Moderators and predictors of treatment outcome following adjunctive internet-delivered emotion regulation therapy relative to treatment as usual alone for adolescents with nonsuicidal self-injury disorder: Randomized controlled trial

JCPP advances Pub Date : 2024-05-06 DOI:10.1002/jcv2.12243
Olivia Ojala, Hugo Hesser, Kim L. Gratz, Matthew T. Tull, Erik Hedman-Lagerlöf, Hanna Sahlin, Brjánn Ljótsson, Clara Hellner, Johan Bjureberg
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Abstract

Background

Despite the wide-ranging negative consequences of nonsuicidal self-injury (NSSI), there are few evidence-based treatments for NSSI among adolescents and little is known about what treatments that work best for whom. The objective of this study was to investigate moderators (i.e., for whom a specific treatment works) and predictors (i.e., factors associated with treatment outcome independent of treatment type) of treatment outcome in a randomized clinical trial comparing internet-delivered emotion regulation individual therapy for adolescents (IERITA) plus treatment as usual (TAU) to TAU alone.

Methods

Adolescents (N = 166; mean [SD] age = 15.0 [1.2] years) with NSSI disorder were randomized to IERITA plus TAU (n = 84) or TAU-only (n = 82). Adolescent emotion regulation difficulties, suicidality, NSSI frequency, depressive symptoms, sleep difficulties, global functioning, and age, and parental invalidation, were measured pre-treatment and investigated as moderators and predictors of treatment outcome (i.e., NSSI frequency during treatment and for 4 weeks post-treatment). A zero-inflated negative binomial generalized linear mixed effects regression model was used to estimate the rate of NSSI change as a function of both treatment condition and moderator/predictor.

Results

No significant moderators of treatment outcome were found. Parental invalidation was a significant predictor of treatment outcome regardless of treatment condition, such that high levels of parental invalidation pre-treatment were associated with a less favorable NSSI frequency.

Conclusions

We did not find evidence of a differential treatment effect as a function of any of the examined client factors. Future research should investigate moderation in larger samples and with sufficient statistical power to detect moderation effects of smaller magnitude. Results suggest that parental invalidation may have a negative impact on treatment response and highlight the importance of further investigating parental invalidation in the context of NSSI treatments.

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针对患有非自杀性自伤障碍的青少年,采用互联网辅助情绪调节疗法与单纯常规治疗相比,治疗效果的调节因素和预测因素:随机对照试验
尽管非自杀性自伤(NSSI)会带来广泛的负面影响,但目前针对青少年非自杀性自伤的循证治疗方法却很少,而且人们对哪些治疗方法对哪些人最有效也知之甚少。本研究旨在调查调节因素(即特定治疗方法对哪些人有效)和预测因素(即与治疗结果相关的、与治疗方法无关的因素)、患有 NSSI 障碍的青少年(人数 = 166;平均 [SD] 年龄 = 15.0 [1.2] 岁)被随机分配到 IERITA+ TAU(人数 = 84)或 TAU-only(人数 = 82)。治疗前对青少年情绪调节困难、自杀倾向、NSSI频率、抑郁症状、睡眠困难、整体功能和年龄以及父母的无效性进行了测量,并将其作为治疗结果(即治疗期间和治疗后4周内的NSSI频率)的调节因素和预测因素进行研究。采用零膨胀负二项广义线性混合效应回归模型来估计 NSSI 变化率与治疗条件和调节因子/预测因子的函数关系。无论治疗条件如何,父母的无效性都是治疗结果的重要预测因素,因此治疗前父母的高无效性与较低的 NSSI 频率相关。未来的研究应该在更大的样本中对调节作用进行调查,并且要有足够的统计能力来检测较小程度的调节作用。研究结果表明,父母的无效性可能会对治疗反应产生负面影响,并强调了在NSSI治疗中进一步调查父母无效性的重要性。
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