The Impact of Perceived Parental Invalidation and Self-Invalidation on Suicidality in an Adolescent DBT Partial Hospitalization Program

Abstract

Background

Dialectical Behavior Therapy’s (DBT) original biosocial theory and subsequent iterations as a transactional model suggest that invalidating social and family environments can contribute to emotion dysregulation and patterns of self-invalidation that may lead to suicidal and non-suicidal self-injurious behaviors over time. To our knowledge, no studies have examined the relationship between parental and self-invalidation on suicidality in a treatment setting or longitudinally over the course of treatment from pre-to post-treatment. This study examined the relationship between youth-reported parental invalidation, self-invalidation, and suicidality over the course of treatment in a comprehensive DBT partial hospitalization program (PHP).

Methods

Two hundred sixty-four adolescents and young adults admitted to a four-week comprehensive DBT PHP that incorporated family, individual, and skills group therapy components. All patients completed surveys evaluating perceived parental-invalidation, self-invalidation, and suicidality pre- and post-treatment.

Results

Patients reported significant decreases on all outcome measures: perceived mother and father invalidation, self-invalidation, and suicidality after 4 weeks. Changes (reductions) in both self-invalidation and mother invalidation were significant predictors of reduced suicidality.

Conclusion

Comprehensive DBT is a viable treatment option for decreasing invalidation and suicidality in four weeks. These findings emphasize the importance of parent involvement in improving treatment outcomes for adolescents and young adults.

Plain Language Summary

Dialectical Behavior Therapy’s (DBT) Biosocial Theory suggests that invalidating environments (an environment where individuals feel ignored, belittled, or misunderstood) can lead to difficulties in managing emotions and the tendency to self-invalidate (mistrust, minimize or dismiss internal thoughts, feelings and experiences). These patterns may increase the risk of suicidal thoughts and behaviors. This study explores how parental and self-invalidation are related to the severity and frequency of suicidal thoughts and behaviors (suicidality) in adolescents and young adults receiving DBT treatment. A total of 264 adolescents and young adults attended a four-week DBT Partial Hospitalization Program (PHP) that included therapy with families, individual sessions, and skills groups. Participants filled out surveys on their first day of treatments and again, four weeks later to measure perceived parental invalidation, self-invalidation, and suicidality. Our patients reported a decrease in perceived parental invalidation, self-invalidation, and suicidality after four weeks of adherent DBT treatment. Further, our results showed that changes in self-invalidation and mother invalidation were the strongest predictors of change in child suicidality. Thus, greater decreases in self-invalidation and mother invalidation predicted a greater decrease in child suicidality after four weeks of treatment. These findings support the effectiveness of DBT in reducing invalidation and suicidality and highlight the importance of familial involvement in improving treatment effectiveness and outcomes for adolescents and young adults.