoo and 3 others
PMID 39673449WHAT IT FOUND
Dialectical behaviour therapy added to usual care modestly improved social functioning and quality of life in autistic adults with suicidal thoughts and behaviour, at six months and a year.
Autism traits did not change, and the authors call the functional gains small.
Key findings
01Social functioning improved significantly more with dialectical behaviour therapy than with treatment as usual, both at the end of treatment and at the 12-month follow-up, but the authors describe the change as modest and below the threshold they treat as clinically significant.
02Quality of life improved significantly more in the DBT group than in the treatment-as-usual group at the end of treatment, and the difference between groups was still there at follow-up.
03Autism traits did not differ between the two groups.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The social functioning gain averaged about 6 points, below the 10 points these authors treat as clinically meaningful, and the separate domains of work, relationships and aggression showed no significant group differences. Therapists and participants both knew which treatment they were getting; only the assessors were kept unaware. Outcomes relied on self-report, which can attract socially desirable answers, and the scales used were not validated in autistic samples. DBT was compressed into six months rather than the usual twelve, with skills training twice weekly, so this is a more intensive version than standard practice. Therapists new to DBT had limited training and adherence to the protocol was low to moderate. Some participants were lost to follow-up (8.9%), though repeating the analysis with those missing values carried forward gave comparable results. Participants in the usual-care group also improved, which the authors suggest may reflect regression to the mean or the benefit of ordinary therapeutic support. When the analysis was adjusted for COVID lockdown disruption to care, the quality-of-life difference between groups lost statistical significance.
Declared interests
The authors declared no conflicts of interest. The study was funded by Stichting tot Steun Vereniging voor Christelijke Verzorging van Geestes- en Zenuwzieken (grant 240) and by Innovatie Platform Parnassia Groep (grant 211001). The funders had no role in designing or running the study, analysing the data, writing the article or deciding to publish it.
The easy way to misread this
Do not read the significant quality-of-life and social functioning results as a large clinical change. The average social functioning gain was smaller than the change the authors themselves call clinically meaningful, and only self-care improved among the individual functioning domains. When the analysis was adjusted for COVID lockdown disruption to care, the quality-of-life difference between groups lost statistical significance.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →